ESC: English Studies in Canada

On reading my essays over, I found that I was talking most of the time about what poetry cannot be expected to do to save mankind from the disasters in which poetry itself must be involved: that, I suppose, is a “limit” of poetry … I am saying in this book, with very little systematic argument, that it is neither religion nor social engineering.

Allan Tate, The Limits of Poetry

Poetic knowledge is born in the great silence of scientific knowledge.

Aimé Césaire

First identified in the psychological literature over seventy years ago by Frenkel-Brunswick, Blake, and Ramsey but further codified as a variable of personality by Stanley Budner in 1962, ambiguity tolerance is a relatively late-blooming subfield of study in academic medicine, with the number of papers published on the topic in the past decade increasing by a factor of three (PubMed). Often, these papers call for further study of ambiguity tolerance for the reason that the ability to tolerate diagnostic ambiguity without undue discomfiture is not well taught in modern [End Page 101] medical education (Weissenstein, Ligges, and Brouwer; Geller). Medical educators have long been calling that need pressing, in particular during early training (Bleakley and Brennan; Luther and Crandall), because the stakes are high. As Atul Gawande has written, “The core predicament of medicine—the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing—is uncertainty … Medicine’s ground state is uncertainty. And wisdom—for both the patients and doctors—is defined by how one copes with it” (229).

Unfortunately, medical students often cope poorly with ambiguity. The consequences of intolerance of ambiguity in medical students are well-known, including increased psychological distress (Ianello et al.; Lally and Cantillion; Simpkin and Schwartzstein), but also avoidance of complex patients like addicts and the poor (Wayne et al.). Biomedical attempts to address the negative affect in learners enmeshed in ambiguous diagnostic circumstances, such as Bayesian probability as per evidence-based medicine, act to reinforce the certainty paradigm. The inability of biomedicine to fix a problem intrinsic to itself (a self-referential power regime predicated on phantasmic certainty) has instigated a nascent literature on the role of Keats and negative capability when it comes to cultivating the tolerance of ambiguity in physicians (Lysaker, Roe, and Lysaker; Unterhalter; Wear; Holt; Bleakley, “‘Your creativity or mine?’ ”). To date, not much has been published bringing Keats’s ideas, as well as the scholarship from the health humanities, in conversation with the literatures of Canada. Therefore, I bring forward some concepts from the health humanities in order to interpret “Menstromania,” the first poem in Emily Skov-Nielsen’s debut collection The Knowing Animals, to show how Keats’s idea remains relevant in the present moment of medical education but also to productively complicate Keats’s idea with the emerging concept of translationality in the health humanities. My goal is not to recapitulate a perennially passing era of the health humanities, in which I ameliorate a lack in biomedicine by adding the humanities as a supplement, but, rather, to argue boldly— translationally—that poetry can change medical students’ experience of ambiguity. To accomplish this, I must first spend considerable time defining and delimiting the discourses of “biomedicine” and “poetry.” I will then provide a brief geneology of the emerging field of translationality to frame the border crossing to come. Biomedicine’s adversaries, uncertainty and error, are productively explored using Keats’s concept of Negative Capability as it can assuage learners left in a Bayesian uncomfortability. With theoretical concepts adequately defined, I turn to a unique reading [End Page 102] of Emily Skov-Nielsen’s “Menstromania,” developing the theory already presented while augmenting the reading with concepts from feminist medical sociology. At the heart of my article is this question: How can poetry rightly and productively appear to medical students as a biomedical body to be interrogated, but how also can it transcend traditional medical modes of inquiry such that it problematizes the original terms of inquiry while offering other...