As an associate professor of philosophy, Tom Davis, doesn’t often find himself diving into the world of medicine. However, recently he has experienced it twofold: as a cancer survivor and as co-author of the new book “Story by Story: Who I Am, What I Suffer.”
The monograph, written by Davis and Walla Walla psychiatrist Dr. Robert Arnold Johnson, attempts to tackle the important distinction between the “who,” or identity, of the patient and the “what,” or problem, of their illness.
A Patient’s Perspective
As a cancer patient, Davis experienced first-hand many of the difficulties in healthcare and patient support that he and Johnson had been discussing and writing about. Davis attributes the problem-focused attitude of medicine to its obsession with protocols. Davis found himself as part of these protocols as he went through seven weeks of chemotherapy last year.
“It is the protocol and it is very effective, but what happens when the protocol is finished? Well, the problem has been solved, so the doctors are done. But, in terms of the damage that radiation does to the body, you are at your worst place at the end of the seven weeks,” he said.
This prompted Davis to consider how the culture of problems and protocols leaves the patient alone at their most vulnerable point of healing.
“I’m a philosophy professor, I’m supposed to be good at understanding things and figuring stuff out. But, the hardest thing for a cancer patient, whose body has been subjected to a huge amount of damage, is to take initiative,” Davis said. “Precisely when you need the most help, your formal relationship with your treatment provider ends.”
There is a lot of hope for the influence of the monograph. Not only could it introduce a new diagnostic language, but it could change the experience of so many cancer patients like Davis that felt alone and abandoned when their problem was solved and the protocol ended.
“I would sit in the oncology room waiting for my radiation and I would be there with many other people. I would look at everyone and I would think ‘I hope you are not alone’,” Davis said.
Using Narrative and Analyses
“Story by Story” follows a unique format: It begins with a fictional story written by Johnson about a man suffering from catatonia, an abnormality of movement and behavior that arises from a disturbed mental state. Johnson tries to evoke a sense of the “who” of the character. The story is followed by a philosophical analysis and response written by Davis. The monograph continues the stories followed by analyses format and ends with chapters written by Johnson detailing the new diagnostic vocabulary he has developed called “who-what” talk.
Catatonia is a rare pathological state, and it was what inspired Johnson to write the story. Ever since moving from practicing cardiology to psychiatry in early 2000, Johnson has been intrigued by the ways in which mental states like catatonia defy the use of dichotomous language like mind and brain.
“It was impossible to say whether it was a disorder of the mind or the brain, the words just fell apart. They didn’t work, and that fascinated me,” Johnson said.
With a background in fiction writing and the inspiration brewing for a new medical language surrounding mental health and medical prejudice, Johnson sought out the philosophical perspective of Davis.
“I would always pepper him with questions like ‘why don’t we explore this issue of catatonia together,’ and he finally agreed. It became sort-of an extended conversation, with us writing about it as we went,” Johnson said.
The project was fueled by their curiosity and desire to explain the mind-body dualism through the language of “who-what talk.” Davis and Johnson discovered that one of the problems they continually came across in their research was the mere concept of “a problem.”
“The fascinating thing about 'a problem' is the assumption that when you solve a problem, that problem goes away,” which makes perfect sense if you have a broken bone and it heals, Davis said. “When you are talking about mental health, the idea of a problem and solution doesn’t apply.”
Instead, Davis and Johnson offer the concept of an “enigma” instead of the language of “problem” when explaining and diagnosing mental health conditions. The term “enigma” signals complexity and intricacy, something that requires time and attention to even begin to understand.
“The ‘who’ of a person is an enigma, not a problem. You can gain greater and greater insight into who a person is, but the notion of ‘who’ as a problem, doesn’t make sense because you can’t get rid of the ‘who’,” Davis said.
Discussions of enigmas and more are often part of the philosophy courses that Davis teaches at Whitman. This semester, he is teaching a course titled “The Hermeneutics of the Subject” which explores the lectures of Martin Heidegger and Michel Foucault that developed and explored the act of understanding.
“The course is really about what it means to read a person as a person, and what that is, actually has a really long history,” he said. Davis finds that the practice of “reading a person as a person” is directly related to the important patient and doctor mutual understanding that he and Johnson have developed in their monograph.
For students hoping to study medicine, both Davis and Johnson believe that the liberal arts context is the precise context in which their investigation and diagnostic language can begin to be explored.
“For liberal arts students, this monograph is a boost of morale. In an age where the ‘whatness’ surrounding human existence is everywhere in the forefront, fueled by science and technology, the exploration of identity, autonomy and the good of the collective are all classic themes of liberal arts,” Johnson said. “Anyone interested in becoming a healthcare provider will profit from becoming well-grounded in this distinction of who and what, keeping them separate so that one doesn’t become lost in the other.”