Performative Medicine

How do we change medicine? My thoughts are really questions and my questions spark further inquiry. How does one engage to change a system that doesn’t acknowledge its own malleability? Last year with the help of Anna Deveare Smith, I created a basic model for the collection of a medical history that was organic and comprehensive of a health narrative that moved beyond ‘ruptures’ of normal, and at times beyond words to describe events on and within the body. This model was based on practice as a midwife and my lifetime of observation of medical practitioners, performing on and around me. It is the beginning of an inquiry into better practices, better performance and better healing.

Modern medicine is based on the notion that what ‘science says’ is right. Even though what science says often changes, in the moment it is treated as the absolute and last authority. “Science Says” language positions the logic of science over the expression of human experience or knowledge of self. We are conditioned to believe and trust ‘science says’ over our own innate knowledge or feeling. Human voice, agency and desire are wrapped up in a system that is integral to their existence and yet does not acknowledge them as important. I believe that medicine must acknowledge human experience as intrinsic to what science says. The separation of the two is dangerous.

Science say is also related to ‘liability says’. Healing in this country is tied to money and to insurance coverage. Doctors and nurses are trained to heal from a liability perspective. Unless science says, liability says that it cannot be done. This severs the intuition present in genuine human interaction and also locks Doctors into a system from which there can be no creativity or out of the box thinking.

I realize that I can write a medical model for care but unless it is actually used, the model as a tool does not reach its full potential. It becomes like a script for a play that never gets produced; one that just sits in a file somewhere, or is performed for only an audience that likes and agrees with what it is saying. We need to challenge the audience who does not agree with us. Fortunately and unfortunately this is a very large audience. It constitutes most of the Doctors and the nurses who manage medicine and therefore what ‘science says’ is health in this country. Those of us working off the grid need to be a good enough engagers to work with other medical practitioners- to ask questions of the system we work in; to try new things; to trust the human voice and human emotion as intrinsic to the numbers, the cells, the blood and the skin.

As healers we are channelers. We take in another persons story, the account that they give about their embodied experience and channel what we have heard into some sort of action. I thought a lot about this in watching Anna perform her 'ADS' method, which is indeed a channeling; a taking in and a feeding back of words, gesture, expression so that you become a conduit for that person’s energy and story. As Richard Schechner would say, one becomes simultaneously ‘not and not not’ the person that one is performing. Intrinsic to this is a deeper understanding of a person’s role or position. I believe this to kind of transmission, of really listening and offering back, could transform medicine.

I want to think about and question the role of listening and the role of empathy in medicine. I once had a therapist who would cry every time that I cried. This made me terribly uncomfortable. In fact, it was inappropriate. He was taking on my emotion as opposed to staying removed from it. I expected him to be removed so I was unsettled when he was not. And yet, if ‘science says’ language told me that a therapist healed through empathy tears, I would most likely have expected and desired for him to cry with me. What is ‘normative’ we accept as healing. Truly, empathy does play a big role in healing. Healers take in an account of the body in dis-ease and the only way that we can relate to it is through our own embodied experience, or through the logic of science. Most people are informal healers all the time, suggesting that friends take a certain vitamin that we took that energized us, or offering soup to someone who is sick. Empathy is the reason that women often feel more comfortable with a woman gynecologist; aside from a scientific understanding, empathy (a not but not not situation) can make it easier to engage; easier to heal. So how do I engage with the medical institution so that the performance of healing is more holistic, more empathetic?

My personal primary care physician is a woman named Dr. Susan Massad. Six year ago, for fun she took a theater improvisation class and realized that all Drs should learn to improv, because it would make them better listeners, better reactors, better engagers, and thus, better healers. She partnered with an organization called ‘Performance of A Lifetime” and began teaching improvisation classes for medical residents in New York. You can check out an article about her at http://nymag.com/nymetro/health/bestdoctors/features/9259/ http://www.performanceofalifetime.com/press3.html

In my opinion, Dr. Massad has a proverbial ‘toe in the door’ into the way that medicine needs to be reframed and re-thought if we are going to truly improve health care in this country. I think the next step is to develop engagement workshops for healthcare practitioners. In order to do that we need to locate medicine in key moments where it both engages and disengages embodied experience. We need to understand where and why these practices both work and don’t work. I am concerned with what science says but also concerned with myth as lived experience and representation as product and practice.

How do we channel the story of the body into something that fits within science…. What would happen if we channeled science into the story of embodied experience? What if Doctors performed their patients? What if patients in return, performed their Doctors? What if Doctors were trained as extensively in listening as they are in anatomy? What if healing were to be approached from a ‘healthy’ perspective as opposed to only the moments when health ruptures? What if we learned from and shared healing practices with other countries…. we certainly share what ‘science says’ with other countries, why not performative healing as well? What would happen if we directly asked Doctors to imagine and think about their own position within the health dynamic?

We need to ask more questions to get more questions. Try things and fail at them, try things and succeed at them. Not every practice will work for every body. Be open to the futility of concrete answers, only a humble questioning. A celebratory loss of control. The story of medicine is as ancient as the human body itself. There is no point of origin. No beginning and no end. Only multiple points of entry. From this perspective, my engagement with medicine is a journey; one that starts in my body, in my inquiry, and lands itself in the resonance of questions and answers that follow. In my near future, I hope to make an offering to the medical communtiy, a series of workshops and performance practices whose boundaries will be also defined by the resonance of questions, thoughts, and action that are provoked through their telling.