The distinguished subjects of art sometimes had diseases, and often, so did the artists themselves.
Their symptoms — whether of physical ailments or mental illnesses — are in their art. Rembrandt, who depicted himself in self-portraits with an off-centered eye, likely had stereoblindness, which impedes depth perception. Van Gogh, who painted with color combinations and an extreme productivity characteristic of epileptics, suffered seizures. Toulouse-Lautrec, who painted several portraits of desolate-looking women drinking at café tables, coped with alcoholism and absinthe abuse.
Increasingly, keen doctors are bringing their diagnostic tools to bodies of art to revitalize old conversations about canonical works. But the relationship is symbiotic: Art can also make physicians more in tune with their senses, improving their diagnostic acuity and ability to empathize.
The mutualism of art and medicine is a long-standing tradition that traces back to the Renaissance and even earlier. Andreas Vesalius, who is widely regarded as the father of anatomy, published his richly illustrated “De humani corporis fabrica” (“On the Fabric of the Human Body”) in 1543.
“Vesalius is making an intervention, both in the things that he's finding when he opens bodies, like correcting certain errors from Galen, but also a huge intervention and visual argument in how the work is presented,” Hannah Marcus, a history of science professor at Harvard, says.
Science is a visual pursuit. It's always about making a scientific rhetorical argument.
Vesalius’s detailed depictions of the human body contrast greatly with the simple images favored by his predecessors. “It's like schematic images versus this beautiful person tearing their skin off in a classical landscape,” Marcus says.
Before photography and modern diagnostic technologies, art was one of the only mediums of the sciences, and aesthetic acumen was an integral aspect of any scientific profession. “Science is a visual pursuit,” Marcus says. “It's always about making a scientific rhetorical argument.”
The visual traditions established in astrology and taxonomy were among those carried over into medicine. Galileo Galilei’s acute illustrations of different angles of the moon attest to his artistic training. Botanists, whose work entailed finding herbal remedies, made critical calls in determining how to depict specimens in books and taxonomic keys. Leonhart Fuchs and Conrad Gessner, 16th century botanists, grappled with whether to illustrate plants exactly as is or as archetypal models.
“There'll be a flower that is depicted in all stages of its life,” Marcus says, alluding to many illustrations of plants with fruit, flowers, and buds all at once. “It is naturalistic, but not realistic, exactly.”
The respective roles of artist and scientist have been fluid over time, as seen at the centuries-old Warren Anatomical Museum, which houses the pathology and anatomy collections at Harvard Medical School’s Countway Library of Medicine.
“The physicians might actually have some artistic skill. And probably the artists have a very good understanding of the human body,” Dominic W. Hall, curator of the Warren Anatomical Museum, says. “They were at least living in each other’s mediums.”
Vesalius created these “gorgeous” and “groundbreaking” images in collaboration with Jan Steven van Calcar, according to Scott H. Podolsky, the Director of the Center for the History of Medicine, which contains the Warren Anatomical Museum. Podolsky is also a professor of global health and social medicine at the Faculty of Arts and Sciences. “That whole lineage of medical illustration goes through the 21st century,” he says.
The Warren Anatomical Museum has many modern examples of this timeless collaboration between artists and physicians. It holds a collection of watercolors jointly produced by Henry Jacob Bigelow, who was a professor of surgery at Harvard in the 19th century, and the artist Oscar Wallis. One watercolor depicts tongue ulcers, rendered with a pattern delicate as lace, and another a swollen star-shaped wound in deep purples and pinks.
Also held by the museum are the stately “Normann” and “Norma” — sculptures of the average American male and female — commissioned by surgeon Robert Latou Dickinson and realized by sculptor Abram Belskie in the mid-20th century. Hall says that “Normann” and “Norma” are not “straight clinical models,” but rather boast “artistic flourishes” and “neoclassical details.”
“We have these consequences of defining norms of maleness and femaleness which we might really engage with and perhaps deconstruct,” Podolsky says on “Normann” and “Norma.” “Like any type of art or any other piece of information, it requires reflection on the context for its original production and the context for how we would consider that today.”
Insofar as these artifacts invite the admiration of beauty and inspire reflection, then, the Warren Anatomical Museum is also an art museum of sorts.
Hall contrasts “Norma” and “Normann” to the casts — or “direct captures” — on display in the museum. Of the former, he says, “There’s a lot more sort of intellectual fuel happening there and lot more discussion of what you're making.”
By contrast, the latter is largely skill based. “There’s no artists there. There's just a physician making the cast or some sort of technician,” he says. “There's a skill, but it's not interpretive.”
But Podolsky thinks direct capture artifacts that “aspire to objectivity” may still remain art forms. “Thinking about radiology and various degrees of going through X-rays, CAT scans, and MRIs,” he says, “there's still certainly an interpretative frame.”
Shahram Khoshbin, an associate professor of neurology at Harvard Medical School, is a doctor who applies his diagnostic skills to the canvas.
As a medical student at Johns Hopkins University, Khoshbin attended a talk by the late Harvard Medical School graduate and neurologist Norman Geschwind on hypergraphia — pathological productivity — as a symptom of epilepsy. Afterwards, Khoshbin approached Geschwind and claimed to know of a hypergraphic artist who did not suffer from seizures.
“He said, ‘You mean Van Gogh?’ I said, ‘How did you know?’” Khoshbin says. Geschwind told the young Khoshbin that Van Gogh was indeed epileptic.
Intrigued by Geschwind’s intuition, Khoshbin took it upon himself to find the medical records of Henri Gastaut, a neurologist and an epileptologist in Marseille. The records confirmed Geschwind’s conjecture.
But the evidence for Van Gogh’s epilepsy did not exist solely within his medical records. As it turned out, clues about the man’s disease were contained within his art itself.
Van Gogh’s work is distinguished by a tension between tertiary — or complementary — colors: purple and yellow, red and green, blue and orange. While working at the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital, Khoshbin noticed that epileptic patients produced works characterized by similar color complementarity. The work of depressed patients, by contrast, featured only brown, black, or primary and secondary colors.
Khoshbin began to notice instances of epilepsy — generally read as the subject being possessed or in religious rapture — in theological artworks. He believes that Saint Teresa in Bernini’s “Ecstasy of Saint Teresa” is experiencing a seizure, as is the child in the lower right corner of Raphael's “Transfiguration.”
Not only does medicine reveal tremendous insights into past artwork and artists, but it also teaches valuable skills in medicinal practice.
The course PB 707: “Training the Eye: Improving the Art of Physical Diagnosis” at Harvard Medical School sharpens students’ diagnostic skills with art analysis and observation. Khoshbin co-teaches the course with Joel T. Katz, an associate professor of medicine at Harvard Medical School.
On one of several course trips to the Museum of Fine Arts, Boston, students studied paintings and lithographs of Toulouse-Lautrec. They examined a poster of Jane Avril, whose distinctive dancing style with jerky, involuntary movements in Parisian cabarets is now thought to be characteristic of Sydenham's chorea. The disease was once known as St. Vitus’ dance, after the patron saint of acting, dancing, and epileptics; devotees would dance before his statue on the day of his feast. While debilitating, disease can provide an original expressive style that arises from an alternative condition..
Sharpening your ability to look and understand what you're seeing and understand what your preconceived notions about what you're seeing, that's what visual thinking strategies is all about.
In one exercise, students analyzed the power dynamic between the two subjects of the double portrait “At the Café La Mie,” while they diagnosed patients based on the subtle changes of a chest X-ray in another. Thick fat pads under the heart suggested the patient uses steroidal medication; a filled aortic-pulmonary window suggests lymphoma.
The course teaches students visual literacy, a skill increasingly emphasized by the medical community. As Kitt Shaffer, vice-chair of the Education Department of Radiology at Boston Medical Center, and a former instructor of “Training the Eye,” says, “Sharpening your ability to look and understand what you're seeing and understand what your preconceived notions about what you're seeing, that's what visual thinking strategies is all about.”
Co-creator of “Training the Eye” Alexa Miller took this opportunity further by starting Arts Practica, a medical education consultancy that creates “arts-based experiential learning opportunities that enable leaders, practitioners, and teachers in healthcare to be more effective and mindful in uncertainty,” according to its site.
The Arts Practica homepage flashes with slides that read: “Observation is knowledge.” “Observation is respect.” “Observation is care.” “Observation changes minds.”
According to Miller, observation does indeed change minds. “We found that students who took the course improved — they made almost 40 percent more observations on clinical pictures,” she says. “Meaning they actually just saw more, they noticed more details.”
In 2008, these results were published in the Journal of General Internal Medicine under the paper title, “Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills.”
“There is a difference between looking and observing,” Khoshbin says. Khoshbin uses the renowned example of Sherlock Holmes and Watson camping. “Holmes wakes [Watson] up in the middle of the night. And he says, ‘What do you see?’ Watson looks up and says, ‘Oh, I see the beauty of heavens and I see how God has created this universe, etc.’ And Holmes says, ‘Stupid! Somebody stole our tent.’” According to Khoshbin, observing is an active and dynamic synthesis of information to make inferences, while looking is more passive.
Musical training can also refine the observational skills demanded in clinical practice. Lisa M. Wong, an assistant professor of pediatrics at Harvard Medical School, invites reflection on its role in her book with a musically alliterative title, “Scales to Scalpels: Doctors Who Practice the Healing Arts of Music and Medicine.”
For two decades, Wong served as the president of the Longwood Symphony Orchestra, which comprises of medical professionals who play music for social change, or “community healing.”
She estimates that about 60 to 80 percent of her fellow clinicians had musical training as children, which she doesn’t find surprising. A developed pitch sense in musicians makes them better able to hear murmurs, she says. She even has a colleague whose oboe sensitized his fingers, making him defter and more dexterous at palpating tumors.
“When you're learning music… you're responsible for every single note in tune and in the right order and the right rhythm. So that is already a big requirement,” Wong says.
“But the right order is not enough,” she adds. “It's putting your heart and soul into it and putting your understanding and telling your story through it — that's where the music comes in. And it's the same when you grow up to be a doctor. You can look at lab values, you can look at the data sets[...] But if you don't apply it to the story of that patient, then you're not really caring for that patient.”
Though medical professionals are often imagined to be reading strictly X-rays and MRI scans, they need literacy in far more than imaging technologies. What often gets overlooked by outsiders is the skill to read the bodies and expressions of patients and their loved ones, because a diagnosis can bear a psychological burden as substantial as the disease’s symptoms.
Khoshbin emphasizes how good caregiving demands more than technical knowledge. “You could know every enzyme in the universe and every gene in the universe and try to go take care of somebody who's in pain and have no idea what that is, because pain is not just a gene or an enzyme. It's human condition.” In their capacity as caretakers, empathy and the ability to understand the experience of the patient is an invaluable skill to doctors.
David S. Jones, a professor in the History of Science and the director of the Arts and Humanities Initiative at Harvard Medical School, says that the humanities offer a “rigorous way to try to understand the human condition, through these various works of art motivated in part by disease or by death and dying.”
Literature is one of these media. “Studying literature — so in other words, thinking about tone, and language, and metaphor — is an excellent tool for sharpening our diagnostic abilities and also increasing our ability to listen to our patients and their stories,” Suzanne J. Koven, the writer in residence at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School, says.
Susan E. Pories, an associate professor of surgery at Harvard Medical School, borrows an example from Rita Charon, founder and executive director of the Program in Narrative Medicine at Columbia University. Pories says Charon uses Kafka’s “Metamorphosis” in a clinical context — namely, to elucidate the extreme “otherness” of some patient experiences. She explains how a patient who has a stroke is like Kafka’s protagonist, who wakes up as a cockroach.
The metamorphosis and stroke incite analogous upheavals in people’s lives. “[It’s] how your life can change overnight, and then how your relationship with everyone around you changes, when you can't communicate and when you can't take care of yourself,” Pories describes.
Karen L. Thornber, professor of Comparative Literature and of East Asian Languages and Civilizations who co-teaches the undergraduate course CB 58: “Case Studies in the Medical Humanities: Interdisciplinary Perspectives on the Experience of Illness,” agrees that the study of history, anthropology, and literature is indispensable in medicine.
Literature, as a social force that conveys the medical experience, can help deconstruct stigma, she says. It helps physicians understand variability in worldviews that feed into patient care and also fosters intimacy with the patient.
Studying literature... is an excellent tool for sharpening our diagnostic abilities and also increasing our ability to listen to our patients and their stories.
She notes that a salient book in her curriculum is “The Spirit Catches You and You Fall Down,” in which a Hmong refugee family’s understanding of epilepsy clashes with the suggested treatment of the physicians they encounter in California.
Pories encourages her medical students to think of their patients’ lives as narratives. Recently, she co-compiled essays produced in the “The Mentored Clinical Casebook Project” — which describes the experience of first-year medical school students who spend time with patients both in and out of clinical settings for a year — into a collection called “The Soul of a Patient: Lessons in Healing for Harvard Medical Students.”
Pories highlights “Mother’s Day” — about parents whose child is in a vegetative state — and “Heartbeats” — about a couple whose fetus is diagnosed with Down syndrome — as two notable pieces.
“It's not just about the patient, but about the medical student making a relationship with the patient — or a relationship with the family — and learning so much about themselves in the process and growing so much from the beginning to the end of the year,” she says.
Artistic expression is a tremendous asset for physicians in supplying inspiration and insight, but the artistic process can also provide release. Jones notes how the arts can be integral in preventing burnout. “The pursuit of the arts is often an important part of individuals’ lives,” says Jones, “and some people mistakenly think that by going into medicine, they have to cut off that piece of themselves and focus just on their clinical work.”
“We find that even if we’ve had a very stressful day, or a day where surgery was difficult or there was a difficult patient, when we come back together again we're playing in harmony,” Wong says on the Longwood Symphony Orchestra. “So it's sort of a multifaceted way of healing.”
Pamela Chen, a Harvard Medical School student who took “Training the Eye,” agrees that medicine and the arts complement one another, but adds a caveat when it comes to seeing art too simply as a measure against burnout.
“I think a lot of people are artistic. And they want that kind of outlet,” Chen says. “I also think that while art can be cathartic and helpful for wellness, it also requires discipline and emotional input and it can be very frustrating in and of itself, trying to produce something and create something. So it's giving you a different outlet, but often one that requires a similar amount of training and discipline, if you want to have a high quality result.”
Art is remedial for Wong and Chen, but it can be healing for patients as well as for clinicians. Susan N. Nathan, an instructor in medicine at Harvard Medical School, harnesses patient narrative as a tool for healing. The United States Department of Veterans Affairs program she founded, My Life, My Story, pairs veterans with students, interns, residents, and fellows from a health background — the largest group of whom are training the become physician assistants. The students interview the veterans about their life histories, taking only notes by hand, and synthesize them into a first-person story in the voice of the veteran.
“When the stories are read back to them, [the veterans] laugh and they cry, and it's really meaningful and emotional,” Nathan says. “It might have been stories that they've told a lot of times — but, somehow, now it's formal, and it's sort of reflected back through another person listening.”
Koven and her patients occasionally co-curated their stories in her monthly column, “In Practice,” which was published in the Boston Globe between 2011 and 2014. “Literally, a patient was dying — a woman exactly my age. And I asked her if there was anything I could do for her, and she said, ‘Yes, put me in the newspaper,’” Koven says.
“I came back the next day, and she said, ‘I decided what I want the column to be about. What I want it to be about is how important it is to have good palliative care at the end of life.’” The column was titled, “Message From a Dying Patient.”
“I received emails from all over the world, from people talking about how they were a palliative care doctor, or they had received palliative care, and how much it had meant to them,” says Koven. “And I forwarded all of these to her, and she just found that incredibly gratifying.”
Students who want to bridge the rift between medicine and the humanities have found spaces both at the College and the Medical School to do so, such as through the Medical Humanities Forum at the College and the Arts and Humanities Initiative at the Medical School.
“At Harvard Medical School, the Dean of Admissions says that if he's given two equal candidates, he'll always choose the musician over the non-musician for admission to medical school,” Wong says.
“They're more comfortable with ambiguity, more comfortable with that a piece of music can go fast or slow — and they're both right,” Wong says about prospective physicians with musical training. “And so they're more resilient and more flexible.”
From the undergraduate side, the Medical Humanities Forum encourages members to develop these complementary skills and traits that medical educators are looking for in applicants. Emily R. Gordon ’20, director of the forum, says the club invites medical professionals to come in as speakers and attest to the value of their alternative artistic experiences in their work.
“The club has a lot of different purposes. We have a blog where people can post pictures, photographs, art, poetry, news articles, that are related to medicine,” Gordon says.
At the Medical School, with funding from the Arts and Humanities Initiative, Chen co-founded the Longwood Chorus in 2017. Having been in the Harvard-Radcliffe Collegium Musicum during all four years at the College, she describes it as “a vocal ensemble for healthcare students and professionals.” The group, which began with 12 members, has expanded to include nearly 50 students, physicians, therapists, and researchers from the Boston University School of Medicine and Boston Medical Center, according to Chen.
“There's a ton of other music opportunities for medical people at HMS,” Chen says — groups that raise money for charities and provide an exhaustive artistic community.
Illness, death, and dying can paradoxically be fruitful and live-giving. “The challenge of illness, disease, and suffering has been artistically productive for humans for centuries,” Jones says. “Many of the great works of literature, of painting, of music have been motivated in part by death, dying, disease — suffering of various sorts.”
If you go into a hospital, there is the best of humanity and the worst of humanity and everything in between.
Not only does the altered state of illness inspire artists, but their heightened consciousness of mortality can push them to create.
“There's a very long history of artists being transformed and influenced by events in their health,” Miller says. “And there's just story after story after story of an artist getting sick and — just out of a sense of their time being extremely limited — doing what matters most to them.”
Sickness can serve as both impetus and muse to art. It also shapes clinical skills and practices. As the line blurs between the humanities and medicine, it becomes hard to delineate one from the other.
“If you go into a hospital, there is the best of humanity and the worst of humanity and everything in between,” Miller says. “I think of medicine as pretty raw humanities work.”
— Staff Writer Juliet E. Isselbacher can be reached at email@example.com.
— Staff Writer Shruthi Venkata can be reached at firstname.lastname@example.org.