Blog post for The Lancet Student written by Nathan Carlin

Nathan Carlin, PhD authored recently a blog post in the Student Section of The Lancet. The piece discusses the Pathographies of Mental Illness, a fourth-year elective directed by Carlin and offered to students in May.

Pathographies of Mental Illness

I teach at the University of Texas Medical School in Houston, Texas, as a faculty member in the McGovern Center for Humanities and Ethics. When I began teaching, I sometimes heard the claim that professors should not assign books to medical students because they will not read books, mainly for two reasons: (1) they do not have time to do so during their first three years of medical school; and (2) when they do have time during their fourth year, they have fallen out of the habit of reading after years of memorizing facts. But I wondered if this were true—that is, I suspected that medical students would read books if the courses offered were interesting and important enough to them. So I decided to try to design a course that would capture their attention. The result was a course titled “Pathographies of Mental Illness.”

The course was a complete success. In this blog, I offer a description of the course with the hope that other such courses will be developed; I hope that medical students reading this blog will call for similar courses to be developed at their own medical schools.

In the course, I ask students to think deeply about the moral meaning of mental illness, about what it is like to be mentally ill, about how we, as healthcare professionals, can best care for sufferers of mental illness as well as their families and friends. In search of answers we turn to sufferers and their loved ones, exploring experiential (auto)biographical works that concern mental illness—an intellectual enterprise in medical humanities sometimes referred to as “pathography.” We also explore cinematic representations of mental illness; artistic creations relating to mental illness, such as painting and graphic novels; and other scholarly literature related to mental illness. The class consists of ten three-hour sessions. Most of these sessions focus on the class readings, and, in general, each of these sessions focuses on a particular pathography of mental illness. Examples have included:

  • Darkness Visible, by William Styron, which focuses on depression;
  • An Unquiet Mind, by Kay Jamison, which focuses on bipolar illness;
  • Just Checking, by Emily Colas, which focuses on obsessive-compulsive disorder;
  • My Friend Dahmer, by Derf Backderf, which focuses on social deviance and the serial killer Jeffrey Dahmer;
  • Wasted, by Mayra Hornbacher, which focuses on eating disorders;
  • The Center Cannot Hold, by Elyn Saks, which focuses on schizophrenia; and
  • Another Bull**** Night in Suck City, by Nick Flynn, which focuses on substance abuse and homelessness.

In terms of films, we have examined A Beautiful Mind (a movie about mathematician John Nash, who apparently suffered from schizophrenia) as well as Girl, Interrupted (a movie about Susanna Kaysen, who apparently suffered from borderline personality disorder). We also have read scholarly monographs, such as Donald Capps’s Jesus the Village Psychiatrist (which focuses on how Jesus was able to heal), T. M. Luhrmann’s Of Two Minds (an anthropology of modern psychiatry), and Thomas Cole’s No Color is My Kind (a contextual and social psychobiography of Eldrewey Stearns, an African American Civil Rights leader who suffered from bipolar illness and substance abuse issues).

So this course is reading-intensive. Each class meeting is discussion-based, not lectured-based—that is, the class meetings are conducted as a humanities-style graduate seminar. And because it is difficult to have a seminar with more than nine people, the course is run in a “fish-bowl” manner, which works as follows: two circles are formed, with the inner-circle sitting at the table and discussing the text for the vast majority of the class, while the outer-circle sits in chairs beyond and around the table. At the end of class, everyone gets a chance to speak up. Students rotate session to session, alternating between the inner-circle and the outer-circle.

I have offered this course in May, immediately before graduation. Students have enjoyed ending medical school in such a manner, free from their clinical duties and free to reflect on meaningful questions before they go onto residency. By this point in their medical education, all of these students have worked with patients with mental illness. And many, too, have had experience with mental illness in their personal lives in some way as well. It has been my experience that students do read books—I know this because the three hour seminar meetings would not be sustainable otherwise—and they welcome the opportunity, so long as the material is interesting and important.