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The Arts and Medicine
April 18, 2017

Look. Listen. Receive.Surrendering to the Art

Author Affiliations
  • 1Duke Divinity School, Theology, Medicine, and Culture Fellowship, Durham, North Carolina; and University of South Carolina School of Medicine, Columbia
JAMA. 2017;317(15):1508-1509. doi:10.1001/jama.2017.2397

The first demand any work of art makes upon us is surrender. Look. Listen. Receive. Get yourself out of the way. (There is no good asking first whether the work before you deserves such a surrender, for until you have surrendered you cannot possibly find out.)

C. S. Lewis

In 1899, Louis-Ernest Barrias (1841-1905) completed his sculpture La Nature se dévoilant à la Science (Nature Unveiling Herself Before Science)—featured on the June 16, 1993, cover of JAMA. Nature is personified as a beautiful woman, veiled in layered robes of onyx, caught in the midst of removing her outermost cloak.1 Her breasts are exposed, but any suggestion of eroticism is lost in the modesty and elegance of her form. She stands gently, humbly removing her gown, but seems aware of us, observing our repose, character, pride, and motives. She is eager to show us her mysteries, but protective of her dignity. Through this personification, Barrias teaches us an approach to art and nature that forms the patient-physician relationship: patients reveal themselves to us as physicians just as nature reveals herself before science.

Louis-Ernest Barrias (1841-1905), Nature Unveiling Herself to Science, after 1899; gift of John N. Stern. Photo credit: Courtesy of The David and Alfred Smart Museum of Art, The University of Chicago, Chicago, Illinois, © 2017.

The icon illustrates reverse perspective. With conventional perspective, the lines formed by the chair edges would converge in the background onto one or more vanishing points. With reverse perspective, the lines formed by the chair edges converge in the foreground onto the position of the viewer. Andrei Rublev (1360s-circa 1430), The Trinity, circa 1410. Courtesy of the Tretyakov Gallery, Moscow, Russia. Photo credit: Scala/Art Resource, New York, New York.

The first demand of any art is surrender to an unveiling of truth, beauty, or goodness. Art commands attention, demands pause, and models for physicians an appropriate posture of humility before the patient’s unveiling—literally for the physical examination, or figuratively in the collection and review of data.

Art and medicine share this first demand of surrender. I do not merely stand in interpretive judgment over the work of art; it also stands in interpretive judgment over me. As Lionel Trilling wrote, “A real book reads us.” The physician not only interprets the patient, the patient also interprets the physician. In the strange space of that reciprocal “reading,” the arts teach us to regard rather than to grasp—to be the recipient of a gift. Art tempers the maddening, carpe diem impulse to “seize” that is so prevalent in medicine and suggests an alternative: “receive.”2

The medical profession prides itself on self-sufficiency, grit, and an attitude of perpetual self-seizing: seize medical school, the boards, residency, fellowships, publication. Seize the day—your day.

While a strong work ethic and a balanced reward for hard work are healthy and necessary for wise living, an attitude of perpetual seizing inevitably becomes impatience. As poet and farmer Wendell Berry writes, “If nature releases her wealth too slowly, we … take it by force.”

A subtle violence can be done, both to the painting in the art museum and to the patient in the clinical space, when we seize rather than receive, impose rather than pause. In the art museum, it is easy to take aesthetic wealth by force through a 5-second glance or Instagram post, rather than attend to the art. The result is not illumination, but disorientation. Indeed, when I speak to friends who “don’t do art” (largely kind, self-aware people), they describe the familiar experience of getting lost in the art museum. When I ask them how often they look at each piece, they usually admit a figure of around 10 seconds.

Trying to digest an entire art museum in one day by taking 10 seconds with each piece of art is like trying to binge watch a dozen movies in one day, read 30 books in one sitting, or listen to 50 poems in tandem or several symphonies back to back. The overexposure is exhausting and desensitizing. As Allan Bloom wrote in The Closing of the American Mind, “when they take [their headphones] off, they find they are deaf.”

The practice of medicine can feel the same. The sheer volume of individual patients and practitioner responsibilities overwhelms us. We get lost in the hospital, literally and teleologically. Like a pilgrim rushed through the Sistine Chapel by the force of the tourist crowd, the physician is pushed through the gallery of patients by growing responsibility and dwindling time. And so the physician understandably adapts, grasping where she cannot attend—seizing where she cannot surrender. As the physician tries to seize more data and balance more responsibility in an environment that demands ever-increasing efficiency and empathy, it is no surprise that she seizes, imposes, and finds herself vocationally “deaf,” leading in the worst of instances to professional burnout, depression, substance abuse, or suicide.

The work will not magically grow easier, and the demands of the day will not decrease. But the meaning of the physician’s work could grow if the art of medicine is practiced as surrendering and receiving—if we look to the patient with a renewed perspective.

Most two-dimensional works of art use perspectives that imitate reality. Typically, a vanishing point is located within the artwork, past the picture plane, creating a life-like appearance as if looking through a window onto the horizon of another world. The action of the artwork is projected from this vanishing point out of the painting and on to us, the viewers. We become “what matters” as we experience and interpret the artwork.

In religious iconography, however, this perspective is often reversed. “Reverse perspective” places the vanishing point on us, the viewers, while “what matters” is contained within the icon itself. The icon becomes what is truly happening, and the viewer surrenders to a sort of “self-vanishing” as the icon draws the viewer into itself. Rather than merely interpreting the icon, in a very real sense, the icon interprets the viewer. Like Barrias’ Nature, we do not merely look at her; she also looks at us.

Andrei Rublev’s (1360s–circa 1430) revered icon The Trinity is a great example of reverse perspective and of surrender as invitation. Here there are three figures, seated around an open table, who seemingly look at each other and are, perhaps, about to enjoy a meal. We are not the subject of their gaze, but we get the feeling that the three are waiting on another to join them. Because of reverse perspective, we are drawn in, invited to enter the perichoretic dance of the Trinity itself, to take our place at that table, and to receive and step into “what matters.”

C. S. Lewis’ wise words on art, Barrias’ image of a woman unveiling herself before science, and Rublev’s image of an open seat at a divine table are fitting allegories for the space the physician enters with the patient. It is a space that flourishes when marked by surrender, humility, and reception. Let us give each painting and patient their due time, as brief as it may be, asking ourselves if we are seizing the day or receiving the gift.

C. S. Lewis had it right: Look. Listen. Receive. Get yourself out of the way. There is no good asking first whether the patient before you deserves such a surrender, for until you have surrendered, you cannot possibly find out.

Section Editor: Roxanne K. Young, Associate Senior Editor.
Submissions: The Arts and Medicine editors welcome proposals for features in the section. Submit yours at artsandmedicine@jamanetwork.com.
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Article Information

Corresponding Author: John Brewer Eberly Jr (brewer.eberly@uscmed.sc.edu).

Additional Contributions: The author would like to thank Judith M. Heyhoe (Duke Divinity School) for her editorial comments, as well as his father, John B. Eberly, MD, from whom he has received the gift of The Art of JAMA for years and the gift of friendship for decades.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
1. Southgate  M.  The Art of JAMA III. New York, NY: Oxford University Press; 2011:164-165.
2.
2. I am indebted to Brett McCarty (Duke Divinity School) for drawing my attention to this point on “receive the gift” vs “seize the day,” which comes from Davis E. Getting Involved With God: Rediscovering the Old Testament. Lanham, MA: Rowman & Littlefield; 2001:107.
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