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ART & MEDICINE

To Help Each Other So:

Art and Defamiliarization in Medical Education

Mark A. Clark, PhD

Proponents of incorporating experiences of the arts in medical congruence and harmony with the nude body, even as some tortu-
education often tout the fact that the slow, careful examinations ous tension prostrates that body in debilitating pain.
of artistic representations promote crucial observational skills The observational skills one acquires by means of an absorption
called for in clinical practice. I agree with this claim, but I would in the Ferguson representations are crucial to one’s development
also assert that the point deserves some elaboration. It’s not simply as a clinician, though the understanding they afford is qualitatively
that, in looking at works of art, we pay attention to physical details different than those promoted by much of medical education.
and therefore develop skills that will help us read X-rays more Much of medical education and practice is aimed at seeking explicit
carefully or become more astute in picking up diagnostic clues re- knowledge that can be told, recorded as a collection of facts, re-
lated to the structure and function of a patient’s body. Artistic rep- peated, and described. It tends to conceive of the patient in the
resentations are infused with an emotional dynamism such that third person—as an other about whom medical professionals may
the devoted observer beholds—and develops important observa- make factual statements based on measurements, scans, and evi-
tional skills in beholding—an integration of mind-body-spirit and dence—and is inclined, indeed, to regard the patient as a biological
a wholeness of personhood that medical imaging and representa- puzzle in need of solving. A clinician, on the other hand, is, by
tion tends to undo. virtue of the physician-patient relationship, called to develop
To make this point with my students, I engage them in visual knowledge through second person, I-Thou experience, which is
Thinking Strategies with respect to (a) the photograph, as one might interpersonal, engages the integrated mind-body-spirit, and yields
find in a medical text, of a woman with scoliosis; (b) a medical il- tacit understanding of another person, where, as Polanyi would say,
lustration/drawing of a woman with scoliosis; (c) an X-ray of a “we know more than we can tell” or put in words explicitly. It’s
woman with scoliosis; and (d) a selection of self-portraits by artist more than knowing a collection of facts about the structure and
laura Ferguson, who has suffered from severe scoliosis all her life. function of this body: it’s knowing you. And such knowledge is
In each case, students are invited to respond to the visual Thinking crucial to understanding suffering and offering care that is truly
Strategy questions, “What do you see? What do you see that makes compassionate. It is this kind of knowledge and understanding that
you think that? What more do you see?” And what becomes clear, engagements with art can offer.
of course, is that the nature of the observation and the nature of Such engagements serve as experiences of epistemic defamiliar-
understanding that flows from it are quite different when it comes ization in medical education. Promoting the tacit knowledge they
to the Ferguson representations. Ferguson’s pieces feature the sen- do, this is to say, they disrupt the habits of knowing that pervade
sual, nude body of a woman rendered transparent to reveal the spine medicine and that would conceive of persons as biological puzzles
contorted by the condition. In the arabesque of that spine, one be- of structure and function. They bring to consciousness the habits
holds and shares in some approximate feeling of persistent, ago- of thinking that would otherwise remain unacknowledged and
nizing, debilitating tension. but almost impossibly, it seems, one is mindlessly adopted.
simultaneously drawn into an experience of calm, exquisite beauty Consider, for example, the cases of Problem-based learning
and gracefulness—as if the body itself had captured and held for- and Case-based learning programs in medical schools. The cases
ever before our eyes, in a kind of transfiguration, the movement are stories by means of which medical educators promote in stu-
and spirit of dance. The arabesque of the spine dances in perfect dents’ habits of thought. The “characters” of patients in these sto-

12 San Antonio Medicine • June 2019