Tag Archives: Philip Davis

Can Occasions Think?

Paul Krugman used to add a parenthesis to the title of some of his New York Times economics columns warning the reader to expect “geekish”. This blog posting may be my most abstract to date, but the implications of the issue are real, especially in my longterm quest to understand what happens in clinical encounters.

I begin for the third posting in a row (and it will stop after this) with the writing of Philip Davis, this time from his book Shakespeare Thinking. That title is literal: Davis’s project is to show how Shakespeare’s language creates spaces in which though is elicited; at the extreme, how Shakespeare creates, or generates, or even evolves the possibility of thinking, which sounds hyperbolic, until you see Davis showing how it happens. But let’s begin with something easier to hold onto. Here’s an observation that restates what others have suggested about Shakespeare:

“Shakespeare is closer to Renaissance tricks of double perspective. For the shape of a thing depends on the perspective–shift it ever so slightly and the ‘object’ changes. So, Edgar on Dover cliff [in King Lear] has different perspectives in the same painting. In that sense Shakespeare is more like a cubist in action: taking multiple points of view almost simultaneously until it is not two or three people separately inserted into one solidly external situational container so much as two or three reciprocally overlapping situations within one complex blended happening” (Davis, Shakespeare Thinking, p. 86).

Now imagine, please, a familiar hospital scene: a patient in bed, a physician standing over the bed, delivering news maybe about test results or whether a treatment is succeeding, a nurse standing slightly back, and a family member on the other side of the bed from the physician. Apply what Davis says about Shakespeare: “it is not two or three people separately inserted into one solidly external situational container so much as two or three reciprocally overlapping situations within one complex blended happening.” Most healthcare studies of what’s called “doctor-patient communication” assume the narrational privilege of one actor, the physician, and measure how well the patient understands and retains the information conveyed by that physician. More enlightened studies go further, recognizing that each person in this situation has her or his own interests and agenda; each not only comprehends (or not) the content of information, each assesses and interprets what is said, including messages that are enacted, not spoken (Goffman’s signs given off, beyond signs consciously given). Davis calls upon us to understand the situation as more complex still: “three reciprocally overlapping situations within one complex blended happening.”

The ethical question this raises–at least ethical is the best I can think to call it, although the word seems inadequate; should I just say human?–is whether the participants in this situation can each remain self-aware that the other participants do not share their perspective. Something beyond empathy (a word I seek to avoid) is involved here; it’s rather an awareness of the limits of fellow-feeling, the limits of what George Herbert Mead called taking the role of the other. To return to Davis’s metaphor, can we put ourselves inside a Cubist painting and live with the fracturing of the lines that, in normal perception, make the scene around us cohere?

Davis continues, and here is where I find his thinking going beyond anything I remember from all that sociologists have written about interaction and situational framing: “It is as though the occasion itself, like a living thing, knows nothing about the parts within itself being separate or, at least, thinking themselves to be so. It is we who habitually think in terms of subject and object…” (86, my emphases). Sociologists have talked for nearly a century about how people define situations. Goffman showed how situations frame interaction, but that only shifted the emphasis from human actors actively defining to definitions being culturally given as resources for humans. What Davis offers is the idea of the situation itself as one of the actors, like a living thing. But this thing is not fully self aware. It cannot understand that the people in it think themselves to be separate: subjects perceiving others as objects of their perception.

In what I think was one of the great observations of clinical medical practice, Anatole Broyard pointed out that his doctor did not realize that as he was examining Broyard, so also Broyard was examining him. Or Montaigne asking whether, as he played with his cat, the cat understood itself to be playing with him.

Neither Davis nor I is doing philosophy, so we don’t aim at a resolution. What I at least want is a change in perspective, or an opening to multiple perspectives. Decades ago Alfred Schutz wrote about multiple perspectives, drawing in part on William James. There’s nothing new here. It’s more a question of whether we can ever take seriously what’s been recognized all along. Whether it’s Edgar and his father on the Dover cliff in King Lear or an everyday hospital room consultation, there’s a dramatic tension that makes all the difference. Edgar actually can–he has the grace to be able to–see the cliff from above (the perspective he’s playing, for his father, Gloucester), from below (the perspective of Gloucester who believes he has fallen), and no cliff at all (which is reality to anyone observing them). Shakespeare’s art is to enable us, as we experience the play, for just a moment to see from all three perspectives at once.

So here’s the ethical question, so far as Davis concludes it, or maybe as far as anyone can conclude it, and here also is another take on what Davis means by thinking: “…it is thought that has to come out there, in the world, rightly taking its anomalous place amid the whole intervolved reality to which it so uncomfortably belongs and refers” (87). It’s not the communication, or the definition of the situation, or the frame–although each of these attends to something–rather it’s thought, taking its anomalous place, so uncomfortably. Having seen this enacted on Shakespeare’s stage, can we experience our lives as thought arising?

Narrative Medicine or Lyric Medicine?

Most of the medical Covid stories I read involve hospital work; here’s a different scene. My 100-year-old father used to get monthly B12 injections from his doctor. That ended in March when the physician shut his practice due to Covid. They’ve now reopened, but not the actual office. My father gets driven into a designated parking spot by his doctor’s building. His doctor then comes out, looking like what my father describes as a “spaceman” in protective gear, syringe in hand. He gives my father a shot through the car window, asks (through mask and visor) if there’s anything else, and retreats back to his office, presumably to shed the gear and suit up for his next patient. That’s a sort of story, but the narrative in such medicine is not between patient and physician.

I now make a big jump–or is it so big?–to Clive, which is the name that Philip Davis gives to a physician whom he writes about in Reading for Life, which was the topic of my previous blog post. Both Clive and Davis admire and are influenced by John Berger, especially his study of a rural physician, A Fortunate Man. Davis’s discussion of Clive is richly nuanced, including poems they read together. But let me focus on one moment, at risk of taking that out of context. Clive dislikes, or is suspicious of, what he understands as “narrative medicine”. What’s he mean by that? “He is referring,” Davis writes, “to the common belief that people must be able to have access to their own story, that they suffer without it, and that one way to realize it is by telling it to their physician who won’t otherwise recognize their individual depth” (144). Readers may want to take a deep breath, reread that, and ask how far it fits their previous ideas about what narrative medicine is. Clive’s sources for his understanding of narrative medicine are not specified.

My own reaction begins by noting that what Davis, maybe Clive, understands as a “common belief” has become common only fairly recently. Charles Taylor’s The Ethics of Authenticity is still the best genealogy of this belief that I’ve read, and the best critique of what’s inadequate about the idea of people having “their own” story. Taylor turns, as I do, to Mikhail Bakhtin to understand personal stories as never our own individually, but always dialogical, held between persons in relations of response. Davis doesn’t cite Bakhtin specifically, but Bakhtin’s dialogism is consistent with the process philosophy Davis aligns with. That limitation of how much a story can be anyone’s “own” is not, however, what Clive worries about. Clive actually listens to people, and what he hears disrupts the idea of what’s “narrative” in narrative medicine, or, what kind of story people are prepared to tell, or maybe what they are all too well prepared to tell.

What Clive hears, and what troubles him, are people “losing their initial insight, thinking it down into a more conventionally normalized and stereotyped account of their lives”. That’s the problem with the stories people tell in self-help groups on the AA model. One’s “own” story becomes a conventional narrative. Becoming a member consists in learning to tell your story that way, and the group enforces expectations for telling the story just that way. So let’s go back to what Clive means by “their initial insight”.

“I want the clue of the lyric glimpse,” Davis quotes Clive saying about his clinical practice; “the vestige or the fragment to begin from, not the self-conscious spelling out of an over-clear narrative.” Following Clive makes narrative medicine seem an odd name for what he’s perpetually looking for. There isn’t and won’t be and even shouldn’t be a narrative, in the sense of a sequential events connected by some sort of immanent logic of sequence (even if, in a particular sequence, time is out of joint). What there are instead, maybe, are moments of seeing through conventional, normalizing narratives to something beyond. Clive speaks of “the lyric glimpse”, so let’s call this beyond the lyric, which is momentary, a perceptual and affective instant, rather than the narrative, unfolding in longer durations. Clive, as I understand Davis’s understanding of him, wants what would be better called a lyric medicine. He wants people to stop at the moment of some initial insight and just stay there; don’t turn it into a narrative or a story.

I find much to recommend the idea of lyric medicine. There was a time, back in the late 1980s, when I would have aligned with the common idea (although then not so common) that people have a story and they suffer for the non-recognition of that story. That’s true, but maybe less so about personal illness experience; it may better fit collective stories, like the national identity stories that Charles Taylor was most interested in. For people whom illness makes feel radically alone, there’s not, I think, a story as much as a swirling confluence of narratives competing to direct how ill persons make sense of people and demands around them. Narratives appear and speak in fragments more than as wholes. These fragmented voices from narratives can be powerfully directive. Some are helpful, others not at all. What Davis, channeling Clive, calls the conventional normalizing narratives are often least helpful, and I think Clive is correct in suspecting that institutionalized storytelling, whether in dyads with professionals or in groups, often regresses to the conventional.

A serious problem for narrative medicine is whether it can survive not Covid, although that certainly presents challenges to clinical relationships. But more fundamentally, whether narrative medicine can survive what degree of institutional acceptance, with normalization being a price for support. Lyric medicine remains fugitive, practiced in small acts of affirmation such as repeating a phrase that the other person might want to hold onto, not to develop another narrative, but to find within the confluence of narratives something that can be called one’s own. Lyric medicine may be best practiced in significant pauses, moments of eye contact, shared silences: holding time in suspension, to allow what was said to resonate.

A Second Life in Literature

I’ve neglected this blog for a month due to other writing commitments, and one of the most rewarding of these was a review essay on Philip Davis’s Reading for Life (Oxford, 2020). I hope this will eventually appear in Literature and Medicine. Pending that publication, I’d like to offer some outtakes, especially Davis’s idea of how in reading fiction and poetry, we have the opportunity to develop what he calls a second life: in his words, “trying to make a second smaller world, a warmer human environment, in which to do better thinking” (7). But let me back up and say something about Davis and what reading means in his project.

Philip Davis is a well-known literary critic whom I first heard of when I read a piece in the New York Review of Books on his biography of George Eliot, which has the fascinating title, The Transferred Life of George Eliot. The word transferred in this title surprises me; I would have expected maybe transformed. Unexpected words figure large in both Davis’s own writing and the way of reading he recommends. The writing he most admires finds ways to wake us up by surprises that force us to take a different perspective. We’re momentarily disoriented by a word like transferred–how can a life be transferred, from what? is that a transitive verb?–and in the space of this disorientation, we have to find ourselves anew. All of that opens up a potential for what I call vulnerable reading. But I keep getting ahead of my story.

Davis is professor emeritus at the University of Liverpool, where he directs the Centre for Research into Reading, Literature and Society (CRILS), a collaboration across multiple disciplines including psychology and neuroscience. CRILS especially studies what happens in groups organized by The Reader, a charity founded in 1997 by Jane Davis. The Reader runs shared reading groups in multiple settings; Davis lists community centres, schools, hospitals, drug rehab units, dementia care homes, and prisons, among others. Until Covid-19 has endangered the project, there were over 500 of these groups meeting each week in Britain, and more in partner European countries. “Within these local communities,” Davis writes, “literature is read aloud to those [and by those] who for a variety of reasons might not otherwise read it, to give glimpses of how life is or might be, should have been or has to be, in a renewed sense of purpose or dignity or concern for themselves” (7). That, again, could describe what I mean by vulnerable reading, which is why I am excited to have found Davis’s work.

Most of the chapters in Reading for Life describe Davis and one of the readers associated with The Reader reading together different poems and novels that Davis has asked that reader to choose for their meeting. The relationships between Davis and those with whom he reads often go back several years. In these meetings, he tries “to find out what sort of reader [this person] is” (109). And that involves the converse: the reader is learning what sort of reader she is, or to press the point further, what sort of reading is necessary in the life she has led, and what sort of reading can help her to lead a life that reading helps her to imagine living. It’s crucial for Davis that we cannot yet imagine–that’s why it’s not useful to readers to digress into what he calls confessional stories; shared reading groups try to stay clear of these. The point is the yet scarcely imaginable story, and that requires avoiding retelling the too often retold life story.

Davis describes the reading that he seeks to instigate, and that people readily come to, as responding to the “need to create time-out for an inner life, a second world within this world, not in simple retreat from it but for the sake of attempting a better return to it” (13). The second life is Davis most recurring metaphor, as he circles around what it means to read for life. Davis describes one reader who suffers from chronic illness. When she is ill “everything…looks flattened–and garish at the same time”. And then: “there is poetry and a second life for life” (122). Now as I quote that, it’s an empty testimonial. The richness of Reading for Life is being privileged to participate in the shared reading that Davis and different readers do together, in responsive dialogue with each other. We see them bringing a poem or novel to life as it rekindles the life of the reader. And for me, it reanimated my reading of some long neglected poems and novels; the book taught me to read differently.

Ultimately, the second life in literature creates a new space of being: “There is now a third thing, a reader aware between the two, going to and fro in various relations between himself and the book, in that area of imaginative feeling that the book had opened up” (30). Davis makes reading a “to and fro” work of multiple voices. Imagination is what is opened up in the space those voices create for themselves.

I should note that Davis’s readers do not read literary works that speak directly to the content of what they face in their lives, whether that’s illness or a history of abuse, or personal losses. They read works we’d call canonical–John Bunyan George Herbert, Wordsworth, John Clare, George Eliot, Joseph Conrad–but their readings liberate these books from imprisonment within the canon as an academic constraint on reading. The literature has to prove itself in the life of the reader. In my favourite moment, a reader named Georgina describes taking Lord Jim with her to an appointment in the hospital. “I got it out with a sort of ‘OK, come on, show me something then'”. And the book does. Georgina, who has had a difficult life, deserves the last word: “I do not like deliberately ‘positive’ messages, the unconvincing will in them. But to me the negative is not nihilism: it means first of all not being able to make something cheer up or cure all too easily. It is a sort of respect for the real as resistant: the inconceivable, unconsolable, incomprehensible” (222). That’s vulnerable reading.