Medical Intellectuals: Resisting Medical Orientalism

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Journal of Medical Humanities [jmh] ph256-jomh-481701 March 31, 2004 13:38 Style file version Nov 28th, 2002

Journal of Medical Humanities, Vol. 25, No. 2, Summer 2004 (C© 2004)

Medical Intellectuals: Resisting Medical Orientalism

Felice Aull1,3 and Bradley Lewis2

In this paper, we propose analogies between medical discourse and Edward Said’s“Orientalism.” Medical discourse, like Orientalism, tends to favor institutional in-terests and can be similarly dehumanizing in its reductionism, textual representa-tions, and construction of its subjects. To resist Orientalism, Said recommends thatcritics—“intellectuals”—adopt the perspective of exile. We apply Said’s paradigmof intellectual-as-exile to better understand the work of key physician-authors whocross personal and professional boundaries, who engage with patients in mutuallytherapeutic relationships, and who take on the public responsibility of represen-tation and advocacy. We call these physician-authors “medical intellectuals” andencourage others to follow in their path.

KEY WORDS: power relations; medical discourse; physician narratives; physician-poets; exile;Orientalism.

Colonization was central to the achievement of modernist medicine. . .

reducing the particular to the general provided for scientific achieve-ments, but the clinical reduction created a benevolent form of colonialism.

—Arthur Frank4

Who speaks? For what and to whom?

—Edward W. Said5

1Department of Physiology & Neuroscience, New York University School of Medicine, New York.2Assistant Prof. of Science Studies and Cultural Studies of Science, Gallatin School of IndividualizedStudy, New York University, New York.

3Address correspondence to Felice Aull, Ph.D., M.A., Department of Physiology & Neuroscience,New York University School of Medicine, 550 First Avenue, New York, NY 10016; e-mail:[email protected].

4Frank, A. (1995).The wounded storyteller: body, illness, and ethics.Chicago: University of ChicagoPress, pp. 10–11.

5Said, E. W. (1989). Representing the colonized: anthropology’s interlocutors.Critical inquiry. 15 (2):195–226, p. 212.

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Edward Said’s early groundbreaking study of the system of thought he terms“Orientalism” (1978) argues that European discourse constructed a stereotypedArab identity—the Arab as Other—that was ideologically biased, “regularized,”hegemonic, and that enabled the Western imperial project.6 Said makes a com-pelling case that Orientalist textual representations led to political subordinationand oppression and that the practice was (and remains) profoundly dehumanizingfor the Arab world. In Said’s later work, he goes on to develop a general theoryof “the intellectual” who must work in the face of Orientalism and orientalism.7

Said argues that the key role for cultural and literary intellectuals must be to resistorientalizing representations by reading them against the grain. Intellectuals mustbe able to simultaneously read these representations from the perspective of theirproducers and, in addition, read them from the perspective of “the Other” being de-scribed. Said calls this reading from dual perspectives ”contrapuntal” reading (Said,1993, pp. 66, 259). To facilitate contrapuntal reading and to overcome orientalizingrestraints on thought, Said urges intellectuals to situate themselves conceptually asgeographic and cultural boundary crossers, or as exiles. (Said, 1978, p. 336; Said,1993, pp. 317, 332–335).8

To bring out the relevance of Said’s theory of intellectual-as-exile for under-standing certain physican-authors, we first highlight similarities between Said’snotions of Orientalism and the orientalizing discursive practices of contempo-rary American medicine. Second, we apply Said’s later work on the intellectualto certain key physician-writers and physician-scholars for whom, we believe,the title “medical-intellectual” is fitting. We show how the perspective of bound-ary crossing and exile are very much present in the work of these physician-authors and how they use these intellectual tools to counter the orientalizingdehumanization of medical discourse. Finally, since we believe that intellec-tual critique of this sort is invaluable for medical discourse, we encourage thefurther development of “medical intellectuals” and “medical scholars”(writers, teachers, master clinicians, interdisciplinary academics) who serve arole for medicine similar to the role Said’s “intellectuals” serve for generalculture.

6Said gives numerous definitions of Orientalism. Two are useful in the present context: (1)“ . . .Orientalism, by which Europeans imagined and represented the timeless Orient as they wishedto see it, not as it was, or as its natives believed.” See Said, E. W., (2000). Invention, mem-ory, and place.Critical inquiry. 26 (2), 175–192, p. 187; (2) “Orientalism can. . .be regardedas a manner of regularized (or Orientalized) writing, vision, and study, dominated by impera-tives, perspectives, and ideological biases ostensibly suited to the Orient.” See Said, E.W. (1978),p. 202.

7For clarity, we will refer to specific Western representations of the Orient as “Orientalism”—witha capital “O”—and similar generic representational stereotyping practices as “orientalizing” or“orientalist”—with a small “o.”

8See also Said, E. W. (1994), Chapter 3.

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Medical Intellectuals 89

ORIENTALISM

Said’s notion of Orientalism draws extensively from Michel Foucault’s ideaof a discourse.9 Foucault uses discourse to articulate the background distinctions,rules, and expectations that make textual representations possible and understand-able. For Foucault, these background assumptions are primarily determined andlegitimized by power relations. Said (1978) applies Foucault’s insights to the dis-course of Orientalism—textual representations made by Western authors aboutEastern (Oriental) peoples and cultures. For Said, these Western representations ofthe Orient were produced and took on authority through academic disciplines, so-cieties, educational and government institutions, and political practices that makeup a discursive tradition (pp. 3, 94). Said describes how the Orientalists uncov-ered, reconstructed, authorized, and promulgated knowledge of the Orient. Whenthe Orientalist unearthed and translated “the Orient,” he (and it usually was ahe) dealt only in fragments, selecting and reconstructing as he chose (p. 128).The representations that emerged functioned as part of a system that producedand distributed Oriental knowledge that was “embedded first in the languageand then in the culture, institutions, and political ambience of the representer”(p. 272).

For Said, echoing Foucault, the relationship between those Orientalists whowrote and those they wrote about is “radically a matter of power” (p. 308),and the creation of Oriental discourse and discipline required observation andsurveillance—“the Orient was watched”—in ways that both depended on andmaintained relationships of power between the Orient and the West. In other words,due to the power imbalances of representation, Orientalist discourse is largely amonolog and a mono-logic that creates negatively stereotyped assumptions aboutthe Orient. Though the Orientalist does not have total power, the power relations ofOrientalist discourse (between the producers of the discourse and the objects of thediscourse) were markedly uneven and disproportionate. The Orient was watchedand represented by theWest, and the Orient was prohibited from representing it-self to Western readers (p. 103). Said articulates this as the “problematic of theobserver” wherein “someone, an authoritative, explorative, elegant, learned voice,speaks and analyzes, amasses evidence, theorizes. . .about everything—exceptitself” (Said, 1994, p. 212).

9Though our brief comments on the lineage of Orientalism draws out some similarities betweenSaid and Foucault, a more detailed commentary would reveal Said’s complex and conflicted relationto Foucault’s work. Said uses Foucault’s scholarship, but he also critically (and controversially)interprets Foucault as overly paralyzing. For that reason, Said both relies on Foucault and distinguisheshimself from Foucault. For a more extensive overview of Said’s relation to Foucault see Kennedy, V.(2000).Edward Said: a critical introduction. Cambridge: Polity Press, pp. 24–31; and Ascroft, B. andAhluwalia, P. (1999).Edward Said. London: Routledge, pp. 67–69. For more background on MichelFoucault seeJournal of Medical Humanitiesspecial issues devoted to Foucault (Volume 24, Number3/4)

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Two serious difficulties associated with Orientalist discourse are relevant here.First, inescapably, the Orientalist’s observer position created knowledge biased to-ward the Orientalist’s needs and interests. If the observer’s position is authorativeand unquestionable by the observed, as in Orientalism, the subsequently producedknowledge and practice disproportionately benefits the needs of the observer. Notany claim about “the Orient” can be made of course, and Said is not an “anythinggoes” relativist. But he argues compellingly that the cumulative effects of select-ing and reconstructing “the Oriental” through the lens of Western perspectivesproduced a discourse of background assumptions and constraints that negativelystereotyped “the Orient” and disproportionably benefited Western needs.

The second difficulty arising from Orientalist discourse was the Orientalists’need to contain and control the actual living variety of Oriental peoples and cus-toms, resulting in representations that “restrained, compressed downwards andbackwards” to an originary, unchanging, reified essence (Said, 1978, p. 234). Thisreductive essentialism effaces individuals, and resists the pressure for narrative, fordevelopment, change, and for the assertion of individual lives and histories. It re-moves the Orient from historical processes of becoming, and it makes it impossibleto hear the particularities of individual lives and hybrid interactions between theWest and the Orient. It flattens the many differences between individuals and sub-cultures within the Orient, and it obscures the many similarities between Westernand Oriental lives. In sum, Orientalism closes down communication and makes italmost impossible for a Western listener steeped in Oriental logic to empathicallyhear and connect with members of the “Orient.”

MEDICAL DISCOURSE AS ORIENTALISM

The link between “medical discourse” and “Orientalism” starts by returningto Foucault’s work. Foucault derived his conception of discourse through his histor-ical and philosophical study of an array of human science knowledge formations,including psychiatry, medicine, linguistics, biology, economics, criminology, andthe study of sexuality. Foucault’s early work on medical discourse inThe Birth ofthe Clinic(1973) defines the beginning of modern medicine (in the late 18th cen-tury) as that point at which rational discourse about the human body emerged—thepoint at which the human body became an object of study, of surveillance, to bespoken about and integrated into a discipline of knowledge (p. 114). For Foucault,medical practices and institutions evolved to support and sustain this discourse:professional societies and teaching hospitals were established. The medical “gaze”was “no longer that of any observer, but that of a doctor supported and justified byan institution, that of a doctor endowed with. . .power” (p. 89).

Thus, Foucault himself makes the initial link between discourse, power, andmedical practice. Similar to Said’s description of Orientalism, medical discourseis the cumulative effect of selecting and reconstructing “the patient” and “disease”

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through the lens of the medical expert’s perspectives. Medical discourse produces adiscourse of background assumptions and constraints that negatively stereotype thepatient and disproportionately benefit the medical community. Like Orientalism,medical discourse is largely a monologue and a mono-logic; clinicians and biomed-ical scientists create medical discourse, “patients” do not. In medical libraries ormedical records offices one finds almost nothing written by the “subjects” of medi-cal discourse; the writing is by experts: medical clinicians, researchers, marketers,and administrators.10

Because of the severe imbalance of power relations in medical encounters andbecause patients may not represent themselves, medical research, medical com-mentary, and medical records are all forms of generic orientalist discourse. LikeOrientalism, these forms of medical discourse “respond[s] to certain cultural, pro-fessional, national, political, and economic requirements of the epoch” (Said, 1978,p. 273). And like Orientalism, medical discourse essentializes and reduces the pa-tient, making empathic communication between physicians and patients extremelydifficult. For an overt example, consider the medical chart. The patient’s chart is amedical text that reconstructs an individual’s experience of illness, transformingand reducing that experience into a medical history whose chosen elements aremostly physiologic and disease entities. It is written exclusively by medical pro-fessionals who select, edit, and fragment the patient’s narrative; these texts thenserve as the basis for communication of information, authoritative discussion, anddecisions about the patient. Elements of the chart may even eventually be incor-porated into scholarly investigations that are written up as journal articles. In theconventional patient chart the sick person’s subjective experience of illness is lost,even when the physician has elicited it.

The patient chart has a form and language developed by the medical professionand mirrors the assumptions, point of view, and interests of the medical cultureout of which it arose. The medical chart reflects, reinforces, and simultaneouslyproduces a medical culture that takes a particular stance toward physicians and theirpatients—toward those who write (physicians) and those who are written about(patients). Physician and medical humanist, William J. Donnelly, has commentedon the power relations implicit in the language of the medical chart. He argues thatthe conventional division of findings into “subjective” (what the patient reports)and “objective” (what the doctor finds; laboratory results) privileges informationobtained by the medical establishment over what the patient provides (Donnelly,1992, p. 481). Donnelly also gives examples of rhetorical devices that, in his

10While first person, written accounts of physical or mental illness—illness narratives—have become anincreasingly common sub-genre of autobiography, these accounts are rarely included in the holdingsof medical libraries or in medical records offices. For discussion of the scope and significance ofthis genre, see Hawkins, A. H. (1993, 1999).Reconstructing illness: studies in pathography.WestLafayette: Purdue University Press.; Frank, A. (1995).The wounded storyteller: body, illness, andethics.Chicago: University of Chicago Press; and Couser, G. T. (1997).Recovering bodies: illness,disability, and life writing.Madison: The University of Wisconsin Press.

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opinion, devalue or denigrate the patient’s words—the patient “denies,” “claims,”“says” while the physician “observes” or “finds” (Donnelly, 1997, p. 1045). Writingin the “agentless passive” voice rather than in the first person active voice givesphysicians an authoritative omniscience that misrepresents the actual uncertaintiesof the clinical situation—as per Said, texts may take on a greater authority thanthe reality they represent.

Just as the patient is constructed and classified in the medical chart, so toois disease itself constructed and classified within the context of medical discourseand research. Physician Robert Aronowitz (1998) argues convincingly that dis-ease definitions are influenced by the vested interests of physicians, researchers,and policy makers in the biomedical enterprise, and are not immutable biologi-cal entities, disconnected from the cultural context in which they are described(pp. 11–14). Aronowitz has traced the recognition, characterization, and namingof “minimally-value resonant” diseases such as angina pectoris to demonstratethe shifting priorities in medical practice that have evolved over time.11 Originallycharacterized (in 1768) from the patient’s perspective of the pain s/he experienced,and without reference to any anatomic or physiologic findings, the emphasis hasshifted to the physician’s perspective—the pain is only the “true” pain of anginawhen it can be technologically associated with narrowing of the coronary arter-ies. The shift in attention from the individual’s particular subjective experience togroups of people constructed, categorized, and objectified by medical discoursehas been accompanied by reductionist (essentialist) models of disease—the viewthat there is always a specific invariant cause that will explain the way a patientfeels. For Aronowitz the important consequence of reductionist thinking is that itfails to deal with individual and personal idiosyncracies or to address the patient’sstory of suffering. Instead, doctors and their patients seek to legitimize the illnessexperience by labeling it—a legitimate disease must have a name and a specificcause (p. 175).

Critique of depersonalized medical reduction has a long history in medicalhumanities.12 But, to fully understand the link between medical discourse andorientalism, it is important to note that medical essentialism also contributed toand perpetuated medical imperialism—the colonization and medicalization of thebody, territorialized by medical institutions, practitioners, and procedures—and tothe false binarism of health/sickness (normal/abnormal, known/unknown, famil-iar/Other, colonizer/colonized).

Medical philosopher and women’s studies scholar Kathryn Pauly Morgan hasworked out the process of biomedicine’s colonization through medicalization in

11While the whole point of Aronowitz’s argument is that the definition of angina pectoris has changed,for present purposes it can be thought of as a particular kind of chest pain often associated withheart disease. See Chapter 3, From the patient’s angina pectoris to the cardiologist’s coronary heartdisease, pp. 84–111 in Aronowitz, R. (1998).

12See Thomas Couser’sRecovering Bodies: Illness, Disability, and Life Writing(1997), Madison: TheUniversity of Wisconsin Press, pp. 18–35 for a review.

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great detail (Morgan, 1998). In Morgan’s “medicalization model” (see her figure 1),she develops the following moments of medicalization:

1. Conceptualizationthrough theories and paradigms2. Macro-institutionalizationthrough interacting social, economic, political

and symbolic structures3. Micro-institutionalization through direct and mediated doctor-patient

relations4. Micro-institutionalizationthrough medicalized self-monitoring, surveil-

lance, and self-management5. Ordinary lifeworldsthrough lived embodied experiences (p. 87).

At conceptualization, medical researchers and medical experts produce au-thoritative and legitimized medical knowledge systems that become availablefor distribution and consumption.Macro-institutionalization, for Morgan, is themovement of conceptualization (production and representation) into institutionalpractice: “authoritative knowledge, theoretical paradigms, and abstract researchmethodologies lead a largely ethereal existence until they are realized in andthrough actual practice performed by real human beings in specific social, po-litical, economic, and symbolic contexts (p. 89).” Macro-institutionalization ofbiomedical conceptualizations produces, and re-produces, a powerful and oftenoverwhelming interlocking system of biomedical cultural dominance.

Morgan gives the example of the medicalization of pregnancy (conception,gestation, and birth) in North American culture. A woman who seeks conceptionassistance through in vitro fertilization will be processed through a dense web ofbiomedically animated clinicians and institutions including:

geneticists, embryologists, fetologists, endocrinologists, neuroscientists, prenatal techni-cians, fetal surgeons, anesthetists, obstetricians, neonatal surgeons, neonatal pediatricians,intensive-care technicians, obstetrical nurses, laboratory technicians, hospitals, insurancecompanies, public health policies, autonomous professional organizations with professionalcodes, hospital administrators and boards, various kind of engineers engaged in developinggenetic tests and technologies, medical computers and other monitoring and surveillancedevices, the computer industry, the larger judicial system and juridical codes, the profit-oriented genetic and reproductive technology industries, the marketing industries, and thevisual and print media (p. 90).

This kind of “expert monopoly” is placed at the “top of a health care–knowledgepyramid” that has tremendous shaping power on the experience of pregnancy andchild-birth (p. 91). Any health care institution which does “not ‘fit’ into this pyra-midal structure will be ignored, ridiculed, criminalized, or suppressed through avariety of institutional mechanisms” (p. 91). As a result, women’s pregnancy ex-periences are severely constrained and any treatment concerns or conflicts theymay have are almost impossible to contest because the biomedical conceptual-ization grid through which resistance would occur is controlled by the expertmonopoly.

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Resistance is further complicated by the way these medical macro-institutionalizations do not exist in isolation—they must be understood as workingwithin even further macro-institutionalized frames. For Morgan, “those expertsand those [medical] macro-institutions that claim control over the authoritativeknowledge central to Western biomedical medicalization and whose technocraticaspirations are closely linked to ideologies of control are often powerfully posi-tioned by virtue of their critical alliances with other forms of social control in localand global economies and cultures (p. 105).” Thus, it is impossible to understandmedical macro-institutions without also taking into consideration the social, eco-nomic, political and symbolic context of Western biomedicine. Morgan points outfour important contextual frames for biomedical macro-institutions:

1. political economy: (domestic) welfare capitalism and (global) neo-colonialimperialism by industrialized countries

2. multiple dimensions of patriarchy: able-ism, normalized sexual violence,heterosexism, class-bias, racism and white privilege

3. technocracy and the ideology of control: geneticism, risk management,birth and death as forms of production

4. structural alliances: the state, legal-juridical, educational, funding agen-cies, religion, pharmaceutical industries, health care businesses

In a spiral of co-evolving support, these contextual frames simultaneously legit-imize the macro-institutions of biomedicine, and, in turn, the seemingly beneficentgoals and practices of biomedicine serve these contextual frames as a key site ofjustification and legitimization. The network of interlocking support between med-ical macro-institutions and these larger frames contributes to the default “commonsense” of the biomedical grid and further blocks and maddens those who may tryto resist.

Going from macro-institutional to micro-institutionalization, Morgan arguesthat the consumption of medical conceptualizations is also mediated at a smallerscale. In micro-institutionalization“through doctor-patient relations,” macro-institutionalized conceptualizations are further mediated through the interrela-tions of the clinical encounter. Because of the cultural status and cultural capitalof physicians and the physical and emotional vulnerability of patients (who oftencome to the clinician in “pain, uncertainty, dread, terror, and suffering from the lossof integrity (p. 92)”) the clinical encounter is a highly charged transfer(ence) sitewhere the micro-institutionalization of medicalization can take place with minimalimpediment. As Morgan explains, “the institutionalized power of the physician todiagnose, to discipline, to carry out surveillance, to expect confession and com-pliance to ‘doctor’s orders’ are particularly central to the exercise of authorita-tive knowledge built into the hierarchical medicalized doctor-patient relationships(p. 92).” Resistance under these circumstances is a direct challenge to the physi-cian’s epistemic authority and institutionalized power. Physicians are often quick

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to counter such resistance with a literally dismissive charge of non-compliance,leaving vulnerable patients at an untenable risk of abandonment.

In micro-institutionalization“through medicalized self-monitoring, surveil-lance, and self-management,” medicalized conceptualizations which have beenmacro-instituionalized and clinically micro-institutionalized are further, and per-haps most profoundly, micro-institutionalized through individual internalization.For Morgan, medicalized conceptualizations are “produced and reproduced whenindividual members of the culture internalize, use, actively support, and demandthe use of medicalizing concepts, discourse, and practices and when they not onlycomply with but seek out active involvement in medical technologies claimingmedical discourse and vocabularies as their own (p. 96).” In Morgan’s discussionof ordinary lifeworlds, she highlights the variability of micro-institutionalizationthrough self-management. Not everyone internalizes medical conceuptializationsthe same way and Morgan makes this point visually in her figure by showing smallsketches of human forms representing “medicalized subjects” who are variouslyintertwined by the coiling figure of the medical snake and who have variouslyinternalized medical conceptualizations.

Morgan’s model clarifies the process through which biomedical reductionismand reification create and perpetuate a form of medical colonialism: a medicalizedand naturalized power structure in which professional experts interpret (represent,in Said’s terminology) the complex plenitude of patient experience into a phys-iological stereotype. This professionalized structure has only minimal room forambiguities resulting from cultural, social, or historical conditions that help to de-termine human experience. The resulting bio-molecular model of disease becomesa reified essence that configures and fixes the “patient” in the same way that Orien-talism configures the “Orient” and “Orientals.” In both instances the messy realitiesof subjectivity and contingency are ignored and repressed in order to gain control.

We should point out that the power imbalances and negative assumptions as-sociated with Orientalism and medical discourse do not mean, however, that thesesystems of thought are “all bad.” Certainly Said would not reject all “Westerninfluence,” and neither we nor Morgan would deny the many biomedical advancesthat have come from medical discourse. Accordingly, the intellectual task in re-sponse to these orientalizing discourses cannot be wholesale rejection. Rather, itmust be a sustained, but nuanced, effort to put these discourses in perspective andto reverse the power imbalances embedded and encoded in their production andcirculation.

INTELLECTUAL RESPONSES TO GENERICORIENTALIST DISCOURSE

We begin this section with an important distinction between “the social” and“the individual”: orientalism is a primarily a “social” phenomenon, but a specific

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intellectual’s resistance to orientalism is largely an “individual” phenomenon.13

Thus far in our discussion of orientalism and the orientalist dimensions of medicaldiscourse, we have emphasized the social level phenomena of constructing “theOther” through representation and representational practices. We have focusedspecifically on problematic aspects of how the “Others” of medicine (the patients)have been negatively categorized and fixed, and we have discussed the imbalanceof power relations in medical discourse that lead to these problematic represen-tations. The process molds and contains individuals, but the process as a wholeis social phenomena bigger than any individual. Thus, with this section, we turnour attention from the social phenomena to the possibility of intellectual resis-tance from individual physicians who must work with (and against) these sociallyconstructed biomedical representations.

Individual physicians do not create medical discourse or medical practiceby themselves, and individual physicians may be usefully distinguished from the“medical community.” Medical discourse and medical practice rules, norms, stan-dards, protocols, and expectations are the outcome of social level patterns of inter-action located at the level of the medical community, not at the level of individualphysicians. Individual physicians practice in conditions that are not of their ownmaking. They may attempt to shape the medical community, but they have nodirect control over the outcome of their efforts, and while these efforts are some-times effective, often they pass away without meaningful consequence. As a result,individual physicians cannot (in and of themselves) determine medical communi-ties because variables that effect community patterns of action and interaction arebigger than any one individual member of that community.

Looked at from the other direction, we may say that the reverse is also true—orientialist medical discourse and medical practice patterns do not determine indi-vidual physicians. Although medical communities do extensively shape individualphysicians, individual physicians are not as automatically and homogenously re-flective of medical discourse. Once again, the variables are different. Individualphysician responses to medical communities will vary depending on their individ-ual psychic dreams, desires, identifications, fears, and fantasies. And individualphysician responses will vary depending on the various other discursive commu-nities in which they are simultaneously located and positioned. These individualvariables often create complicated, contradictory, and highly ambivalent relationsto the medical community.

In the remainder of this paper, we exploit this distinction between “the social”and “the individual” to consider the tactical possibilities for individual physiciansin resisting medical colonization within themselves and within their practice. Onceagain we turn to Said’s work for guidance. Just as we found useful connections

13This does not mean, of course, that individual resistance has to be isolated. When individuals cometogether to form consciousness raising groups, write journal articles, develop networks, or startalternative paradigms (journals, programs), they greatly increase the effect of their resistance.

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between Said’s early work on Orientalism and medical discursive practices, we alsofind useful connections between Said’s later writings on “intellectual” resistanceand the work emerging from recent physician-authors.14

In Said’s most sustained study of the intellectual (1994), he develops severalrecommendations for intellectual resistance. These recommendations are also rel-evant to certain recent physican-writers engaged in the process of countering thenegative aspects of medical discourse. We see these physician-writers as a formof “medical-intellectual,” and in reviewing their work we find that these physican-writers already make very similar moves to the ones Said recommends for intel-lectuals. By articulating those moves and making the connection between Said’sintellectual and recent physician-writers, we hope to encourage more “medical-intellectual” and “medical-scholar” activities. Said defines the “intellectual” in thisway:

The intellectual is an individual with a specific public role in society that cannot be reducedsimply to being a faceless professional, a competent member of a class just going abouther/his business. The central fact for me is, I think, the intellectual is an individual endowedwith the capacity for representing, embodying, articulating a message, a view, an attitude,philosophy or opinion to, as well as for, a public. And this role has an edge to it, andcannot be played without a sense of being someone whose place it is to raise embarrassingquestions, to confront orthodoxy and dogma (rather than produce them), to be someonewho cannot easily be co-opted by governments or corporations, and whoseraison d’etreisto represent all those people and issues that are routinely forgotten or swept under the rug.(1994, p. 11)

For Said, intellectuals transcend local career concerns and speak out against socialproblems and social injustice. Intellectuals give voice to the perspective of thevoiceless. They often work in a “spirit of opposition, rather than accommodation,”and they usually persevere in “dissent against the status quo at a time when thestruggle on behalf of the underrepresented and disadvantaged groups seems sounfairly weighted against them” (1994, p. xvii).

Intellectuals are skilled at the art of representation and persuasion. Whetherit be “talking, writing, teaching, or appearing on television,” intellectuals breakout of their specific backgrounds into the arena of “the public” (1994, p. 13).Intellectuals often work at considerable personal risk and with tremendous personalcommitment to their concerns. Their influence comes not only from the content ofthe messages they bring, but also from the person of the messenger. Intellectuals,for Said, must be people of tremendous integrity and whose personal history,

14Several additional authors have also recently written on “intellectuals,” but our focus here will beon Said’s efforts. For an extensive review of other recent work on “intellectuals” see John Michael’sAnxious Intellects: Academic Professionals, Public Intellectuals, and Enlightenment Values.Durham:Duke University Press (2000). Although we see value in these additional writings on intellectuals,we also agree with Said that “in the outpouring of studies about intellectuals there has been far toomuch defining of the intellectual, and not enough stock taken of the image, the signature, the actualintervention and performance, all of which taken together constitute the very life-blood of every realintellectual” (Said, 1994, p. 13). Our discussion of physician-writers at the end of this paper is a formof stock taking that Said recommends.

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values, and writings evolve directly from their experiences with those who havebeen marginalized and devalued.

Accordingly, the responsibilities of the intellectual are to confront dogma,take risks, provide alternate interpretations, represent the weak and oppressed,and “advance human freedom and knowledge” (1994, p. 17). Said sums up theseresponsibilities with the phrase “speaking truth to power.” Intellectuals take astand against the power effects of orientalist discourse. They “write back” to thecolonist and imperialist consequences of elite discourses that exclude, stereotype,discipline, and control the large numbers of people affected by those discourses.The intellectual brings these principles to bear on actual situations, even if thatinvolves ostracism from communities in which they work. Intellectuals engage in“dispute with all the guardians of sacred vision or text, whose depredations arelegion and whose heavy hand brooks no disagreement and certainly no diversity”(1994, p. 89). But, they do not do so recklessly. Intellectuals choose their battles.As Said puts it, “speaking truth to power is no Pangolossian idealism: it is carefullyweighing the alternatives, picking the right one, and then intelligently representingit where it can do the most good and cause the right change” (1994, p. 102).

For Said, intellectuals should avoid inclusion into orientalist hegemonies byconsidering themselves metaphoric (and sometimes literal) boundary crossers—asexilesfrom their homeland. Like geographic exiles, intellectual exiles are outsiders.They remain at odds with their society, “never being fully adjusted” to it and “al-ways feeling outside the chatty, familiar world inhabited by natives” (1994, p. 52).Insiders who stay within the boundaries, or what Said calls “yea-sayers,” flourishin the prevailing social order without feeling extensive dissonance or dissent. Intel-lectuals by contrast are “nay-sayers.” They do not make the insider’s adjustment.Intellectuals cross the insider’s boundary and remain “outside the mainstream, un-accomodated, unco-opted, resistant” (1994, p. 52). This metaphorical exile givesintellectuals a marginal position that allows them to move away from the central-izing authorities and to perceive things that are lost on minds that remain conven-tional and comfortable. For Said, exiled marginality keeps intellectuals responsiveto those disadvantaged by orientalist hegemonies, and it frees intellectuals “fromhaving to always proceed with caution, afraid to overturn the apple cart, anxiousabout upsetting fellow members of the same corporation” (1994, p. 63).

PHYSICAN-WRITERS AS MEDICAL INTELLECTUALS

All of the physicians whose work we discuss in the remainder of this paperexemplify Said’s characteristics of the intellectual. They all write to a larger publicand all are engaged in an effort to “speak truth to power.” They all work to countermedical orientalism and to humanize medicine. They are all in exile from themedical mainstream in that they have crossed personal boundaries and have crossedthe boundary between professional and personal involvement in interacting with

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the sick. Indeed, from our perspective, the physicians under discussion may beusefully placed in three categories of intellectual displacement or exile. First, theyare physician-authors or physician-poets, a migratory combination in and of itself.Second, some (Richard Selzer, Sherwin Nuland, Kay Jamison, and Oliver Sacks)altered their perspective after undergoing a role reversal—they experienced seriousillness or injury and became patients, or had a close relative who became a patient.Third, some are geographic and/or cultural exiles who have made conscious useof this condition in their medical work (Kate Scannell, Abraham Verghese, andRafael Campo).

Physician-Poets

Several physician-poets have commented on the intertwining of writing anddoctoring, and the corresponding intertwining of themselves with their patients.For William Carlos Williams (1967), medical practice and writing poetry are bothconcerned with “our inability to communicate to another how we are locked withinourselves” (p. 361). His preoccupation was to listen to his patients for the wordsthat would render them both articulate. The professions of writing and doctoringfed and complemented each other. He was interested in the individual in all hisparticularity: “the patient himself would shape up into something that called forattention, his peculiarities, her reticences or candors” (p. 357).

Jack Coulehan is a contemporary physician-poet who became convinced thatgood medical practice requires the physician to fully experience the emotionsengendered during contact with patients: “emotions. . .are the energy and life ofmy practice” (1995, p. 224). He rejects the more traditional dictum that physiciansshould cultivate a detached concern (an intellectual should confront dogma).15

For Coulehan, an effective physician must imaginatively experience a patient’sfeelings, and not try to intellectualize his own reactions. This skill—empathy—“is crucial to both diagnosis and treatment” (Coulehan, 1992, p. 516). In his view,seeing, entering into the subject—not simply observing—is common to both poetryand medicine.

Coulehan assumes his patient’s persona in several poems. In “I’m Gonna SlapThose Doctors” he speaks in the voice of an angry patient (Belli & Coulehan, 1998,p. 21). This man who hasn’t “had a drink in a year” is furious at the condescendingdoctors who go “with their noses crunched up like my room/is purgatory and they’rethe/goddamn angels doing a bit/of social work.” The man imagines how he willget his revenge on them, assuming the role of “Doctor Big Nose,” smellingtheirbreaths, wrinklinghisforehead.16 The patient in “Good News” is bewildered by the

15See Lief, H. I. and Fox, R. C. (1963). Training for detached concern in medical students. In: H. I.Lief, V. Lief, and N. Lief (Eds.),The psychological basis of medical practice(pp. 12–36). New York:Harper & Row.

16The patient was a real person being cared for by Coulehan. The man’s imaginings are Coulehan’s.After it was written, Coulehan presented the poem to the patient (personal communication).

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succession of tests, procedures, and bad news to which he is subjected “when all Icame to the doctor for/was a leg that burnt like scalding water.” Medical authorityinsists that the circumstances are dire “though I’m still not sick” and the patientfeels himself being colonized, taken over by the medical narrative, wondering “ifI [can] ever get out of here” (Coulehan, 2001, p. 17). With these poems, Coulehan,like Said, represents those who are prohibited from representing themselves. Hewould agree with Said that detached observation does damage, because such anattitude prevents true understanding—in medicine, this means the understandingnecessary to diagnose and treat comprehensively in order to effect healing.

For Rafael Campo, a physician-poet whose work is discussed more exten-sively later in this paper, poetry provides a tangible, if unconventional vehiclefor connection with patients. Campo reads poetry—his own, and others’—to/withpatients, for mutual benefit: “I’d read to him at night. . .Some lines by RichardHoward gave us hope.” (Campo, 1994, p. 115). Poetry for Campo is an expressionof the body—”it is felt in the heart, in the genitals, in the mouth and tongue”—andit ”provid[es] the kind of empowerment that comes from fully occupying one’sbody” (1997, pp. 195, 194). This empowerment nourishes not only Campo butalso the patients with whom he shares his poetry and personal history: “I wasamazed when she [a patient with metastatic breast cancer] brought me poems ofher own one day. . .poems that got her through the chemotherapy. . . [her] innerresources. . . turned out to be prodigious, enough to sustain us both” (1997, p. 253).When Campo acknowledges shared need to his patients and to us, his “public,”engaging with all through poetry and shared narrative, he diminishes the powerimbalance of the patient-doctor relationship and flies in the face of traditional med-ical practice (the intellectual’s role has an edge to it, the intellectual articulates anattitude to and for a public).

Physician-Patients

Becoming seriously ill or disabled is a traumatic, disorienting experience formost people who undergo it, but its effects are difficult to imagine for those whohave been spared this ordeal. When Richard Selzer (1994) contracted Legionaires’disease, he was shocked to find that he was completely unprepared for the experi-ence. Finally well enough to converse with his doctor, he is unable to respond tothe simple statement, “I’m going to try to answer your questions.” Selzer “tries tothink what is expected of him and cannot. How can it be that a lifetime of treatingthe sick has not prepared him at all for the role of the patient?” (p. 84). In a comafor three weeks, he remembers nothing of that period. During his conscious time inthe hospital he is, however, aware of the pomposities of the medical establishment.In an attempt to reconstruct the lost weeks and to “shatter the sophistication of thehospital, the complacency of the doctors,” he writes the story of his own death andresurrection (p. 112). He becomes an advocate on his own behalf, taking charge

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once again. One presumes that, were he still a practicing physician, he wouldadvocate with new insight for his patients.

Other medical professionals who have been personally close to illnesshavebecome advocates. Sherwin Nuland (1994) became interested in medical attitudestoward death and the need to exert control over it after his brother underwent debil-itating and futile experimental chemotherapy for cancer—treatment which Nulandhimself had urged. His purpose in writingHow We Diewas to “demythologizethe process of dying” and to advocate that physicians relinquish control over it,restoring it “to the dying and to those who love them” (pp. xvii, 265). Kay Jamison(1995), professor of psychiatry at Johns Hopkins University School of Medicine,and a recognized expert on manic-depressive illness, decided to publicly revealher own history of manic-depression in order to raise awareness of its devastat-ing effects when untreated, de-stigmatize the disease, and encourage the sick toseek treatment. She gave up her private practice of psychotherapy—the therapeuticrelationship with her patients was not sustainable after this disclosure—in orderto carry out her mission. Jamison acknowledges that her revelations may have anegative impact on her personal and professional life (the intellectual must takerisks), but she believes that her unique perspective provides her with “the humanexperiences necessary to try and make a difference in public awareness and clinicalpractice” (1995, p. 7).

Neurologist Oliver Sacks experienced an existential crisis after surgery fora leg injury, an experience that altered the subsequent direction of his clinicalstudies and changed the way he perceived his patients. In typical elegant prose hedescribes, inA Leg to Stand On(1984), how he lost the sense of his own leg: “Icould no longer feel it as mine, as part of me. It seemed to bear no relation whateverto me. It was absolutelynot-me” (p. 51). More than a simple loss of sensation,there seemed to be a change or loss of internal representation of the leg, “so that Ihad lost much of my feelingfor the leg” (p. 54). None of the hospital staff had everknown a patient with similar symptoms, and his own doctor refused to acknowl-edge that there was any problem.17 In his fear and anxiety Sacks recalls that as amedical student he himself saw such a case, but that he had repressed the memoryof it for years, because it had been so disturbing, without explanation (Aronowitz:if medical discourse has not constructed a recognizable disease entity that ex-plains a patient’s symptoms, the patient’s subjective or idiosyncratic experience isdiscounted).

During this period of intense disorientation Sacks is acutely aware of patient-hood. The admissions process makes him feel like a non-person, an “inmate.” Hechafes at being limited to telling the relevant facts of the case: “I wanted to tellthem [the doctors] everything—the entire story” (p. 28). (Said: the pressure fornarrative.) He is caught between being a physician and being a patient, aware of

17It was later determined that there had been nerve damage (p. 83); Sacks eventually found numerousdescriptions of states of alienation like those that he underwent (Chapter 7).

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the medical hierarchies, expected to play the role “of the Know-nothing Patient”against the doctor as “All-knowing specialist” (p. 81). After he is well enough toenter a convalescent home he perceives that the patients are seen as a race apart bythe non-patients, and that admission to a hospital really meant “the removal of in-dividuality, the reduction to a generic status and identity” (essentialism, the Other)(p. 134). But even more, he understands that he himself had viewed patients in thesame way. He vows to utilize this new understanding by changing his approach topatients: “I could now open myself fully to the experiences of my patients, enterimaginatively into their experiences and be accessible and ‘hospitable’ in theseregions of dread” (p. 168). (Recall Coulehan’s conclusion that a good physicianmust imaginatively experience what the patient experiences.)

Physician-Exiles

Physician Kate Scannell relates, in her memoir,Death of the Good Doctor(1999), how she emerged from a state of exile from her profession—exile as afemale physician, as a lesbian, and as one for whom the “medical model” underwhich she trained was profoundly flawed. She describes the lonely alienation ofbeing, in 1976, a woman medical student who had never encountered a womanphysician role model. In addition, much of society attached stigma to lesbianism,and the medical profession of which she was a part considered homosexuality tobe pathological. Some of Scannell’s patients made homophobic comments to her.To prevent overt marginalization she felt obliged to keep her sexual identity secretfrom friends and colleagues, “annihilating” herself. The AIDS crisis of the 1980s,which forced her to confront suffering and death on a daily basis, eventuallyallowed her to emerge from “exile” through the relationships she formed withdying patients. In forming these relationships, she rejected the institutional modelthat surrounded her: “the trend toward increasing technological interventions; theoverriding philosophy that competent physicians save lives, not ‘lose’ them; theblatant chastisement and devaluation of physicians who use their empathy andintuitive insights when interacting with patients” (p. 13). (The intellectual confrontsorthodoxy.)

The episodes so movingly related in her memoir demonstrate the witnessingin which she was engaged with her patients, and its unusual and powerful conse-quences for all concerned. There is the belligerent Jay, whom Scannell activelydislikes. At her wits’ end, she asks him, “isn’t there anyone or anything you haveevercared for besides yourself?” (p. 33). To her surprise, Jay admits, tearfully,that he likes to watch pet fish. Defying hospital regulations—no pets—Scannellbrings him a bowl of fish, and together they sit and watch. The doctor finds herselfmesmerized, floating and drifting along with the fish. As time goes by and Jaybecomes increasingly weak and unresponsive, Scannell simply sits in his room,peacefully watching the fish and Jay. Catching her at this, Jay asks, “You get it

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now, don’t you?” Scannell realizes that “he was aware of sharing something withme. That he was even advising me about my experience” (p. 43). As Jay “unchar-acteristically” and smilingly wishes her a “great weekend,” Scannell is aware thatboth of them have been changed and that together they were being “carr[ied] tonew territory.” In this and other accounts, Scannell and her patients become almostinterchangeable, collaborating in a narrative that has a new trajectory for each ofthem. Scannell’s refusal to cooperate with institutional practices and her abilityto cross boundaries allows patient and physician to change, develop, and to asserttheir individual narratives.

Abraham Verghese personifies the geographic and metaphorical condition ofexile discussed by Said. Born in Ethiopia to Christian Indian parents, Verghese’smedical education in Ethiopia was interrupted by war and political unrest. Heentered the United States to work as a medical orderly, eventually emigratingto India to complete medical school. In 1980, duly certified, he returned to theUnited States to undertake medical residency training in the small mountain townof Johnson City, Tennessee. Following advanced training in infectious diseases inBoston, he went back to Johnson City in 1985—early in the AIDS epidemic—asa staff physician for the Veteran Administration hospital and adjoining JohnsonCity Medical Center. His award-winning book,My Own Country(1994), is thestory of his Johnson City work with AIDS patients–most of whom were gay–andit is the story of his personal negotiation with the cultures he encountered.18 Evenas Verghese found his “own country” in the lives of his patients and their families,he reflected on and used his exile status to inform his work. At the same time, hisexile status was reinforced: the nature of his practice—AIDS patients, especiallygay AIDS patients—alienated him from some colleagues and townspeople (he wasthe only AIDS doctor in Johnson City), and strained his marriage (an intellectualrepresents the marginalized, takes risks, and “always stands between lonelinessand alignment” [Said, 1994, p. 22]).

By choosing to locate in Johnson City, Verghese had made a conscious deci-sion to practice and live in a place that didnothave a large Indian community (Said:“Being skilled at survival becomes the main imperative, with the danger of gettingtoo comfortable and secure constituting the threat that is constantly to be guardedagainst” [1994, p. 49]). Thus, although his reading of the people he was treatingis interwoven with and dependent on a conscious awareness of his own status asa dark-skinned outsider, it is not from the point of view of victim. Rather, it is, inSaid’s words, from “a double perspective that never sees things in isolation” (1994,p. 60). This allows Verghese to speculate that some of the gay men who find theirway to his office for advice must find it easier to discuss their sexual orientation(for which they would have been ostracized by their community) with him thanwith the typical white authority figure doctor; the preacher with gonorrhea who

18Verghese discusses his background inMy Own Countryon pp. 16–21.My Own Countrywas nomi-nated for the National Book Critics Circle Award, and won a Lambda Literary Award.

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was so comfortable in his office might even think that Verghese “had noright topass judgment on him” (Verghese, 1994, p. 97).

Natural curiosity together with the parallel he drew between his alien im-migrant status and the alienated status of the gay community propel Verghese toopen himself up to gay culture, and to immerse himself in the lives of his patients,their partners, and their families. He crosses the boundaries between personal andprofessional spheres, visiting many in their homes, not to make house calls, but togain understanding of their lives, of their individuality. While he is attentive to hispatients’ medical histories, Verghese is interested in their narratives as well. “I hadread through the chart and had understood the medical elements of the case. Butthestoryof this couple was not in there” (p. 106). This involvement yields insightsthat Verghese shares with his readers (the intellectual unmasks, provides alternaterepresentations). Describing the man whose “natural state was to be happy andto laugh,”—which he felt free to do with his gay friends, but could not do withhis own family—the author is “haunted” by the realization of “how few of theirfamilies were able to see their sons’ best, most engaging selves” (p. 78).

Openness extends also to frank introspection about his own motivations. Ad-mitting that he had held typical condescending attitudes toward gay men when hewas younger, and that he had been uncomfortable with these men in the clinicalsituation, Verghese recalls that he had even wondered whether he had subcon-sciously been afraid of being seduced (the Other as sexual threat). He explores hisown attitudes toward sexuality to try to understand gay promiscuity “in its hey-day.” Perhaps, he speculates, any man “whether gay or straight, given his druthers”would find anonymous sex thrilling (p. 192). Perhaps all men would be promiscu-ous if they had willing partners. Verghese is not afraid to interweave the privatewith the public in order to demystify the Other. (Said, discussing the intellectual:“There is always the personal inflection and the private sensibility, and those givemeaning to what is being said or written” [1994, p. 12]).

The interplay of medical curiosity and personal interest lead him to identifya recurrent theme common to the expanding population of gay AIDS patients inhis practice: these men had left their rural home towns years earlier because theycould not openly live there as homosexuals, and had moved to more tolerant urbanareas that also conferred anonymity; in the cities, they contracted AIDS and werenow returning home to die. Much of the book is the story of these individuals,of their return, the difficult reunions with their families, the ultimate sadness forall concerned, including Verghese. In telling their individual stories, he providesa narrative for the marginalized. For him, professional and personal interest inpatients always coexist and reinforce each other, informed by his exile status, hisopenness to the foreign.

Immersion in his patients’ lives took its toll on Verghese. “I seemed to beliving in a separate world which those who had not been touched by the disease[AIDS] could not enter” (p. 137). On the one hand the people that he met had

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enriched and changed the direction of his life; on the other, he could not maintainthe “professional detachment” that he had been trained to assume. “[E]verything Iwitnessed was imbued with this sense of loss” (p. 185). Further, he felt quite alien-ated from the surrounding medical community which looked with condescensionon his practice, consisting as it did largely of homosexuals. With mixed feelings ofrelief and guilt Verghese left Johnson City after five years, wondering whether hiscontinual migrations “[were] a way to avoid loss” (p. 346). He continued, however,to work with AIDS patients. He continued also to cross traditional professionalboundaries.

The Tennis Partner(1998), a sequel toMy Own Country, tells the parallelstories of Verghese’s disintegrating marriage as he establishes new roots in El Paso,Texas and of his friendship with a (male) medical student who shares his passionfor tennis. Both men are struggling to re-establish order in their personal lives:Verghese, in easing himself out of a dying marriage while trying to maintain a closerelationship with his two sons; David (the tennis partner), in remaining drug-freeand successfully completing medical training, which had been interrupted by hisaddiction. Besides crossing the conventional-student teacher boundary (Vergheseis David’s immediate supervisor and instructor), the author is unusually open indescribing his own vulnerability and idiosyncracies, thereby deflating the doctormystique. Much to Verghese’s horror and grief, David eventually reverts to druguse, and commits suicide. Verghese believes this tragedy was the outcome ofDavid’s self-imposed emotional isolation, an isolation that he considers to becommon among physicians. In interweaving his own life with David’s and that ofhis patients, in identifying and disclosing his own emotions, it is as if Verghesewere determined to break out of the professional tradition that he criticizes: “Theprofession is full of ’dry drunks,’ physicians who use titles, power, prestige, andmoney just as David used drugs; physicians who are more comfortable with theirwork identity than with real intimacy” (1998, p. 341).

He carries this theme further in a consideration of doctoring and desire(Verghese, 1999). Once more invoking personal experience and crossing tradi-tional boundaries, Verghese discloses the physical and emotional attraction that hefelt toward a young woman patient who suffered from AIDS. There are indicationsthat she is attracted to him as well, but he behaves “politely and professionally.”Believing that he could have provided her with better care, made her feel better,had he acknowledged his attachment to her, he chastises himself after she dies fornot having done so. Citing similar experiences of colleagues, Verghese argues thatlove, desire, and personal involvement cannot and should not be separated fromthe practice of medicine.

The most audacious exploration of desire and doctoring is made by physician-poet, Rafael Campo, a young gay Latino who grew up in white American suburbia.An outsider by skin color, ethnicity, sexual orientation, and even by his proclivityfor writing poetry, Campo documents his painful struggle to feel comfortable with

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himself and with the profession of medicine. Subtitled, “A Doctor’s Education inEmpathy, Identity, and Desire,”The Poetry of Healing(1997) details the journeytaken toward Campo’s realization that love and desire are “one of the most powerfulelements of the therapeutic relationship” (p. 12). These elements, however, weredisallowed by traditional medicine, and therefore it was medicine that providedCampo with a protective shield with which he could distance himself from thedying, gay patients that surrounded him. It was also the medical profession thatprovided camouflage (and self-deception) for his exile status—“as a. . .physician, Icould not, by definition, be gay and only marginally and hardly noticeably Latino”(p. 154). With a self-loathing so strong that he frequently considered suicide,Campo hid his homosexuality, viewed his AIDS patients with condescension,resented his professional obligations, and repressed his inclination to write poetry.

It was a dying, gay writer who helped Campo not only to accept, but to revelin his sexuality, his contact with patients, and his need to write. For Campo, theseare interdependent. Furthermore, the body, desire, and language are the currencywith which physicians and their patients (should) interact in a relationship thatis (can be) healing for both. The body—both “terrible” and “fabulous”—is theliteral and metaphoric space for this transaction (1996, p. 122). In trying to cometo terms with the devastation of the AIDS epidemic, Campo considers the physicalexamination of his AIDS patients: “I listen to the abdomen, digesting everything,the internal, constant interface with the outside world. I try desperately not todesire them, because it is unprofessional, and because it is too human and scaryand powerful. I imagine having their bodies, though, possessing them as I do myown, occupying that same space” (1997, pp. 162–163). Similarly, in poetic form,“I keep imagining/The AIDS ward where I saw a man my age/Die yesterday. . . Iwanted him to kiss/My face. I wanted him to live with me //Wanting him/To live,I stood erect beside the bed,/Wanting him.”(1996, p. 57).

At times taking considerable risks in writing highly personal poetry that isoften explicitly sexual, he also represents the marginalized patients that comprisethe population with whom he has chosen to work. He is the doctor tending tothe dying drag queen, whose dignity he preserves with rich description and directquotation: “The stench of her infected Kaposi’s/Made bearable by the Opiumapplied/So daintily behind her ears: ‘I know/It costs a lot, but dear, I’m nearlygone.’” The doctor’s final acts of respect also highlight the patient’s own efforts tomaintain dignity as “I turned the morphine up. She hid her leg/Beneath smoothedsheets. I straightened her red wig/Before pronouncing her to no applause” (1996,p. 22). Or he is the doctor comingled with his patients, “I’m drowning in hisblood, his purple blood. . . I call/To him one night, at home, asleep. His breath/Idreamed, had filled my lungs—his lips, my lips/Had touched. (1994, p. 115). By“owning desire,” Campo found his own voice and that of his patients. In writingso openly and articulately of the intertwining of desire and doctoring, he shatterstradition, erases boundaries, and exemplifies the intellectual as Said conceives of

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him: “someone who visibly represents a standpoint of some kind, and someonewho makes articulate representation to his or her public despite all sorts of barriers”(Said, 1994, p. 12).

MEDICAL INTELLECTUALS AND MEDICAL SCHOLARS

The position we have taken in this paper is that there are analogies betweenEdward Said’s conception of the discourse of Orientalism and the discourse ofmedicine. In its reductionism, construction of disease, and textual representationof the sick, medical discourse, like Orientalism, dehumanizes and stereotypes. Saidproposes the metaphor of exile for the intellectual or cultural critic, who, as anoutsider can best resist Orientalism. We argue that this paradigm applies to medicalwriters, in the work of physician-poets, physician-patients, and physician-exiles—writers who cross personal and professional boundaries to engage with patientsin a mutually therapeutic relationship. When Verghese writes, “I have come tobelieve that. . .moments of true safety are rare” (1994, p. 345) and when Campocomments that “being gay was joyfully not to have a country of origin at all,”(1997, p. 110) they sound remarkably like Said’s intellectual exiles. As writers,they take on the public responsibility of representation and advocacy that Saidrequires of intellectuals. They take risks and they speak truth to power on behalfof humanizing medial discourse and practice.

We believe that medicine and medical education should encourage more worklike the kind found in the physican-writers discussed. Medicine needs intellectualdissent to counter the dehumanizing aspects of its dominant discourses. From ourperspective, encouraging more “exiles” from mainstream medical science by fos-tering programs, conferences, journals, etc. in creative and critical writing, medicalhumanities, and medical arts is a good thing. All these efforts work toward cre-ating medical intellectuals and medical scholars who will be outside the medicalmainstream. These “outside” positions allow medical intellectuals and scholars tosee aspects of medicine not available to those trained only on the inside. Thoughmedical intellectuals are hardly the only catalyst to change in medicine, we be-lieve that these medical intellectuals do provide an important contribution towardcorrecting the worst aspects of medical orientalism.

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Campo, R. (1996).What the body told. Durham, NC: Duke University Press.Campo, R. (1997).The poetry of healing: A doctor’s education in empathy, identity, and desire. New

York: W. W. Norton.Coulehan, J. (1992). On medicine and poetry. In S. B. Walker & R. D. Roffman (Eds.),Life on the line:

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Smith, Trans.). New York: Vintage Books.Jamison, K. R. (1995).An unquiet mind. New York: Alfred A. Knopf.Morgan, K. P. (1998). Contested bodies, contested knowledges: Women, health, and the politics of med-

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Nuland, S. B. (1994).How we die: Reflections on life’s final chapter. New York: Alfred A. Knopf.Sacks, O. (1984).A leg to stand on. New York: Simon & Schuster/Touchstone.Said, E. W. (1978).Orientalism. New York: Vintage Books.Said, E. W. (1993).Culture and imperialism. New York: Vintage Books.Said, E. W. (1994).Representations of the intellectual.New York: Pantheon Books.Scannell, K. (1999).Death of the good doctor: Lessons from the heart of the AIDS epidemic.San

Francisco: Cleis.Selzer, R. (1994).Raising the dead. New York: Viking Penguin.Verghese, A. (1994.).My own country. New York: Simon & Schuster.Verghese, A. (1998).The tennis partner. New York: HarperCollins.Verghese, A. (1999, April). Death & desire.Mirabella, pp. 117–119.Williams, W. C. (1967). The practice. InThe autobiography of William Carlos Williams(pp. 356–362).

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Documents

Medical Intellectuals: Resisting Medical Orientalism