Rx: Literature | A Reading to Celebrate Bellevue Literary Review's 30th Issue

May 5, 2016 at 11:27 am

PLEASE JOIN US Monday, May 16th | 6pm
Bellevue Hospital, 462 First Avenue at 28th St. - Chapel Hall

BLR spring reading 2016

Our readers:

Sonni Aun had the great fortune of growing up all over the world and is now a painter and writer in New York City. She holds a BA in Biochemistry and Art from Rice University and is currently studying writing with the poet Philip Schultz at the Writers Studio.

Katy Lederer is the author of the poetry collections Winter Sex (Verse Press) and The Heaven-Sent Leaf (BOA Editions), as well as of the memoir Poker Face: A Girlhood Among Gamblers. She is currently at work on a collection of essays around apocalyptic themes and a book of poetry about autoimmunity, deformity, and motherhood titled The Engineers.

Susanna Nguy is from Brooklyn, New York. She graduated from the City College of New York in 2013 where she developed a passion for oncology research. She is completing her medical degree and will be doing her residency in Radiation Oncology at NYU. "The Lump," from this issue of BLR, is her first published story.

Adam Young was born and raised in Providence, Rhode Island, where he attended Classical High School. He is currently studying English Literature and Creative Writing at New York University and he is volunteering at Writopia Lab, a creative writing organization offering workshops for kids and teens. His work has appeared in the Zine Play(ed) Boy: Volume II and he hopes to continue to participate in the creative writing community.

States of Grace: From Doctor to Patient and Back Again

April 5, 2016 at 3:39 pm

Katie Grogan, DMH, MA and Tamara Prevatt, MA,
Master Scholars Program in Humanistic Medicine, NYU School of Medicine

 

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Before the accident, Dr. Grace Dammann was a caregiver through and through, in every aspect of her life. A pioneering AIDS specialist, she co-founded one of the first HIV/AIDS clinics for socioeconomically disadvantaged patients in San Francisco at Laguna Honda Hospital. She was honored by the Dalai Lama with an Unsung Heroes of Compassion Award for her service and devotion to this population. Grace was also the primary breadwinner and parent in her family with partner Nancy "Fu" Schroeder and adopted daughter Sabrina, who was born with cerebral palsy and HIV. She lived and worked in such close proximity to illness, death, and disability, but nothing could have prepared her for the devastating injuries she sustained when a driver veered across the divide on the Golden Gate Bridge, crashing head on into her car.

Grace spent seven weeks in a coma, hovering on the precipice between life and death, like so many of her own patients. Ultimately, she awoke with her cognitive abilities miraculously intact, but her body was irreversibly impaired, leaving her wheelchair-bound and dependent on others for simple daily tasks. States of Grace, a documentary film about her profound transformation, picks up Grace's story when she is discharged following a thirteen-month stay in rehabilitative hospitals. Members of NYU Langone Medical Center, including medical and nursing students as well as faculty and staff across all disciplines, were invited to attend a screening of the film and talkback with Dr. Grace Dammann and the filmmakers, Mark Lipman and Helen S. Cohen of Open Studio Productions.

States of Grace captures the expansive and rippling effects of the accident, how it left every corner of Grace's life radically altered-personal, professional, psychological, spiritual, and economic. The family dynamic is turned on its head. Fu becomes the primary caregiver to both Grace and Sabrina, and as Grace says, "Sabrina's position in the family was radically upgraded by the accident. She is so much more able-bodied than I am." Fu struggles with the enormity of the role she has signed up for. Grace wrestles with her gratitude for having survived and the frustrations of her new life: "I feel like I've lost a best friend-my body . . . When I first woke up, I was just glad to be alive, plain and simple. Now I'm just annoyed-annoyed at the limitations. I'm bored." In one scene we see Grace argue with Fu about her right to die if she continues to be so impaired.

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Grace grieves for her old life, for how effortless things were. We watch as her fierce resilience pulls her through to acceptance. She credits her Zen Buddhist practice for her ability to keep moving forward: "Nothing lasts forever, even great pain and sorrow." Though some of her ultimate goals-to walk again, to dance again, to surf again-remain unattainable at the film's conclusion, Grace sets, meets, and exceeds new ones. Acknowledging that she only felt completely whole when practicing medicine, she "comes out" as a disabled person to the medical community, returning to Laguna Honda Hospital as its first wheelchair-bound physician, where she is appointed Medical Director of the Pain Clinic. She resumes the caregiver role, but with an intimate knowledge of the lived experience of pain, suffering, and disability. In the talkback Grace remarked, "Once you disrupt the integrity of the body, you're disrupting the integrity of the psyche, and I don't think any of us think about that. I certainly didn't as a physician. I hate to admit how many times I discharged people without even getting them up to see that they could walk." She also brings her Buddhist training to the clinic, where she promotes wellness among the staff and patients by teaching meditation.

As the talkback ended, attendees lingered, eager to chat with the filmmakers and shake hands with Grace, awestruck by her story of triumph, adaptability, service, and the lessons learned on both sides of the doctor-patient divide.

Sabrina will graduate this May with her Bachelor's degree. Grace partnered with the driver who hit her to advocate for a median barrier on the Golden Gate Bridge to prevent similar accidents from happening in the future. The barrier was installed in January 2015.

This screening was co-sponsored by the Master Scholars Program in Humanistic Medicine, the Office of Medical Education, and the Department of Physical Medicine and Rehabilitation. Special thanks to Drs. Pamela Rosenthal and Marianne Sommerville for bringing the film to NYULMC. For more information on States of Grace and to arrange a screening, go to: www.statesofgracefilm.com

 

NYU Center for Humanities Event Imagining Illness: Pulitzer Prize Winners on Truth and Fact in Narrative David Oshinsky and Paul Harding

March 29, 2016 at 1:30 pm

By J. Russell Teagarden
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On a recent winter's evening, Pulitzer Prize winners David Oshinsky and Paul Harding appeared together at the NYU Center for Humanities in an event cosponsored by the NYU Division of Medical Humanities and the Bellevue Literary Press. Erika Goldman, the publisher and editorial director of the Bellevue Literary Press, moderated the session. Jane Tylus, faculty director of the NYU Center for Humanities, provided opening and closing remarks. The evening also had support from the Pulitzer Prize Campfire Initiative.

David Oshinsky's book, Polio: An American History (Oxford University Press) won the 2006 Pulitzer Prize in History, as well as the Hoover Presidential Book Award in 2005. It became the basis for a 2009 PBS documentary on polio. In 2010, Paul Harding's book, Tinkers (Bellevue Literary Press) won the Pulitzer Prize in Fiction and a PEN/Robert W. Bingham Prize. Drawing from their respective genres in the humanities, the authors shed light on how chronic illnesses can affect individuals and their families, in the case of Harding's novel, and on how epidemics can affect populations and national responses in the case of Oshinsky's history of polio.

In her annotation of Oshinsky's book in the NYU Literature Art and Medicine Database, Dr. Janice Willms notes that the narrative was written in a way that readers were easily able to grasp how it was "real people fighting a battle that swept from certain success to likely failure and back again many times, often almost overnight." Dr. Tony Miksanek, in his annotation of Harding's book, focuses on how the "story presents some exquisite impressions of seizures along with the aura that precedes them," and how it "masterfully represents how we measure life."

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Both authors spoke of creating narratives that convey a truth, yet their sources for truth are antipodal in nature. As an historian and documentarian, Oshinsky goes to archives and other sources of objective facts and occurrences to build his narrative. He told the audience that in creating his narratives, "not only am I telling a story, but I am fitting into a larger mosaic of other stories." He read a section from his book about a particular polio victim, Fred Snite, that interweaves both the personal suffering and social responses his plight generated.

He had lost the ability to cough so his throat had to be regularly suctioned. He had to be fed in rhythm with the respirator which caused his chest to rise and fall every four seconds, 21,600 times a day. But that was only part of the story, the lesser part. What kept Snite in the public eye was his determination to lead "an otherwise normal life." He became a tournament-tough bridge player, reading the cards in a rearview mirror placed above his head. He traveled to race tracks and to college football games in a trailer equipped with a spare iron lung. "His arrival at Notre Dame Stadium was one of the events of the afternoon," a friend recalled, "Enter the visiting team, polite cheers, enter the home team, loud cheers, enter Frederick, pandemonium." (p. 63)

Oshinsky lamented that as an historian he can't take the liberties availed to novelists, but Harding noted, in referring to this passage, that he is actually "deploying the same tactic as a fiction writer." Harding was allowing that the historian must work from facts and documents, but like the fiction writer, must create compelling narratives if the goal is to reach the general public.

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As a novelist, Harding builds his narratives from what he calls "imaginative truth." He starts by "imagining my way into the lives of people…whose lives might otherwise pass by unremarked. The value of their lives would not be witness to." In Tinkers, he imagines his way into the life of a person with severe epilepsy and what it must be like to experience a seizure. He gives witness to the experience in the section he read (or "tone poem" as he called it):

The aura, the sparkle and tingle of an oncoming fit, was not the lightningait was the cooked air that the lightning pushed in front of itself. The actual seizure was when the bolt touched flesh, and in an instant so atomic, so nearly immaterial, nearly incorporeal, that there was almost no before and after, no cause A that led to effect B, but instead simply A, simply B, with no then in between, and Howard became pure, unconscious energy. It was like the opposite of death, or a bit of the same thing death was, but from a different direction: Instead of being emptied or extinguished to the point of unselfness, Howard was over-filled, overwhelmed to the same state. If death was to fall below some human boundary, so his seizures were to be rocketed beyond it. (pp. 47-48)

Harding said he assiduously avoided doing any research about epilepsy, and had only some family mythology and his own close call with electrocution to inform his writing. But, although the seizure experience he describes was mostly mined from his imagination, it covers basically the same scope as a traditional biomedical description of seizures that can be found in Harrison's Principles of Internal Medicine-minus the literary splendor:

Some patients describe vague premonitory symptoms in the hours leading up to the seizure…The initial phase of the seizure is usually tonic contraction of muscles throughout the body, accounting for a number of the classic features of the event. Tonic contraction of the muscles of expiration and the larynx at the onset will produce a loud moan or "ictal cry." Respirations are impaired, secretions pool in the oropharynx, and cyanosis develops. Contraction of the jaw muscles may cause biting of the tongue. A marked enhancement of sympathetic tone leads to increases in heart rate, blood pressure, and pupillary size. After 10-20 seconds, the tonic phase of the seizure typically evolves into the clonic phase, produced by the superimposition of periods of muscle relaxation on the tonic muscle contraction.


Thus, Oshinsky and Harding compose compelling narratives about illness experiences originating from different places and evolving from different forms. In her forward to Humanity in Healthcare: The Heart and Soul of Medicine, Iona Heath captures the essence of what the varied approaches Oshinsky and Harding use when she states, "skilled writers help us to see the world and our own place within it in a new light-a light that falls from a slightly different direction revealing subtly different detail." (p. iv)
These are just a few of the many insights the authors provided during the session.
A video of the entire program is available at: https://www.youtube.com/watch?v=w-l86fOAsLY&feature=youtu.be.

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Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images

March 23, 2016 at 1:17 pm

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NYU Langone Medical Center welcomed author/painter Cortney Davis to the Smilow gallery for the opening of "When the Nurse Becomes a Patient." Laura Ferguson's interview with Ms. Davis appears here.

Exhibition presented at the NYU Langone Medical Center Art Gallery by the Art Program and Collection.
Photo: Art Program and Collection.

 

The Vaccine Project

November 6, 2015 at 1:25 pm

An interview with Philip Cawkwell, MS4, NYU School of Medicine, Rudin Fellow 2014-15
By: Katie Grogan, DMH, Associate Director, Master Scholars Program in Humanistic Medicine
Assistance from Tamara Prevatt, Intern, Master Scholars Program in Humanistic Medicine

The Rudin Fellowship in Medical Ethics and Humanities supports medical trainees at NYU School of Medicine - including medical students, residents, and clinical fellows - pursuing year-long research projects in medical humanities and medical ethics under the mentorship of senior faculty. It was established in 2014 through a grant from the Louis and Rachel Rudin Foundation, Inc. and is a core component of the Master Scholars Program in Humanistic Medicine.

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Philip receiving his fellowship certificate from Drs. David Oshinsky, his Rudin Mentor, and Lynn Buckvar-Keltz, Associate Dean for Student Affairs, at the Rudin Fellowship Project Showcase, July 7, 2015.

How did you become interested in vaccine refusal and why did you decide to pursue this as a project through the Rudin Fellowship?

Vaccine refusal is something I've been interested in for a long time. As a medical student, and someone with a lot of doctors in my family, it was just accepted that you go to the doctor and get your vaccinations. So, growing up in an age where it felt like there was this huge movement of people who weren't vaccinating their kids, was something that I didn't understand very well. The goal behind this project was to dig a little bit deeper and figure out why this was happening. Why weren't kids getting vaccinated? Where were places with better or worse vaccination rates, and why? I also wanted to figure out what pediatricians can do about it. How can they do a better job of talking to parents and talking to kids and improving vaccination rates overall?

Through your research you discovered that the unlikely state of Mississippi, which consistently ranks at the bottom for other health indicators, has the highest vaccine compliance rate in the country. What's going on in Mississippi?

This is pretty shocking to everyone. Here is a state that is one of the most obese, approximately 35 percent of the population smokes, there is no indoor ban on smoking, and it has the highest rate of infant mortality. Yet, if you look at kindergartners in this state, 99.7 percent have gotten the MMR vaccine series, compared to about 95 percent nationally. That's almost every single kid in the state, and it's remarkable. That was something that I chose to focus on for this project because when you have a 99 percent vaccination rate, you're doing something right. The question is, what did Mississippi do to achieve this?

In one way, they're very fortunate because they have a framework that's in place due to a lawsuit, Brown v. Stone, which was brought against the board of education in 1979. Brown sued the school board in Houston, Mississippi to get his six-year-old son into the elementary school by arguing that his religion precluded him from having his child vaccinated. This went all the way up to the state supreme court that eventually ruled, "No you don't, in fact, have the right to a religious exemption because for the good of the public and society as a whole, sometimes you lose a little personal liberty." In their ruling they went further and invoked the Fourteenth Amendment, which is about equal protection under the law. They said that if they allow a way out of this vaccine statute, then it has to apply equally to everyone. If they allow a religious exemption, then they're discriminating against those who don't have that same religious belief. If they allow a philosophical exemption, then they're discriminating against those that don't have that same philosophy. The way they worded this was very important because it not only shot down Brown's case, but it saw into the future and prevented other personal and religious belief cases in the state. It has stood the test of time. However, it's difficult for other states that don't have this historical legal framework working for them.

It was important for me to figure out what else Mississippi does to maintain this high vaccination rate, so I went there and talked to the health department. Only medical exemptions are permitted, and to get one, the parent has to go through the state health department - it is not enough for the pediatrician to sign off on it. The pediatrician writes a letter and the health department reviews it. You only get that exemption if you have a real medical reason for not getting the vaccine. Further, the health department has a state registry of every child enrolled in school with a list of the vaccines required and a check box of whether or not the child received them. This is what the state epidemiologist calls "unit level accountability." So Mississippi's situation is a combination of this nice legal background and having everything centralized within the state department of health. That's what makes them the leader. (Additional information about exemptions can be found at the end of the interview)

As part of your project, you consulted experts in infectious disease, pediatrics, and vaccine education to explore how the rest of the nation can establish and maintain vaccination programs like Mississippi. What did you learn?

I can start with Mississippi, where I talked to Dr. Thomas Dobbs III, who is the state epidemiologist there. He personally oversees the exemptions and told me a lot about the inner workings of the program. One key thing I learned was that it is a lot easier to maintain a program like this than it is to establish one.

I also talked to a lot of pediatricians. At NYU I talked to Dr. Catherine Manno who is the Chair of the Pediatrics Department. She was able to talk about what it was like going through training at a time when we didn't have some of the vaccines that we do now - things like Haemophilus influenza Type b were routinely killing or crippling children. She commented on how it's remarkable that you can be a pediatrician or someone in training now and never have seen some of those diseases.

I spoke with Dr. Paul Offit at the University of Pennsylvania who has published more than anyone on this topic. He's written a number of books trying to dispel the autism-vaccine link and has developed a vaccine himself. We talked a lot about how it's now becoming popular among parents to try and spread out the vaccine series. People are worried about getting too many vaccines. One thing he was telling me that I think is really important to remember is that there are more vaccines now than there were a few decades ago, but if you look at the actual amount of the vaccine that is in each shot, the amount of antigen you are exposing your child to is much smaller than it was even if you combine all of the vaccines. Because Dr. Offit has been doing this for decades, he was able to provide some perspective. I asked him if he felt optimistic even while seeing the anti-vaccination people in the news everyday. He said with this year's measles outbreak at Disneyland people are finally caring and starting to respond. It was a really positive message from him that things might actually be changing and, indeed, we see that they are.

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Philip presenting his research at the Rudin Fellowship Project Showcase, July 7, 2015.

As you mentioned, among younger generations, we don't see many of these diseases firsthand so it's easy to mistakenly believe they've been eradicated. Disneyland was a reminder that this not the case. How did the measles outbreak happen? What did vaccine refusal have to do with it, and were there changes to California's exemption policy as a result?

It started in December 2014, and by February the CDC counted about 110 cases of measles that they could say definitely came from Disneyland. The majority of those cases were children who were either unvaccinated or who had unknown vaccination statuses. I think it was part of the national news and the national conversation and was able to ignite some change in California. The state senators in California who took up this call both had experience with public health. Senator Pan is a pediatrician in California and Senator Allen is the son of a polio survivor, so they both knew how important this was from a personal standpoint. They saw what was happening to their state. California used to have both religious and philosophical exemptions and as of June of this year, they have neither. That was a big change. However, it's important that it's not just California. Vermont got rid of philosophical exemptions this year as well. There are also seventeen other states with some form of legislation concerning vaccine exemptions. In some cases it's to get rid of exemptions and some cases it's making it harder to obtain them. But so far it's just Vermont and California that have actually passed legislation.

Vaccination is an issue that really crystallizes the tension between personal freedom and what's good for society as a whole. Do physicians have a moral obligation to help us reconcile this conflict?

Yes, it's very tough to get people to think about the health of society as a concept rather than the health of their child. If you think about it, these parents are not bad people; they are trying to do what's best for their child. They just have a different view than most pediatricians about what that is. They are really missing the societal aspect to it. Vaccinations are important and necessary because some people can't be vaccinated. If one or two people don't get vaccinated the system won't fall apart because the herd can protect everyone. It's actually safer to be unvaccinated living in a group of people who are vaccinated than it is to be vaccinated living in a group of people who are unvaccinated. And the reason is that around five to ten percent of the time, you don't get full immunity from a vaccine. With parents, there can be this diffusion of responsibility where, "my child does not have to be vaccinated as long as everyone else's is." It's hard to convince someone that you need to be part of the 95 percent that is going to take on that responsibility. It's a really quick snowball when you see states like Colorado, which has the lowest childhood MMR vaccination rate - it's about 83 percent - that's when you start to see problems, when everyone starts to take an individualistic approach.

But you have to look at it from two standpoints - from the parent's and the pediatrician's. Talking to pediatricians like Dr. Manno and Dr. Klass at NYU and Dr. Spiesel at Yale, they all came up with the same scenario: You're a pediatrician and you have someone sitting in your waiting room who can't get vaccinated - maybe he's six months old and not ready for his one-year-old shots yet. Then you have another patient in your waiting room that is sick with a vaccine preventable disease. Because you've allowed that child in your waiting room you now have some liability as a doctor to protect that six-month-old. Now you've exposed him to measles or another potentially deadly illness because you allowed someone who wasn't vaccinated into your office. At the same time, if you say, "As a pediatrician I am only going to see kids who are vaccinated," then what happens to the other kids? Where do they get their care and who sees them? That's a problem too. Several of the pediatricians that I spoke to say they just want to avoid that issue. It's much easier to say, "If you aren't vaccinated, there are a lot of pediatricians around here that will see you so go see one of them." They know they have somewhere else to go, and morally they feel better about that situation than potentially exposing their own patients to someone who isn't vaccinated.

Now if you're a parent, it's a whole other issue. It's this idea that "I'm not going to let the government or the doctor or the establishment make a decision for me about the health of my child." Many talk about it in terms of being forced: "You're forcing my child to get a shot," which isn't technically true. At the same time, there is something that has to be said for herd immunity and protecting those that can't get vaccinated and protecting the health of children as a whole. But when you have all of these vaccines that have been tested so well with data showing their safety and efficacy and you have diseases like measles and polio that we can protect against, it's hard for me to see a way for a doctor to feel comfortable without advocating for all of their patients being fully vaccinated.

What can the medical community do to motivate people who are confused or misinformed about vaccines? Would doctors' offices saying "we will only see patients who are vaccine compliant" compel conscientious objectors to rethink their stance?

It's a really good question. There are two groups of people who won't vaccinate their kids - a group who can be convinced and a group who can't. The really staunch anti-vaccination people, they're settled. They've made up their minds, and there isn't a story you tell them or statistics you give them to change their stance. Then there's a group who aren't vaccinating because they're under-informed or they're a little uncertain. That's the group that is really important because they can be convinced. That's the danger of having a blanket policy that you won't see those kids unless they get vaccinated. Maybe the parents could have been convinced and you shoved them aside.

The other part of my project, besides looking at Mississippi, was looking at strategies for convincing parents to vaccinate their kids. Specifically, I looked at strategies that weren't based in statistics. Doctors love statistics - they speak the language of the p-value and talk about randomized controlled trials proving the efficacy and safety, and that doesn't mean a whole lot to most parents. I looked at narrative medicine and the power of storytelling and whether physicians can talk about stories of patients they've had that weren't vaccinated, or even a personal story about how their kids got vaccinated and how well that's worked out for them. But the problem is that this takes time. When 80% of well-child visits in this country are less than twenty minutes long, it's hard to take five minutes to talk about why vaccines are safe. It's a lot easier to say, "You have to get vaccinated. Vaccines are safe. Here's an information sheet." That's a really complex problem where there's not a great solution at this point.

In addition to considering a narrative approach, you also looked to print media, especially political cartoons, to analyze the anatomy of the vaccine wars. Is there one particular image that you came across that captures the essence of this contentious topic?

There's a cartoon is of a blindfolded man labeled "anti-vaccinationist" walking off a cliff labeled "misinformation" into a big lake of smallpox. My favorite part about it is that it's not a current cartoon but from 1930. So it's this reminder that this isn't new; it's maybe new in the pubic consciousness and becoming a big thing in the media. As long as there have been vaccines, there have been people who have fought against compulsory vaccination. It's always been really tough to convince people that they need to do something for society and that they aren't making a big mistake. It's been played out over and over again every single decade since the 1850's.

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Anti-vaccination cartoon, from cartoon booklet, "Health in Pictures," 1930

So, it's stories, both in narrative or visual form, that resonate with people more than numbers and scientific studies. Can you elaborate on this in the context of the now-discredited 1998 Wakefield study that first claimed a link between the MMR vaccine and autism? Why has it had such a lasting impact?

The Wakefield study is really important because it shows how scientists and the lay population look at information differently. The original Wakefield study was a case series of twelve patients and was published in The Lancet. The scientific community then did large studies and meta-analyses looking at thousands of kids and completely discredited the original Wakefield paper. As far as the scientific community is concerned, that was great. That's how science works - you have a hypothesis, you run a test, and come up with a conclusion. Someone else can run the test differently and see how thing stack up. That's why the issue is settled in the scientific community. With the population at large, that's not the case. In 2009, 25 percent of people in this country still believed that vaccines cause autism. Over a decade after this study has been completely debunked and it was proven that the researcher was engaging in deliberate fraud, the public hasn't gotten that message. All these studies that all these scientists are running, what do they mean if no one really understands them or accepts them? That's why you have to think about the way scientists convey information. The anti-vaccination people do a really great job at getting their information out through social media, the Internet, by having spokespeople who can get through to someone who doesn't know what a p-value is but knows what autism looks like.

You're planning to train in pediatrics so you'll be navigating this first-hand - conveying scientific information in a way that resonates with parents and children. What do you think your approach will be, and how has this project informed it?

From a personal standpoint, my goal is going to be to get 100 percent vaccination rates. Part of that is going to be reading parents and seeing what appeals to them. For some, statistics will be great and they will want to see the studies. For some it will be telling them, "Hey, I've personally vaccinated all these kids and have seen them develop and do great." It's explaining how autism works and that there is no link to vaccination at all. There is no proven blanket strategy, so I think that individualizing it will be very useful to me.

What do you think is the path forward with vaccinations in our country? Are we going to see changes at the national level?

I think it is unlikely to see the federal government taking on this matter. This has really been a states' rights issue over the years. Unfortunately, it takes outbreaks like the one at Disneyland to spark change. Maybe it will be more outbreaks. Maybe that will wake people up. Maybe the California one will be enough and all the states that are starting taking up this issue will push through. But it's still really difficult in this country where you have such a vocal opposition. It's hard to be more than cautiously optimistic. I've seen things improve just over the last year - but still there are only three states with policies to limit vaccination exemptions. There are still 47 to go and I think that will take some time.

Types of Vaccine Exemptions
Exemptions differ on a state-by-state basis, but it boils down to three different kinds.

  • First, every single state allows for medical exemptions, and there are a lot of reasons why a child might need a medical exemption. For example, if you are receiving chemotherapy and your immune system is weaker, you don't want to get a live virus vaccine.
  • The second kind - and about 47 states have this - are religious exemptions. Again, it varies from state to state as to how much evidence you have to provide that you have a religious belief that is counter to receiving vaccinations.
  • The third kind - and I think seventeen states have these - are philosophical/personal belief or conscientious objector exemptions, and these run the gamut of pretty much anything. These are usually designed by the legislature as a catchall to let parents have a way to opt-out.
    For some states, like Wisconsin, it's just a check box on a form, you check "personal belief," and that's it - nothing else is required. In Georgia has you send in a notarized statement explaining the philosophical exemption, so you have to actually articulate the reason you are philosophically opposed to vaccination. New York has a religious belief exemption, and we also have the medical exemption. There is no philosophical exemption in New York.

*You can read more about Philip's research in his recently published articles "Storytelling in the context of vaccine refusal: a strategy to improve communication and immunization" in Medical Humanities, and "Childhood vaccination requirements: Lessons from history, Mississippi, and the path forward" in Vaccine.

Rediscovering a history of trauma: An interview with Dr. Annita Sawyer

August 17, 2015 at 2:20 pm

Dr. Annita Sawyer is a psychologist and the author of several essays, stories, and a memoir titled Smoking Cigarettes, Eating Glass, which was published in May 2015.

In 1960, however, Dr. Sawyer was battling mental illness and thoughts of suicide. She was institutionalized and underwent 89 electroshock treatments. Although traumatized by her experience as a patient, Dr. Sawyer survived the broken mental health system of the 1950s and 1960s and went on to graduate summa cum laude from Yale, earn her doctorate and join the faculty of the Yale University School of Medicine. In 2001, Sawyer sent for the records from the years she was a patient at the two psychiatric hospitals. She decided to reveal her past and began to write only after she had begun to recover from revisiting the early trauma and began to remember what had happened to her.

In this interview with Simone Leung, Dr. Sawyer discusses the process of creating her memoir, how doctoring and writing play into her life, and shifting perceptions of mental illness today.

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What originally led you to dig into your history, and why have you chosen to share your story in Smoking Cigarettes, Eating Glass at this point in time?

I'd been working full time for twenty years. As a psychotherapist I had reached a comfortable place professionally. My children were grown and on their own, so I had privacy. My husband and I were meeting with a marriage counselor who was struck by my sometimes vague, otherworldly demeanor, and the fact that in the middle of an argument I would often forget what I was talking about. She recognized this as dissociation, a symptom of trauma. I still had little memory of my first twenty years, and I had questions about my history, which I thought might have answers in the medical records. I wanted to find out the specific number of shock treatments I'd been given - my estimate of 54 seemed way too high. For all of these reasons, we agreed that I should send for the hospital records.

Conventional wisdom holds that the best way to make a point vivid and memorable is to connect it to a story about a real person. Reading the records triggered a dramatic revisiting of my early life - as a child and also as an adolescent in the hospital. All my old symptoms returned, overwhelming me. Memories I thought had been erased by shock treatment returned in many forms. Most striking were intense physical reactions that often lacked thoughts - memories were stored in my body even though they might have been erased in my mind. This experience of the enduring effects of trauma was so amazing to me that I was determined to share what I'd learned. I felt an urgent need to inform clinicians of the harm they could cause by being careless, by not paying attention, beginning with diagnosis.

A mental illness diagnosis has a powerful influence on one's sense of self. Also diagnosis often determines treatment and some treatments have severe life-changing side effects. Misdiagnosis can seriously compromise people's lives.

Beyond medical side effects, shame and stigma adds to the suffering already caused by mental illness. It can lead people to deny that they are having problems, or to avoid getting help, because treatment also carries stigma. This stigma also affects families and friends, who worry about shame by association. I kept my past hidden for most of my life, long after I was working as a psychologist. This secrecy was a given: no one ever suggested that I should stop hiding my past. However, the gratitude people show - friends and strangers alike - along with their references to my bravery now that I am speaking about my experience, makes clear how powerful the stigma is and how important it is that we work to diminish it.

And finally, I'm here, alive, today because I was fortunate to find the right therapist and to recover through psychotherapy. By showing how it worked for me, I want to inspire people both not to give up and to invest in good quality psychotherapy.

When you were sorting through your journal entries and gathering material for your memoir, did you find yourself having to filter out certain details? If so, could you talk about the process of determining what should be made public and what should be left personal?

Initially I was writing from the midst of urgent chaos, seeking to hold myself together by putting thoughts on a page. I repeated lots of fears; I can see looking back that I was in certain ways repeating my earlier hospital thinking. I had a sympathetic and savvy therapist who encouraged me to write down what was happening and to send it to her by email. The details I filtered out over time included primarily what I considered over the top melodrama. I also toned down what felt like was terrifically immature neediness in my relationship with my therapist. There was just so much embarrassing information I could bear to reveal.

In one of your essays, you explain that you initially held back from sharing your history in part due to fear that it would affect your professional reputation. Did opening up about your past and vulnerability affect your practice?

I am not alone in my concern that the stigma attached to acknowledging a history with mental illness could risk my professional reputation. A number of colleagues have confided their own fears. I kept my past hidden until I'd been in practice for more than twenty years.. The first time I spoke at a psychiatry grand rounds, I was a co-presenter and my name was not on the announcement. Before I did that I met with both a long time supervisor, a senior psychologist in New Haven, and with my former psychiatrist, checking with each one to make sure they didn't think I was compromising myself professionally to do this.

All of these precautions may or may not have made a difference. In fact, everywhere I've gone I've been treated with kindness and respect. I have been invited to make further presentations. People express gratitude and confide their own secrets. Among professionals my reception has been consistently positive. My patients appear unfazed. If anything, they say it makes them feel more secure to know how far I've come. They appreciate that I understand suffering.

Could you talk about the shame and fear of stigma attached to mental illness and psychotherapy today? Do you believe our perception of it is shifting and if so, how?

I hope that increased openness on the internet and the presence of more media series that include mental illness and psychotherapy will help to defuse the stigma. But every time there's a mass murder or similar tragedy and the perpetrator is someone identified with a psychiatric diagnosis much of the media hype that follows only serves to reinforce the fear, and thus stigma, again. I don't think there's a good way to change this except for successful, accomplished, public people to begin to refer to their therapy sessions or their childhood therapist or the year they had to drop out of college for treatment, etc. as if that was a perfectly reasonable response to the situation at the time, so that the public perception shifts to seeing mental illness and treatment, especially psychotherapy, as part of a continuum, as much more common that one would think and something that can be dealt with successfully.

Smoking Cigarettes, Eating Glass, "The Crazy One," "The Other Chair," and many of your other works seem to draw almost exclusively from your personal experiences. What is appealing about writing nonfiction to you?

Nonfiction is what I know. I haven't tried to write fiction because I worry I couldn’t create a good enough story. My own life in psychiatric hospitals, however, delivered hundreds of stories already made. I just had to learn how to capture them on the page. There's the challenge of telling a good story as a way to make a psychological point. By using myself I can show the many sides of a simple action - the shame, fear, excitement, dread and hope that can be part of making a decision or taking a stand. I can illustrate emotions and psychological dilemmas without wondering if I'm accurate or not. The truth has sort of been handed to me and I'm using it.

As a psychologist and an author, you straddle the worlds of medicine and humanities. Could you talk about the interplay between your professions?

At the center of both medicine and humanities is the individual human experience. Yet that experience takes place in a context. We're all products of families and cultures, which vary widely, to say nothing of the larger forces of economics and the natural environment.

For me personally, your question itself couldn't be more affirming. You accept as given that I am an author as well as a psychologist; you refer to my professions, plural. And today this is true: I belong to both worlds. Each enriches the other. I find joy in both. Often the mistakes I make in therapy, the times I'm insensitive or overlook something important, come from rushing, from filling in the blanks with my own assumptions rather than being patient and listening with respect. The more open we are to varieties of experience, the better we can listen and appreciate any particular individual we encounter.

Are you currently working on any new projects?

I have pages of ideas for new projects, but I haven't yet been able to develop one beyond a few tentative stories. I'm learning that to have a book accepted for publication and then actually published and available is only another step in a long, ongoing process. It sounds trite, perhaps, but it's like having a baby. Labor and delivery is just the beginning! I'll be going to a residency in the fall where I'll have three weeks to really focus on beginning something new. I want to write stories about psychotherapy from a variety of points of view - the patient and therapist perhaps, but also the patient's parent or partner or child; people in the therapist's life. I want to see if I can convey the effects of psychotherapy as they ripple beyond the consulting room, to show how it heals (or doesn't) and how one person's change affects a whole system. And I'm beginning to think I want to write a novel that would tell what I imagine to be my mother's story.

Simone Leung is an intern at the Bellevue Literary Review. She is a rising junior majoring in Global Studies at Colby College and is interested in creative writing.

Sawyer's story "The Crazy One" appeared in The Bellevue Literary Review: http://blr.med.nyu.edu/content/archive/2012/spring/crazyone

Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images (Part II)

June 9, 2015 at 2:00 pm

(Kent State University Press, 2015)

[Editor’s Note: This is Part II of a dialogue between author and painter Cortney Davis and our Art Editor Laura Ferguson. Part I can be read here.]

Laura: I'd love to know more about your studio process. I see that some of the pieces are acrylic, some oil, and some include collage. Are they as unselfconscious as they seem? Did they come into being easily and quickly, without a lot of working over - or did you just make it seem that way? You let us feel your pain and your aloneness, you invite us to understand, and you allow us in to your experience. I suspect that may be in part because your paintings are not too perfect and polished.

Cortney: The paintings were painted very rapidly with no working over. I was discharged in mid-July, and the first painting was done at the end of July. Most of the paintings were done in August, six of them, one after the other, usually only a few hours per painting, or less. Three were done in September and two in October. I actually didn’t know what I was doing, technique wise. I painted in my basement in front of an open sliding door, with music playing (most often "The Tallis Scholars Sing Thomas Tallis" or "Agnus Dei, Music of Inner Harmony"). Painting also took my mind off my body (I was having a lot of medication side effects) and I really felt blessed to be alive, to be home, and to be standing by the open door with summer all around me, doing something that seemed totally free from "thought." When I finished the last painting, I looked at them and wondered exactly how they came about. It seemed there was no "planning" to them, just the painting.

As I recovered, however, by October I could sense the paintings becoming more "thought about" and less unselfconscious. I began to wonder if I was painting "correctly" and I found myself being more careful, more precise with the last two paintings. It was as if when I regained control of my body and my illness was less central, less in command of my day, I also moved, little by little, away from the totally un-thought-about and un-planned-expression that marked the paintings. (The paintings in the book, by the way, are not in the order I painted them - they have been arranged, in the book, in a chronological order to tell the story. I painted the images without rhyme or reason, just painting whatever seemed most urgent.)

The commentaries were added in November and December, at a time when words seemed to return to me, certainly the creative medium in which I was most comfortable and felt most proficient.

The Dark Night

Laura: You say that "painting seemed to be all about the body" but also that "painting took my mind off my body." Is that a contradiction? Did it feel like getting back to your body the way it felt before the illness?

Cortney: Painting felt physical, messy. It felt more like my body if my body only consisted of the senses.

When I painted the last one (which is the last in the book, "Angel Band") I noticed it was very neat - it felt less messy than the earlier ones - and I knew it was a sign that my head was taking over again. I haven't really done any more painting since then.

Laura: I wonder if being so vulnerable and out of control, and in a situation that forces us to live in our bodies in a very basic sense, opens us up, frees up that kind of expressiveness. The side of ourselves that needs to get things right becomes unimportant.

I'm thinking about the med students in my Art & Anatomy drawing class. I find myself trying to get them to loosen up, to enjoy being messy, to let go of trying to get it "right" - which is hard, because it's so important in every other aspect of med school. I think this is related to the issue of control that you bring up. You speculate that "maybe turning illness into something creative is a way of taking control," and I think that's true. It allows us to organize the experience, to present it as we see it. But paradoxically, it's a control that comes from letting go of control. As you say, it works best when it's messy and just comes out, without a lot of thought or oversight from one's internal editor.

This tells me that there's the potential for tremendous creativity in the world of medicine, from both patients and caregivers - and that art is a great way for each to communicate and open up the reality of their experience to the other.

Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images

June 2, 2015 at 9:40 am

(Kent State University Press, 2015)

A dialogue with Art Editor Laura Ferguson (Part I)

Carol Donley, in her annotation of Cortney's book in the LitMed Database, writes that "the vivid paintings speak for themselves, and they add a different way of knowing not available through words." As an artist whose work explores the experiences of her own body, I believe strongly in the power of art to express things that can't be as easily communicated in other ways, especially about experiences that go deep, like illness, pain, and isolation. Because Cortney is both a medical professional and a wonderful writer, I welcomed the opportunity for a dialogue with her about the expressive power of visual art.

Laura: You chose painting to express your feelings about the experience of being a patient, even though you are also a writer and poet. Can you say more about why it felt more right to express yourself without words? Do you think it was because the experience was so physical, so much about the body? For me, drawing seems to come directly from my body - it allows my body to express itself directly, through my hand. Is that how it felt for you?

Cortney: I didn’t really choose painting, rather it sort of chose me. When I was finally discharged after the second hospitalization my friends wondered if I was going to write about my experience. I felt the need to respond to my illness in some creative way (maybe turning illness into something creative is a way of taking control?), but I really could not find the words. It felt as if there were no words to adequately express what I had been through or what I’d experienced in the hospital. Words seemed too intellectual, too distant and too controlled to express something that felt raw, profound, and frightening. Also, since I’m primarily a writer, there is always an internal editor that watches over my shoulder when I write, and I didn’t have the emotional energy to embark on a writing "project" that I’d be trying to make "good" or "worthy."

My urge to paint took me a bit by surprise because I’m not a painter. A few months before my surgery, a painter friend had invited me to her house to paint with her, and she had introduced me to acrylics and oils - that was the first time I’d put paint to canvas. But after a few of our painting sessions, I was hospitalized. When I was discharged, I remembered that I had paints and some blank canvases at home. I felt drawn to paint images that I recalled from my hospitalization. My illness was all about my body, and painting seemed to be all about the body too: the smell of the paint and the feel of the paint and the brush on the canvas, the movement of my hand and arm, the lack of an internal editor (since I really had no idea if I was doing the painting "right" or not), the emotional impact of the colors and shapes, and the lack of the need to "intellectualize" the process.

CortneyDavis-Dilaudid-Land-72

Laura: Why did you then decide to add words? How would you characterize the relationship of your words to your paintings, or what you felt their purpose was? Do you think the paintings can stand alone?

Cortney: After I’d painted the twelve images, I wanted to share them with some of my nurse friends and with my family. I took photos of the paintings with my iPad and wanted to send them around, but I knew that viewing the paintings alone, unless someone knew a bit about what had happened, might be confusing. I added the commentaries in an attempt to make my very personal experience more universal, and to put down in words why those particular images stayed with me. By the time I added the commentaries, I was months into my recovery and feeling as if I might now find the words. The painting had helped me enter once again into the illness in an attempt to make emotional sense of it, and maybe the words helped make intellectual sense of it.

I now think the paintings could stand alone (now that I can see them more objectively), or at least a viewer might get a general sense of the story if he or she viewed the images as a series. But, since I’m a writer and not an artist, I felt the urge, eventually, to explain to others and to myself just what was going on in each painting.

Laura: Would you say that you made the paintings more for yourself or for other viewers? Do other paintings convey powerful, deep feelings to you? Do you think the paintings allow viewers to empathize with your experience?

Cortney: I think some artists and writers "do" their art in spite of illness, and some because of illness. In my writing about being a nurse, I write because of others’ illnesses as an observer. But painting as a patient, I was painting and then writing because of my own illness. Interesting! I never would have come up with those specific images if I’d not been a patient.

Laura: You told me that some people were "creeped out" by your paintings, or found them too depressing. - but I don't think people who've been there, who've been through experiences like this, will find them depressing. I think it's great that you go right to the heart of suffering, not sugar-coating it. You're willing to admit how out of control, how vulnerable you felt - and I think that totally comes across in the paintings. I'm sure you were an empathetic nurse, so can you say more about why you needed to experience being a patient yourself in order to understand what it was like to feel that vulnerable?

Cortney: I had been a patient many times before this last illness. But I’d never been close to death as a patient, or so sick for an extended period of time. I believe it might have been the very real possibility that I could die that made a difference in my understanding of the power of illness. I experienced a deep hopelessness and even a wish that I would die quickly, if I was meant to die. I had time to contemplate suffering and to review my life, realizing all the ways in which, while I’d been empathic, I had failed to understand the depths of suffering - mental, physical and spiritual - that gravely ill patients can experience.

In addition, my prolonged hospitalization was the direct result of a surgical mishap and, during my hospitalization, there were other complications that stemmed from lab and medication errors. Not only was I seriously ill, I was for the first time a patient who was unable to rely completely on those who were caring for me. Because I was a nurse, I could see the events and complications of my illness both from the inside - my personal experience of them - and from the outside - my inability to make sense of why or how these errors had occurred and were occurring.

As a writer, I’d always thought that I had the vocabulary with which to express what my patients might be experiencing, and to express what I was experiencing as their caregiver, in my poems and non-fiction. But during this illness, I felt in a very profound way the metaphorical inadequacy or incompleteness of my vocabulary. There is a level of vulnerability that can’t be intuited from the bedside but can only be experienced.

Laura: Related to that, do you think it's possible that nurses (and other medical professionals) get a sense of control from their jobs, that makes them feel protected from being in the patient role - a kind of magical thinking?

Cortney: I believe that all caregivers are acutely aware, especially after years of practice, that it only takes one second for someone to be thrust from the role of caregiver to the role of patient. And I believe too that there are many instances in medicine and nursing in which caregivers feel totally out of control - not wise enough, not quick enough, not prepared enough. I never felt that I would be "in control" by virtue of being a nurse, or that being a nurse combated any fear of dependency. I was more often in awe, feeling great vulnerability, but always both enriched and humbled by my interactions with patients.

[Editor's note: Part 2 of this dialogue will be published next week, with more about Cortney's studio process, and thoughts about artmaking as a way of both holding on to and letting go of control.]

Thinking About the Body Through Visual Art

March 16, 2015 at 1:58 pm

Readers of the Literature, Art & Medicine Blog may remember me as the first Artist in Residence at NYUSOM, or as the creator and teacher of Art & Anatomy in the Master Scholars Program in Humanistic Medicine [previously] [interview]. You may have seen my own or my students' work on exhibit in the MSB (Medical Science Building) Gallery at NYU Langone Medical Center, or read Founding Editor Felice Aull's insightful annotation of my work in the Database. Coming to the world of medicine as an artist, patient, and inhabiter of an unusual anatomy, I've been honored to have a voice in the humanistic medicine dialogue. Today I'm writing to introduce myself in a new role that I'm excited to take on, as the new Art Editor of the revamped, redesigned LitMed Database and Blog.

My first task as art editor was to find an image to represent Visual Art on the website's new landing page. It was a challenge, but a fascinating one … and in the end I was happy to find the solution not in one perfect image but in bringing together this set of four. They represent an intriguing spectrum of cultures, time periods, media, and ways of thinking about the body, each gaining a deeper resonance by being juxtaposed with the others.

Litmed-lpage-VisualArt
left to right: Laura Ferguson, Pavel Tchelitchew, Sopheap Pich, Leonardo da Vinci
more information and links to each image can be found at [http://medhum.med.nyu.edu/about]

In each of these artworks, an image of the head or the brain is imbued with a sense of consciousness, an awareness of its own embodiment. Each of the artists is attuned to correspondences between the forms of nature and those of the body. With varying degrees of transparency, they each allow us to see or sense the underlying anatomy - and more broadly, to look beneath the surface of life, which is what art is able to do so well.

There is an inherent humanism in art, and a great power to communicate - to express things that can't be as easily communicated in other ways. The connection between artist and viewer allows us to share experiences that go deep into the human spirit and psyche - the same places where illness or pain or differentness or isolation often take us.

Leonardo_blogpost

Art looks beneath the surface of life - but strangely enough, it rarely looks beneath the surface of the skin. For Leonardo da Vinci, drawing anatomy was an essential part of his artistic investigations into the nature of human experience. The anatomical studies in his notebooks were drawn (c.1509-10) from personal observation of human dissections - but also from life models. His drawings take us beneath the skin of real people who still come alive to us 500 years later, and make us think about the beauty and complexity that lies within our living bodies.

Surprisingly, since Leonardo's time very few artists have looked inward to show us the beauty of our intriguing, spatially complex inner landscapes, or to explore their meaning. Anatomy became part of a genre, medical illustration - which has given us many great images but, as it grew more scientifically accurate over the centuries, became increasingly generic and impersonal. Now when we try to visualize our unique inner spaces, we tend to imagine something that looks like a medical textbook. It's hard to find images we can relate to - especially for those of us (like me) with unusual anatomies.

Tchelitchew_blogpost-r

One of the few artists to use the imagery of anatomy was Pavel Tchelitchew, who painted Interior Landscape (above left) and The Golden Leaf (right) in the 1940's. He used the imagery of anatomy, glowing from within, to represent the spiritual aspect of human life and its connection to nature and the cosmic order of the universe. His networks of nerves and blood vessels evoke invisible structures at the far reaches of scale, from atoms to constellations.

SopheapPich_blogpost

Sopheap Pich is a contemporary Cambodian-born artist who created Buddha 2 (above left) out of rattan and wire in 2009. The openness of its woven reeds allows light to shine through, suggesting the inner body. Pich was a pre-med student before turning to art, and many of his woven sculptures, like Cycle 3 (center) and Caged Heart (right) suggest anatomical forms. But for him, the spirituality of the body is connected to culture and history. His Buddha radiates a peace and calm that contrast with the tips of its rattan strands, dyed red to evoke the blood spilled during the Cambodian genocide.

Ferguson_blogpost

Finally, my own work: Cerebrum, coronal view, with floating colors (left and also above, the header image for the Blog). Curving vertebrae with spinal nerves (center), and Lung, opened (right). I draw from skeletons and cadaver dissections and from radiology images of my own body, made for my use as an artist: a 3D spiral CT scan of my body and a 7-Tesla MRI of my brain. The open access to anatomical source materials that I've gained through my role at the medical school allows me to evoke the subtle textures of physical reality as I draw my own body from the inside out, attuned to sensory and kinesthetic experience.
You can see more of my work at www.lauraferguson.net.

student art_blogpost

The idea for Art & Anatomy, my seminar in the Master Scholars Program in Humanistic Medicine, came out of my own work as an artist. I knew that drawing would a great way to learn anatomy, and a humanistic mode of engaging with the dissection experience and its intimate involvement with the visceral reality of the body. Art & Anatomy is about learning to draw but even more about learning to see: to visualize the inner body and connect it to the the more familiar outside view. The artists are students, faculty, and staff from the medical school and NYU Langone Medical Center, who bring a special perspective to their work: a knowledge and understanding gained through their hands-on engagement with the body and its ills.
Shown above, Pelvis by Susanna Nguy (left) and Under the Skin II by Karen Ong (right). A gallery of student art is on view at http://school.med.nyu.edu/humanisticmed/artandanatomy

As your art editor, I'll continue to present you with images like these, including the work of artists with disabilities and unusual anatomies whose work comes from their own inner body experience and others whose work captures the uniqueness of our inner bodies and helps us connect with them more closely. I hope they will make you think of anatomy and the body in new ways, and show you the power of art to communicate and connect us. I'd love to hear from readers, especially if you have artists to recommend - you can contact me at laura@lauraferguson.net.

Visualizing Empathy: An interview with Laura Ferguson

April 14, 2014 at 12:40 pm

Artist Laura Ferguson developed a lifelong passion for drawing the body, both inside and out, as a child when she was bedridden with scoliosis. Five years ago she created an Art and Anatomy seminar in the Masters Scholars program, as part of an artist residency at NYU SOM.

The class, which includes medical students, faculty and staff, meets in the cadaver lab where gross anatomy is taught. Once transposed into an art studio, the setting provides students with a chance to engage with the dissection experience more creatively than in gross anatomy, where the focus is on learning the parts of the body and what happens during the disease process. The simple act of drawing, Ms. Ferguson says, encourages a more intimate involvement with the beauty, complexity, mortality, and visceral reality of the human body.

"These artists are imagining the living body as they draw: looking at bones and cadavers but imagining the person who once inhabited them - and also imagining the living, moving anatomy within themselves."
"There is an inherent humanism in art, and a great power to communicate - to express things that can't be as easily communicated in other ways. Art allows us to share experiences that go deep into the human spirit and psyche - the same places where illness or pain or differentness or isolation often take us."

Ms. Ferguson brings her experience as a patient into the studio to encourage students to explore individual differences among body types. While she recognizes that students need to memorize organs, tissues, and nerves in order to become competent physicians, she stresses the importance of recognizing that variations in body types do not define the person nor the illness they may have at any given time.

This year, Ms. Ferguson organized an exhibit of "Art & Anatomy: Drawings" in the MSB Gallery at NYU Langone Medical Center, featuring 76 artworks made in the class. Ms. Ferguson said she was struck by the audience's powerful reaction to the exhibit-for some there was an inherent discomfort, even fear, connected with seeing the inner body, but that became a shared sense of wonder for the viewers as they recognized the transformation of anatomy into art.

At the opening of the exhibit, Hannah Bernstein, one of the student artists, had this to say:

"When I created drawings for the course I tried to capture this appreciation for the beauty and variation of the human body. I learned to appreciate things that aren't conventionally beautiful, like the curves of the femur and the intricate network of blood vessels covering the heart. I also learned that in general, real people don't look like textbook illustrations. No two people are the same, and no one is 'perfect.' Each body has its own unique deviations, and this applies to what's inside as much as what's on the surface. This is an important lesson for any future doctor, and I'm grateful that I got to learn it from such a unique perspective."

_______

More on Art and Anatomy

•On April 30th, a slideshow of "Art & Anatomy: Drawings" will be screened as part of "Reading the Body: Live!"! - a literary evening honoring Frank Netter, with stage actors reading poetry and prose about the body from the Bellevue Literary Review.
•A gallery of images from the show can be viewed online at http://school.med.nyu.edu/humanisticmed.
•A short film about Laura Ferguson and Art & Anatomy was recently featured as one of its "untold stories" by Narrative,ly (http://narrative.ly/art-in-strange-places/how-to-draw-a-human-heart/).