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Through Hamlet to Narrative Medicine and Neuroscience: Literature as a Basic Science of Psychiatry

Through Hamlet to Narrative Medicine and Neuroscience: Literature as a Basic Science of Psychiatry

Psychiatric Times
June 2005
Issue 7

Ever since Sigmund Freud persuasively answered the paramount puzzle of 19th-century Shakespearean criticism--Why does Hamlet delay his revenge?--(in short, Hamlet cannot kill his stepfather because his crime comes too close to Hamlet's repressed wish), psychiatrists have often turned to literature for theory building, clinical understanding and teaching.

Curiously, despite other advances, psychoanalysts and psychiatrists have mostly followed Freud's example of focusing on the psychology of individual characters in literature (e.g., what they are like, what makes them what they are, what intentions--often apparently not conscious--seem to motivate their actions and attitudes). Artists/writers are approached as psychologists who teach us something about human nature, as troubled creative human beings who are attempting to work out their conflicts in the writing of their stories, and as artistic seers who offer us a new vision about the meaning of existence. Many excellent works continue to be produced within this paradigm; yet, their impact on our profession and presence in teaching appear limited.

My foray into literature started when I saw a production of Hamlet on the eve of teaching a seminar on psychiatric interviewing and the basics of the doctor-patient relationship to beginning residents. Most of the residents were relative newcomers to U.S. culture and language, and, even more visibly than their native peers, they needed to learn not only the technique and mechanics of interviewing but also how to integrate such technical skills with an awareness of the sociocultural and psychological dimensions of their encounter with their patient. A key difficulty they struggled with was to give priority to developing and sustaining an emotionally responsive communication with the patient, rather than to fall back on the firing away of specific rote questions from their list of things to ask.

Watching Hamlet, I was struck with how this play's action is, like that of no other, propelled by the main characters' systematic efforts to find out--to extract from one another--the hidden truth. They do this because events (see Insert) force them to start doubting themselves and everybody and everything else that matter to them, and they must resolve their doubts. I realized that seeing characters react so strongly to each other's perceived emotions and imputed intentions, rather than the ostensible questions at hand, would vividly impress on my trainees the primacy of attending to their emotional and ethical relationship with the patient.

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