Karl Kirkland, University of Alabama, Birmingham
Dewy Dell Bundren’s desperate inner dialogue concerning her condition and her speculation as to how Dr. Peabody might help her is a well-known passage in As I Lay Dying. Later, in the bizarre Bundren funeral odyssey to Jefferson, Dewey Dell’s frantic search for a solution to her pregnancy leads her to two different pharmacists, one scrupulously ethical and the other a sexual predator. Faulkner’s works are replete with similar vignettes, relationship dynamics, and studies in characterological development that can be extremely useful tools in the post-graduate medical school curriculum. The purpose of this article is to describe the multiple uses and value of Faulkner’s works as teaching tools in the graduate medical education curriculum.
There is a growing recognition concerning the use of literature and the arts in teaching about the dynamics of illness and human behavior. Family Medicine, the official journal of the Society of Teachers in Family Medicine, regularly includes a feature section entitled “Literature and the Arts in Medicine.” Several authors have noted the value of integrating classical literature into the graduate curriculum of medical and psychology programs. Rita Charon and her colleagues note that the integration of literature into the medical school curriculum began in the early 1970s in order to help physicians develop skills in the human dimensions of medical practice and to convey the “metaphorical richness of the predicaments of sick people” (599). The authors note that there are five goals met by including the study of literature in medical education:
Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people;
Great works of fiction about medicine enable physicians to recognize the power and implications of what they do;
Through study of the narrative, the physician can better understand patients’ stories of sickness;
Literary study contributes to physicians’ expertise in narrative ethics;
Literary theory offers new perspectives on the work and genres of medicine (599).
Many students who avoided Faulkner in high school or college return as adult learners with a fresh and mature perspective. In a recent article in The Atlantic Monthly, Larry Levinger observes that reading Faulkner is an experience that many Southerners spend the rest of their lives trying to “recover from” (76). He further notes that Flannery O’Connor once wrote, “The presence alone of Faulkner in our midst makes a difference in what the writer can and cannot permit himself to do. Nobody wants his mule and wagon stalled on the same track the Dixie Limited is roaring down” (76).
As a Faulkner devotee, practicing psychologist, and teacher in two graduate medical education residency programs, I kept running into elements of Joe Christmas, Quentin Compson, Dilsey Gibson, Anse Bundren, and Rosa Coldfield in different patient encounters. After years of reading and studying Faulkner by night and encountering the characters in the exam room by day, I decided to make the texts of As I Lay Dying, Light in August, and The Sound and the Fury a part of the curriculum. Some eyebrows were raised and there were comments about not having enough time to read The New England Journal of Medicine and The Journal of Family Practice, but when students realized that this was reading for enlightenment, discussion, edification, and growth (with no tests or papers due), everyone relaxed and settled in for the experience. Interestingly, some still bought, used, and needed Cliff’s Notes. Teaching Faulkner can demonstrate through epistemological diagnostics how literary method can help teach medical students how to listen more fully to patients’ narratives of illness and how important perspective shift is to proper diagnosis. Faulkner’s unique style of writing merges epistemology with literary method. A consistent theme concerning the nature of knowledge and truth in Faulkner’s work is that no single view or perspective tells the whole story. One cannot get at the truth or the proper diagnosis from a single perspective. Accordingly, Faulkner tells his stories from the point of view of multiple characters.
In As I Lay Dying, Faulkner uses fifteen different characters to tell the story of Addie Bundren’s death and eventual burial. This literary method demonstrates the importance of multi-method and multi-source diagnostic assessment. This unique mode of presentation can be used to demonstrate the importance of self-report data in medical and psychological assessment that is buttressed by collateral interviews with other sources such as family members, friends, and employers.
In As I Lay Dying, Faulkner introduces Dr. Lucius Quintus Peabody, a wise, corpulent country doctor. Dr. Peabody’s solid ethics, patient care decisions, and general observations are very useful discussion points for a group of physicians in training. Dr. Peabody also surfaces in Sartoris, The Sound and the Fury, The Hamlet, The Reivers, Requiem for a Nun, and The Town. In As I Lay Dying, Dr. Peabody is summoned to Addie’s deathbed, but arrives too late. In response to the loss of his patient he reflects about death: “I can remember how when I was young, I believed death to be a phenomenon of the body. Now I know it to be merely a function of the mind--and that of the minds that suffer the bereavement. The nihilists say it is the end; the fundamentalists, the beginning; when in reality it is no more than a single tenant or family moving out of a tenement or a town” (As I Lay Dying, 39). As I Lay Dying presents multiple scenes and interactions that provide excellent stimuli for conferences and discussion groups concerning heroic acts, callous narcissism, indolence/ennui, death, grief, family pathology, and the ethics of medical practice.
Kirkland describes the use of Light in August as a teaching text for graduate study in forensic psychology and psychiatry, disciplines that are defined as the application of clinical findings to the process of helping courts to answer legal questions. These areas include assessment of specific legal questions such as competency to stand trial, competency to make a will, as well as the assessment of criminal responsibility (legal insanity) and the etiology and explanation of criminal behavior. These professionals are then frequently called upon to testify and assist courts in arriving at just outcomes that presumably are better informed by the inclusion of relevant clinical material.
Joe Christmas, Faulkner’s most alienated pariah regarding an exploration of the psychosocial history in Light in August, gives Faulkner the opportunity to explore themes of psychoanalytic determinism, fate, free choice, misogyny, the causal strength of physical abuse, and isolation versus community. This highly readable novel provides fertile ground for a forensic analysis of the dilemma of Joe Christmas. The novel can be read and studied for the benefit of instruction in the dynamics of criminal responsibility and mental state at the time of the murder of Joanna Burden. As Stephen Meats observes, the novel can also provide an interesting forensic reading with regard to answering the question of who actually killed Miss Burden. Faulkner formulates a psychodynamic mental state theory of responsibility based on neglect, emotional abuse, rejection, physical abuse, miscegenation, misogyny, and displaced aggression.
Faulkner consistently attempts to exonerate Christmas through deterministic, analytic, and psychosocial “explanations” of his violent nature that are ultimately raised to the level of “excuses.” In 1957, at a question and answer session at the University of Virginia, Faulkner ventured an explanation of what he called the “tragic condition” of Joe Christmas (Gwinn and Blotner 72). Gurganas observes, “Joe Christmas is a way of talking about every page of every newspaper we pick up and the eternal dilemma of the presence of evil in our lives” (389). Every forensic psychologist practicing in the area of assessment of criminals alleged to be insane encounters Joe Christmas many times over, as well as the themes Faulkner explores in Light in August. Thus, the work is an extremely valuable text for use in the teaching of forensic psychology and psychiatry.
The Sound and the Fury offers a gold mine of teaching opportunities for graduate study in clinical psychology, psychiatry, and primary care medicine residencies (family medicine, internal medicine, and pediatrics). As with As I Lay Dying, the text is important for what it offers in the area of epistemology and psycho-diagnostics. Faulkner drives home the point over and over that the truth is only known or approached by including multiple sources or points of view. The Compson family provides a mini-course in diagnostics: Benjy (mental retardation, psychosexual development), Quentin (neurotic depression, obsessive thinking, suicide), Jason (narcissism, psychopathy), and Dilsey (balanced healthy functioning, characterological strength). The family, as a whole, provides multiple views of dysfunction, immaturity, hypochondriasis, and deterioration. One family medicine residency educator, Dr. Robert Blake, has used The Sound and the Fury to teach about family systems theory. This theoretical approach conceptualizes individual problems through the eyes of family enmeshment or system dysfunction. Dr. Blake uses a genogram of the Compson family to illustrate maladaptive communication patterns, unhealthy alliances, marital problems, and family enmeshment. Faulkner’s masterpiece novel is also a preeminent text for the study of abnormal psychology and maladaptive relationships.
Winthrop Tilley wrote a well-known, oft-quoted treatise on “the idiot boy in Mississippi” in Faulkner’s The Sound and the Fury. Tilley takes Faulkner to task concerning unlikely events and outcomes in the novel. Given mental health law and policy in Mississippi around the turn of the 20th century, Tilley notes, it would be unlikely that Benjy would have either been castrated or involuntarily committed for treatment. Of greater import for purposes of this article are the points that Tilley makes about the novel that increase its use as a teaching tool in areas such as autistic thought, mental retardation, depression, mental health policy, and stages of psychosexual development. The work can also be explored as a teaching tool in areas such as discussion of ethical issues as applied to mental retardation and legal standards for consent for medical/psychological treatment.
Faulkner’s works have typically been viewed through psychoanalytic theoretical lenses. Presumably, Faulkner was strongly influenced by the stalwart analytic community that was so prevalent in New Orleans intellectual and professional circles during his tenure there. However, relatively few writers have attempted to process Faulkner’s works and ideas through the dominant psychotherapeutic schools of thought that have largely all but replaced analytic theory in the latter half of the twentieth century. A review of journals such as Literature and Psychology would make most modern psychologists think they had stepped back into the 1930s. Family systems theory can be profitably employed to explore the Snopeses, Compsons, and Bundrens. Social learning and cognitive psychology can be used to understand Joe Christmas in ways that far surpass psychoanalytic, deterministic conceptualizations and Lacanian formulations.
Clearly, it is time for Faulkner criticism to progress to theoretical frameworks that are more in keeping with the enormous progress that has occurred in psychology and psychiatry in the twentieth century.
An example of how this may be accomplished in a manner that respects both the work of Faulkner and various revered literary critics can be seen in an application of cognitive and social learning theory to the elegant ideas of Olga Vickery. Vickery astutely observes the similarities between As I Lay Dying and The Sound and the Fury in terms of exploration of the human psyche through recognition of different dimensions of consciousness. Vickery uses a tripartite model of understanding responses to experience (words, action, and contemplation) that actually fits better into modern cognitive-behavioral theory than into a psychoanalytic formulation. Another example is found in scanning the recent panorama of Faulkner criticism, it appears as though some literary critics have never heard of behavior therapy, humanism, existential psychotherapy, cognitive theory, or social learning theory. Even the most recent references to those felt to be at the apex of current integration of Faulkner and psychology (e.g., Irwin and Kartiganer, still limit their conceptualization and treatment understandings to psychoanalytic premises and concepts. From the point of view of contemporary psychology, this is an outmoded practice.
Theoretical orientation is of central importance in determining causal theory and related psychological intervention. For example, if anxiety or panic disorder is viewed from a psychoanalytic conception, the related corollary treatment is drive reduction through catharsis or resolution of intrapsychic conflict. If anxiety is conceptualized in terms of social learning theory, the related cognitive-behavioral treatment package is focused on acquiring the skills necessary to manage the physiological and worry-based components of the anxiety. Psychological treatment in the 21st century is now required to be able to empirically prove its effectiveness. Psychoanalytic treatments, while of great historical interest, are rarely even included in the modern research design protocol.
Vickery calls Dr. Peabody the “country doctor-cum-philosopher” of Faulkner’s works because of his judgment and compassionate but detached vision. She notes, “his insight is the result of long and varied experience with people compelled to face the realities of pain, suffering, and death” (65). In residency training, graduate medical faculty face the challenges of teaching residents how to deliver compassionate, effective care that is characterized by genuineness in communication. This task has become much more difficult in the “wasteland” of managed care and in the much more litigious medical-legal environment of modern medicine. Faulkner can help in this process by adding elements of insight, humor, perspective, and comprehensive knowledge of the verities of the human heart and the universal themes found in medical practice and human behavior. The process of reading, study, reflection, and discussion can also lead to healthy avenues of escape and the experience of being refreshed and restored in order to return to the exam room for another day.
Blake, Robert L. “Family Dynamics in William Faulkner’s The Sound and the Fury. Family Systems Medicine 2 (1984): 320-326.
Charon, Rita, and others. “Literature and Medicine: Contributions to
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Faulkner, William As I Lay Dying. New York: Random House, 1956.
------. The Hamlet. New York: Random House, 1956.
------. Light in August. New York: Random House, 1956.
------. The Reivers. New York, Random House, 1962.
------. Requiem for a Nun. New York: Random House, 1951.
------. Sartoris. New York: Random House, 1956.
------. The Sound and the Fury. New York: Random House, 1956.
------. The Town. New York: Random House, 1974.
Gurganas, Allan. “When I’m a Fog on a Coffin Lid.” The Christ Haunted Landscape: Faith and Doubt in Southern Fiction. Ed. by Susan Ketchin. Jackson: University Press of Mississippi, 1994, 371-375.
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