Medicine in Modern Literature

Five-volume work by the medical historian Prof. Dietrich v. Engelhardt

Prof. Dr. Dietrich v. Engelhardt, Director of the Institute for Medical and Scientific History at the University of Lübeck from 1983 to 2007, presented the five-volume work “Medizin in der Literatur der Neuzeit” (“Medicine in Modern Literature”)(Mattes Verlag, Heidelberg 2018). The following article introduces the work’s content.

On the Healing Power of Reading

Dietrich v. Engelhardt

Since ancient times, medicine has been regarded as not just a science, but also an art. Healing powers are attributed to all the arts, including reading and writing. The labels used are as various today as they were in the past; in addition to bibliotherapy, there is poetry therapy, reading therapy, and biblio counselling.

Aristotle postulated that tragedy, by stimulating pity (éleos) and fear (phóbos), has cathartic or healing effects on the body and soul.  The Bible is a fundamental work of bibliotherapy – for highly educated people and illiterate people, for young and old, men and women, rich and poor alike. The Al-Mansur Hospital in Cairo now offers, alongside medication and surgery, the teachings of the Koran as a therapeutic tool.

Numerous theoretical concepts and reports based on practical experience have arisen in modern times from doctors, psychologists, philosophers, theologians, and writers, rich in suggestions and ideas for the present and the future.

Up until now, music and art therapy have been better established in Germany than bibliotherapy. Many, though by no means all, hospitals have a library for patients. Training courses in poetry and bibliotherapy are available at various locations. In Germany there are currently more than 2,000 writing workshops.

Bibliotherapy, like all pyschotherapeutic processes and art therapy initiatives, faces the issue of how to monitor success based on measurable evidence. However, evidence exists not only in empirical-statistical form, but also as direct insight. The self-awareness of patients and the judgement of therapists and relatives can say just as much about the healing power of reading as external appearances or physiological data can. Subjectivity also has an objective value.   

Six dimensions are essential for bibliotherapy, as for all art-therapy approaches: 1. Reading in sickness and health, 2. The influence of different illnesses, 3. Dependence on the type of therapy, 4. The patient’s personality, 5. How the text is communicated, 6. Job profile of the bibliotherapist.

The way the sick person reads has its foundation in the way the healthy person reads and, irrespective of physiological, psychological, and social requirements, depends on the form and content of the literary work. The content can be real, fictional, fantastic or like a fairy tale; the plot can be static or dynamic, emotional or intellectual; the language flat or poetic.

The general conditions of being ill play an important role in the reading experience. It is not unusual for the level of interest and openness to be heightened during illness, while at the same time attention is focused more strongly on one’s body and personal situation. The conditions of particular illnesses or diseases also have to be factored in: rheumatism, multiple sclerosis, cancer, skin diseases, loss of sight or hearing, depression, amputation, organ transplantation, and acute and chronic diseases all influence the reception and resonance of literary texts in characteristic ways.

Bibliotherapy can be used in all medical disciplines, is not dependent on a specific psychological or pedagogical approach, opens up new possibilities with regard to diagnosis and therapy, prevention and rehabilitation, the doctor-patient relationship, as well as in the patient’s relationship to their illness and their loved ones.  However, expectations should not be unrealistic. Literature cannot replace surgery, though it can be helpful in coping with operations and medical treatment.

Literature can distract or focus attention, can offer models to follow or avoid, can divert or help to find meaning, can have a connection to one’s own life and illness or, on the contrary, guide the reader away from their own situation; it can help to create specific goals for dealing with illness, or draw attention to essential and exemplary examinations of illness, pain and suffering, dying and death.

The ill reader with their personality, social origins, age and gender, interests, intelligence, and education stands at the centre of all this. Everyone can be taught to read and write, notwithstanding differences in ability, inclination, and knowledge. Illness and hospitals, by freeing the patient from everyday tasks, may even represent a particularly suitable environment for this. The healing power of literature is by no means limited to classical or so-called serious literature; light reading, non-fiction books, travel literature, biographies, books of famous or memorable quotations and aphorisms can all be equally effective.

Essential to the success of bibliotherapy are the conditions under which it takes place, the way it is conducted, and guidance towards literary texts. It is not enough to just place a library catalogue in the hands of a patient or a trolley full of books next to their bed. A book is a not a medicine to be “prescribed”. Far more important is support while reading, and encouragement to read of one’s own volition; this requires direct contact and a willingness to talk, as well as empathy and communication. Neither librarians nor literature specialists, psychologists nor doctors with their traditional training are automatically in a position to fulfil the requirements made of a bibliotherapist:  1. Literary knowledge, 2. Socio-psychological knowledge regarding illness and disease, and 3. Most importantly, the ability to communicate empathetically.

Bibliotherapy or literature as a form of healing presents challenges not only to doctors and patients, but also to families, schools, society, politics, and the media. If reading is no longer practised or encouraged by parents and teachers, then its therapeutic or pedagogical benefits in life and in dealing with illness can no longer take effect.

Literature reveals a world beyond time, one of “immanent transcendence”, which is capable of reconciling the individual to their mortality, illness, and death. Literature is a general educational tool that helps the individual to understand themselves and the world. Bibliotherapy, like every other form of art therapy, belongs to medicine as part of the “medical humanities”, as a way of combining the natural sciences and humanities for the benefit of suffering, sick, and dying people.

Literature from the author

Prof. Dr. phil. med. habil. Dietrich v. Engelhardt

Born in 1941, after obtaining a doctorate in philosophy, history and Slavic studies in Heidelberg 1969 worked as part of a criminological research project and in the field of criminal therapy at the University of Heidelberg’s Institute of Criminology, simultaneously in 1971 assistant at the Heidelberg Institute for the History of Medicine, post-doctorate from Faculty of Scientific Medicine in 1976, 1983–2007 Director of the Institute for Medical and Scientific History at the University of Lübeck, 1995 acceptance into the German Academy of Natural Scientists Leopoldina, 1998–2002 President of the German Academy of Ethics in Medicine, 1998–2018 professor for the Ethics of Psychotherapy and Art Therapy at the Medical School Hamburg, 2008–2011 Acting Director of the Institute for the History and Ethics of Medicine at the TU Munich, 2009–2018 professor for the History, Theory and Ethics of Medicine at the Asklepios Medical School Budapest/Hamburg. Main research areas: Theory of medicine and psychiatry; history of medical ethics; medicine in modern literature; the natural sciences, medicine, and natural philosophy in Idealism and Romanticism; how patients cope with illness; bibliotherapy; 16th century botany; scientific-medical journeys in the modern era; European scientific relationships in the 18th and 19th centuries.

Prof. Dr. Dietrich v. Engelhardt