The path that led to my English department thesis began with disembodied lungs. Early in my sophomore year, a professor told me about a former English major who, in her first week of medical school, attended a lecture that included an image of a cancerous lung versus a flawless one. The lecturer had taken some liberties and labeled one image, "patient's lung," and the other, "doctor's lung." The student looked at the images, read the labels, and asked herself, "What kind of message is this sending me? Why is it telling me that the doctor's body is perfect? And, as I enter an often-dehumanizing healthcare system, what kind of divide might this message place between me and a patient?"
When I heard that story, two thoughts came to mind. First, that's an awful lot to think about during your first week of medical school. And second, that's what I want college to do to me. I want to see things differently. I want to know how messages around us shape our interactions with our communities, our surroundings, and ourselves. I want the everyday to be not just experienced, but also examined -- to be made meaningful. I want to do what the former English major did: to see the raw stuff of life as a text to be read.
Two years later, the professor -- the incomparable Dr. Priscilla Wald -- had become one of my most important mentors, and the disembodied lungs had launched me into an exploration of how the humanities could answer some of my prickliest questions about the state of American healthcare. I wanted to know why the vast majority of Americans die in a hospital or nursing facility instead of at home, why so many patients near death opt for aggressive treatment rather than palliative care, and why so few physicians initiate conversations about end-of-life planning before it's too late. In short, I wanted to know not just what we thought about death, but why we thought that way at all -- and the sort of data I needed wasn't in a spreadsheet or a forty-item questionnaire.
See, people have been dying ever since there have been people. Yet even if we can count on death as a constant, our response to death remakes itself time and time again. We emerge from an ever-shifting milieu of cultural traditions, religious beliefs, and scientific advancements, all of which frame particular ways of understanding the value of life and the meaning of medicine. Leaps and bounds in biomedical research have recently made possible a new form of death: the technical one. Cutting-edge treatments can give us years of life, but they also allow us to postpone death and prolong dying in ways no previous culture has ever known. Death at home or the hospital, palliation or resuscitation, last rites or a last fight -- these are choices we must make when we approach the end, decisions foreign to all generations but ours.
How do we decide? What determines how we choose to die? As individuals embedded within ecosystems of information, some of our most significant actions are products of stories we cannot see. Cultural narratives -- like the one about the flawless physician's flawless lung - shape the way we speak and write and think about the world. They circulate in our societal subconscious, biasing our decisions without ever stepping into the limelight. We construct narratives about death -- we always have -- and more recently, we construct narratives about cancer, about chemo, about lifesaving treatments and Christ-like physicians. I wanted to tease out these narratives, to piece them together in order to understand why our healthcare institutions so often fail to prepare patients and families for the end.
Cultural narratives manifest themselves in cultural production. We see them in newspaper articles and comic strips, in magazine advertisements and medical school ceremonies, in public policy and primetime TV. When the New York Times calls an oncologist "The Public's Quiet Savior," that means something. When an artist paints a doctor in a black coat, and then fifteen years later paints a doctor in a white coat, that means something. When The Economist depicts breast cancer as a grim reaper in a pink ribbon, that means something. These signs tell us about the way we understand disease and death, sin and saviors.
As I poured through primary sources, I stumbled upon a salvation narrative of sorts. The advances of biomedicine make possible a crusade for unlimited life and secular salvation, an endeavor that echoes Christianity's promise of eternal life. Christian narratives recast in the medical space may begin to explain aggressive treatment at the end of life, lack of appropriate conversations about palliative care and hospice, and an overall cultural inability to accept death as a natural part of life. The salvation story is only one healthcare narrative among many, of course, but I argue that it's a dominant one. My thesis explores the extent of these secularized Christian narratives in American culture by performing a close reading of the rhetoric and imagery that surrounds doctors and disease.
To find out what medicine means, we have to dissect the semiotics of its players. I began with the doctor, tracing the cultural construction of the physician from the ancient Western world to our contemporary moment -- from Hippocrates to House, Aesculapius to Grey's Anatomy. I examined Greek myths and medieval monastic practices, news releases and tumblr. sites, and I found that physicians often assume a semi-sacred -- even Christological -- identity in our cultural imagination. The ritual of the physical examination and the icon of the white coat as they appear in American poetry, paintings, television shows, and real-life clinical interactions cloak the doctor in the imagery of a savior. Theologians have described Christ as a holy healer for centuries. An analysis of contemporary images of the doctor, however, reveals an inversion of the metaphor: Jesus may be a sacred physician, but the physician is also a secular Jesus.
There can be no savior if there is nothing from which to be saved. I looked for an enemy, and I found one in what studies have called America's most dreaded disease -- cancer. Starting with the creation of the American Cancer Society in the early 20th century, I traced the evolution of anti‑cancer rhetoric in American media. We often speak of a "war on cancer," but the military metaphors we use against cancer actually began as a calculated lobbying ploy involving a well‑heeled activist, a renowned oncologist, and, eventually, President Nixon himself. Nixon, perhaps hoping to divert attention from a failing war in Vietnam, launched a campaign that all Americans could stand behind. He signed the 1971 "National Cancer Act," devoted to "the conquest of cancer." Popular media seized upon the rhetoric, and as the language of invading cells, chemo-based warfare, fallen heroes, and courageous survivors spread, the nation-wide "war on cancer" took on religious overtones. We now speak of "cancer crusades" and "medical miracles." Examine the imagery in various publications and you'll see cancer depicted as a biological devil, a demonic skull, a hellish monster. The more I pried into our contemporary characterizations of cancer and the battle against it, the more I realized that the cancer experience often assumes the status of a pseudo-holy war.
Though the doctor may be our savior and the cancer our mortal enemy, we can find one last crucial piece of the Christian narrative in our contemporary understanding of wellness. Christ may offer humanity salvation from a hellish end, but humans need salvation in the first place because of their sin. Christian tradition often likens sin to a sickness, but the disease prevention movement that began in the 1970s reverses the analogy: if healthy habits signify good character, then sickness itself becomes a sin. When scientific research, surgeon general reports, and popular media began to emphasize behavioral change as a crucial component of the cancer crusade, the focus on individual responsibility took on moral, even religious, connotations. Whether explicitly or implicitly, the way we often talk about health perpetuates a particularly puritan notion of morality. The righteous run 5Ks, or eat kale, or wake up at 5:00 for yoga. In contrast, the sinful succumb to poor health behaviors -- the next cigarette, the second donut, the day on the couch. The language of prevention can translate into the language of fault; cancer patients often blame themselves, linking "sinful" vices to their current condition. The language of sin thus fits into a pseudo-Christian narrative about the causes and consequences of cancer, one that posits the doctor as a savior capable of washing away our transgressions.
In tracing our evolving constructions of physicians, cancer, and wellness, I found an overarching narrative of illness that parallels the Christian quest for salvation. A question still lingers, though: why does it matter? Narratives aren't neutral, whether or not we're aware of them. Stories shape us and our society, and so they necessarily shape our decisions. The Christological metaphors that abound in disease discourse do not simply describe realities -- they create them.
In the Christian narrative, Jesus' sacrifice cleanses the sinner of her sin. Saved and sanctified, she spends eternity with God. When transposed onto the modern healthcare experience, a secularized Christology tells a similar story with a radically different ending. When doctors are Christ figures, diseases unholy enemies, and illnesses an indication of fault, then the imperative at the end of life is clear: cure the patient and banish death. Salvation does not mean going to heaven; it means staying alive. The physician thus serves as a secularized savior, defending the ill from the evil of their disease. Rescued from death and washed clean of their sins, patients stand redeemed in the light of healthcare's glory. That's the story, anyway, but for all of biomedicine's state‑of‑the-art technology, the institution of medicine has always and will always fail in its quest for immortality. Yet despite its doomed end, the narrative persists. Consequently, Christological constructions narrow the focus of healthcare to a single goal: the perpetuation of life.
Secularized narratives of salvation play into a culture-wide death delusion: the assumption that we can and should control our own mortality. Death itself is the problem. It is the product of an accident, a medical mistake, some failing in scientific research. If we throw more money and time and ingenuity into the fight, then death can be overcome. Yet a medical culture deaf to a discussion about death generates an overreliance on the sacred function of the physician and her biomedical toolkit.
By demonizing death, we render acceptance of it impossible. When those who fight cancer until the end are called "heroes," what happens when patients might want to explore non-curative options? When doctors who view themselves as biomedical saviors confront the messy reality of unalterable disease, do they feel like failures? When patients trust in the saving grace of the medical establishment, do they avoid conversations about the end? How might a fear of death have factored into our healthcare reimbursement systems, our hospital protocols, our political debates?
I explored these questions in my thesis, examining the psychological, financial, and societal consequences of a culture convinced that healthcare itself is our modern-day salvation project. The research left me frustrated, furious, and fascinated. See, medicine's ability to heal is one of society's greatest triumphs. Yet medicine's desperation to heal is one of its greatest challenges. I do not judge those who choose to fight their illness with all they have. Yet it must be a fully informed choice, made after honest conversations about their chances for living and their desires for dying. Healthcare that does not prepare for the reality of death -- that does not even, in many cases, acknowledge it -- is healthcare that neglects its patients in the most critical of moments. In order to change the way we understand the end of life, we must first recognize and respond to the narratives that frame our interpretations of modern medicine. Doctors and patients who create counter-narratives about how we ought to die will challenge a culture of biomedicine that focuses on curing rather than caring.
Writing my thesis may have involved more late-night writing frenzies than I'd care to admit, but was also one of the most thrilling experiences of my undergraduate education, caffeine-jitters aside. I took on the project not only because I wanted to poke and prod at medical institutions, but also because, on a larger level, I wanted to witness what the humanities could do. I wanted to find out, first-hand, how narrative inquiry might shed light on contemporary culture, to explore how stories undergird the structure of the status-quo.
As an English major on the cusp of medical school, I am leaving -- at least temporarily -- the world of poetry readings and Shakespeare seminars and courses on literary theory. Yet if there's anything my thesis has taught me, it's this: I'm not done asking questions. And if I want to become the sort of doctor who peers beneath the surface of modern medical culture in order to change it for the better, then I'll be drawing upon the humanities for the rest of my life.
--Jocelyn Streid
The HuffPost College Thesis Project gives students a chance to share with a wide audience the fruit of their hard academic work. The project is launching with about a dozen partner schools, which comprise students from public and private, two- and four-year colleges. To read all posts in the series, visit here.