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Catharsis and Cure

Rafael Argullol

  When Polish cardiologist and humanist Andrzej Szczeklik's remarkable book Catharsis: On the Art of Medicine was published in Spain, Rafael Argullol saw an opportunity to reflect on the increasingly widespread medical practice of viewing disease as a commodity subject to the law of supply and demand. Setting himself against this dehumanizing stance, Argullol joins Szczeklik in calling for a space in which language nurtures a new bond between doctor and patient. The body undergoes an experience akin to catharsis, ceases to be medical "goods" and is returned to us as a birthright truly ours.

In an age in which the warm and reassuring Hippocratic Oath has vanished from clinics and hospitals, and medical affairs are in the hands of "health authorities" ─usually pen-pushers who regard the human being as a beast from which taxes and votes can be extracted─ here is something to be learned from some physicians' reluctance to view disease as merchandise, buffeted about by the laws of supply and demand. For my own part, I am an enthusiastic follower of the opinions of Doctor Moisès Broggi, who has lately become as fine a memoirist as he was a surgeon throughout his long life. A special lucidity burns in this man, who is now 102. In his latest interview ─with Núria Navarro─ he made two apparently unconnected observations that to me nonetheless seemed securely joined by an invisible thread. On one hand, following the ancient Greeks, he reminded us that, "The force that moves the stars is one with the force by which a man's heart beats;" on the other, the journalist's last question ("What would you like to be remembered for?") prompted the pithy response, "For being a good person." Fit these two replies together and what you have is a magisterial lesson in medicine.

At around the same time that Doctor Broggi was interviewed, I came across an exceptionally fine book that in some sense explores the questions that span the gap between those two reactions. Catharsis: On the Art of Medicine, recently published in translation, is an essay by the Polish cardiologist and humanist Andrzej Szczeklik. I ought to confess that the enigmatic subject of "catharsis" has been a fascination of mine since my student days, when I read-or was made to read-Aristotle's Poetics, with its famous definition of Greek tragedy that has aroused endless controversy, particularly as to the precise meaning of that very term, katharsis. What was that catharsis which, according to Aristotle, routinely took place on the Greek stage? Was it a purification of the passions? A purging of moral disorders? A cure for the sicknesses of the soul? The translations are at odds with one another. Later on, as a reader and re-reader of tragedy ─particularly Aeschylus and Sophocles─ I arrived at a sense that this catharsis Attic drama was intent on achieving was a kind of shock: after the protagonists' travails had wound the audience up to a peak of tension, there came a shock, triggering an emotional release, a sensory letting-go.

To put it differently, Greek tragedy was not at all an elite diversion: it was a crowd-pulling event (the Theater of Dionysus could admit one-fourth of the free citizens of Athens). Tragedy held up a terrifying mirror, in which man gazed upon his paradoxes and shortcomings-but, far from drowning him in meaninglessness, it relieved his mind of its burden. The viewer, through the protagonist's ordeal, was excited to boiling point, where his sense of balance wavered; then, the exemplifying action of the tragedy itself sufficed to float him back to safety. It was established practice that a tragic performance be followed by the festive staging of a satyr play, in tune with the audience's sense of reprieve. The effect of a tragedy on an Athenian crowd was rather like the individual outcome sought by the Hippocratic practice of "cure by words." Both were instances of catharsis.  

And this second connection, the Hippocratic principle, serves as the prompt for Andrzej Sczeklik to construct an endlessly intriguing space in which doctor and patient are drawn together. Doctor Szczeklik, an internationally renowned cardiologist who pioneered resuscitation units in his native Krakow, is of course keenly aware of the latest developments in medical science and technology, and they are referenced all throughout his text. But his core argument urges a form of complicity between patient and physician. Words, in this view, and what breathes life into words, are as important as the latest diagnostic instrument and the most potent drug.  

So Catharsis embarks on a crossing, step by step, of all planes of existential relations. Crucially, Szczeklik elects to go beyond the boundaries of his medical specialty and venture into the many worlds of the history of culture. The exercise proves wonderfully illuminating, insofar as the cryptic language in which medical practitioners like to play the shaman is abruptly transformed into a precise, readily comprehensible alphabet. Your body, cut loose from the monopoly of a technical elite, is again "your" body. From this standpoint, the essence of medical practice is to listen to the body; this is what every human being does for herself, and is only secondarily the role of those sophisticated devices that perceive the body's echo-in the literal sense: magnetic resonance imaging, echography.  

In Szczeklik's view, the reason our bodies can be "listened to" is that each one of them is a field of experiment, open to the entire universe. Catharsis regales the reader with persuasive parallels: as Doctor Broggi also hinted, for instance, the pulse of the cosmos beats to the same rhythm as the human heart. A music enthusiast, Szczeklik traces constant connections between medicine and music. Memorably, he likens Chopin's characteristic rubato to the cardiac "melody." Szczeklik makes equally arresting poetic suggestions and pictorial allusions, with references to Velazquez, or the Sybil depicted in the Sistine Chapel. I was intrigued by one of the book's guiding threads, an exquisitely drawn comparison between a patient's description of her symptoms and Plato's path of knowledge. The key is memory, anamnesis. For Plato, to know is to remember; for the physician, nothing holds more value for the curative enterprise than what only the patient can recount: the body's remembrance.  

We might then say that the body's memory, retold by the patient and retrieved by the doctor ─using the eyes and ears of his own body and of medical technology─ pinpoints the symptoms, puts flesh on the diagnosis and prepares the human organism for the curative process much in the way that the performance of a tragedy, by playing out human misgivings on the stage, educates the body towards a restoration of spiritual balance.  

Be that as it may, Catharsis can be urged upon patients both actual and potential ─"that means all of us", as Czeslaw Milosz wryly notes in his foreword─ and ought to be mandatory for any physician who hopes to be more than a mere specialist or mechanic.

El País, March 21, 2010

Translated by Mike Escárzaga




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