Slicing through Thin Layers of Humanity: Narratives of the Abject
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Slicing through Thin Layers of Humanity: Narratives of the Abject Robin Kanak Zwier 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
This essay examines narratives about cadaver dissection through the lens of psychoanalytic theory in order to better understand the nature of medical students’ socialization into medicine and its implications for physician-patient communication. The theoretical framework provided by Julia Kristeva focuses attention on the nature of subjectformation in relation to abjection – that which reveals the contingent nature of the speaking self. Analysis of memoirs and other narratives by medical students demonstrates that students encounter the abject in the process of dissecting a corpse, but are rigorously trained to map over this experience using the technical tools of biomedicine. Other students rely on dark and morbid forms of humor to develop a sense of emotional distance from their cadaver. This analysis reveals new insights about the nature of the gap between physicians and their patients. In particular, it indicates that this gap is not fixed or static but fluid and malleable. Physicians are always shifting between the symbolic realm of biomedicine and the affective, semiotic mode of encountering the abject. This malleability provides the key to training and educating medical students, socializing them in such a way that they are reflexive about this process of oscillation. How physicians handle the reality of their fluctuation between the semiotic and the symbolic is what will determine their ability to engage with patients. Keywords Medical education . Medical students . Abjection . Death . Narrative medicine Relationships between physicians and patients have been at the center of work in bioethics and medical humanities for decades. The clinical encounter has the potential to be a site of healing but instead is often a site of pain, frustration, and powerlessness. Therefore, one of the main goals of work in medical humanities, as demonstrated by narrative medicine in particular, has been to improve these interactions – to make them more personal, meaningful, and ethical. Such approaches focus on enhancing physicians’ ability to communicate meaningfully with
* Robin Kanak Zwier [email protected]
1
1401 Cathedral of Learning, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
Journal of Medical Humanities
their patients, assuming that there is a relational gap between doctors and patients that makes it difficult for them to interact and communicate. Narrative medicine scholar Rita Charon (2006), for instance, argues that patients and doctors are separated by the ways each relates to mortality, contextualizes illness, conceives of disease, and navigates the difficult emotions inherent in the medical encounter (19). Much scholarship in narrative medicine has focused on the laudable goal of bridging this gap, while paying less attention to the nature of this gap and how it develops. Narrative medicine involves using skills in the clin
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