Where Melville and Hippocrates Meet

Stephen Sonnenberg has spent the last 50 years working to integrate medicine and the humanities. Now he’s bringing the fruits of his labor to undergraduates.

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By Daniel Oppenheimer
Editor, Texas Health Journal

 
 

In the spring of 1961, when Stephen Sonnenberg was a senior at Princeton, he took an upper-level American literature course in the English Department. It was an odd choice for that particular juncture in Sonnenberg’s college career. He was finishing up a Bachelor’s degree in history, and had also taken the pre-requisite courses to apply for medical school. His humanities professors were encouraging him to purse a doctorate in history. His parents, who feared there was too much anti-Semitism in the Academy for him succeed as a professor, wanted him to go to medical school. He was on the fence.

He took the English course mostly because a friend of his dared him to. It was a course known for culling out the weak—“the organic chemistry of the English department”—and he wanted to prove to himself that he could thrive even in a discipline that wasn’t his primary one.  For his final paper, he took on Herman Melville’s story “Bartleby, the Scrivener,” and it was in the course of writing that paper that he was able to make a decision about his future.

“I remember looking at the increasingly grimy pages of my edition of Melville’s short stories,” he later wrote. “The color was changed by the sweat and dirt that came off my fingers as I worked and reworked the story. At a certain point in time, looking at the top margin of a page, I ‘saw’ the word ‘job.’”

What was striking about this to Sonnenberg, now Professor of Psychiatry, Population Health, Social Work, and Medical Education at The University of Texas at Austin, was that the word “job” didn’t actually appear on the page. In fact, it didn’t appear anywhere in the text, and Sonnenberg hadn’t scribbled it in himself. It was a “visual imagining,” a psychological product of his time wrestling with the story. It was also a clue, he decided, to Melville’s intentions. The lower-case word “job” was also upper-case “Job,” as in the biblical Book of Job.

His brain was trying to tell him something important about what Melville was trying to do.

“I ran with Job and job,” said Sonnenberg.

He got an A on the paper. He also decided to go to medical school.

“This experience, intellectual and tactile, somatic, visceral, allowed me to make that decision,” he wrote. “I wanted to know more about how my own mind and body had worked to create that appearance of a word on a page that told me so much about a short story. There was a relationship between mind, brain, and body that I wanted to explore.”

For Sonnenberg, who was recently awarded a National Endowment of the Humanities (NEH) grant to help develop an undergraduate course sequence that bridges medicine and the humanities, that exploration continues.  

When Sonnenberg arrived in Austin, in 1994, he didn’t have an affiliation with The University of Texas at Austin. He was recruited to Texas, from Washington, D.C., as the Austin affiliate of the the Center for Psychoanalytic Studies in Houston.

“They didn’t have anyone in Austin to train new psychoanalysts,” said Sonnenberg. “So they brought me in to do that job. That’s what I did, along with running my own practice, for about a decade. But I always hoped to connect with the university.”

His first meaningful university connection was with Elizabeth Danze, a professor in the School of Architecture and a practicing architect who integrates psychology and psychoanalysis into both her theory and design. In 2005, the two organized a conference on the intersection of architecture and psychoanalysis, published the proceedings of the conference, and in 2011 began co-teaching a studio course for graduate architecture students.

Each studio course they taught focused on a different population and its built environment needs. One focused on homeless families, another on troubled youth and young adults. Sonnenberg would lead many of the discussions on the psychological and social aspects of the different populations’ experience, and Danze would guide the students as they designed structures not just to physically serve these people but to psychologically heal and nourish them as well.

Another semester’s studio course focused on developing spaces for returning veterans of wars. Students read Tim O’Brien’s The Things They Carried, along with other war literature, and for their final project developed sketches and renderings for what Danze and Sonnenberg called the Veterans Community Park and Pavilion. It was imagined as a center in Austin for integrating veterans’ support services with a community art and humanities space that would bring together veterans with civilians and help “recommunalize” the experience of war.

The Park and Pavilion project, which Danze and Sonnenberg are still working to make a reality, was a continuation for Sonnenberg of a long-standing commitment to working with veterans. These efforts began when he served in the US Public Health Service during the Vietnam War, and first began treating returning vets, and went on to include some of the early research and advocacy that helped establish Post-Traumatic Stress Syndrome as a distinct and legitimate diagnosis. He also taught psychiatry for 13 years at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

In 2009, after the mass shooting at Fort Hood by Army psychiatrist Nidal Hasan, Sonnenberg reached out to UT Austin classics professor Thomas Palaima to see if he’d be interested in writing about the event.

“If things had turned out a little bit differently, I might have known Hasan,” said Sonnenberg. “I taught at the Uniformed Services University of the Health Sciences, where Hasan earned his medical degree, and the world of military psychiatrists is a small one. It’s not hard to imagine, if he’d reached out to the right person in Washington when he was beginning to have problems, that he might have been given my name as someone in Texas to talk to.” 

Sonnenberg wanted to understand better what could have driven someone like Hasan to commit such horrific violence. He turned to Palaima, a scholar of the ancient world, because of conversations the two had had about the ancient Greeks’ experience of violence and war.  

In an op-ed they wrote for the Austin American Statesman, not long after the shooting, the two didn’t blame the shooting on the wars in Iraq and Afghanistan. They located Hasan’s violence, however, in the context of a much larger pool of pain and trauma that was affecting tens or hundreds of thousands of soldiers and veterans. They also contrasted it with the experience of war and trauma in ancient Greece.

“The Athenians, at their height of power, fought a 27-year, all-out war with Sparta,” they wrote. “Athenian losses were staggering, the equivalent of the lost generation Great Britain and Germany suffered during World War I. Yet we have no reports of rogue actions by Athenian soldiers in the field. The few accounts we have of soldiers suffering from war trauma give no evidence that they committed acts of public violence. The Athenians must have been doing something right that we are not.” 

What the Athenians did right, they concluded, was share and process the experience of war at every level of society. Soldiers came from every class and region of Athenian society, with the wealthiest Athenians often serving in the most dangerous positions. When Athens was at war, Athenian cultural and civic life revolved around the experience of war. Greek playwrites, themselves usually veterans, wrote about war. The performances of their plays, often sponsored by the government, were public events of great significance, as were funerals of soldiers killed in action.

“A stunning example of communal participation,” they wrote, “occurred in 415 B.C., midway through their war with Sparta. The citizens of Athens by formal vote had directed Athenian soldiers to destroy the neutral island of Melos, put all its male inhabitants to death, and sell its women and children into slavery. Months later, those very soldiers sat together with other Athenians in the Theater of Dionysus, 14,000 strong, about one-third of the whole adult male citizen population of Athens. They watched a state-approved play, ‘The Trojan Women,’ in which Greek soldiers do the same horrifying things to the men, women and children of Troy.” 

The Athenian example, Palaima and Sonnenberg argued, is a complex one. The Athenians were able to absorb the reality of war so directly because their society was comfortable with brutality in ways that ours isn’t. The citizens had, after all, voted to decimate Melos. But that difference shouldn’t blind us, now, to what they gained from their candor. And the model itself, of recognizing and owning the truth of war and its consequences, should be one that we can admire and maybe even emulate.

Inspired by this insight, Palaima and Sonnenberg began teaching a course on war and violence in the Plan II Honors Program in the College of Liberal Arts at UT Austin. Sonnenberg also began thinking more broadly about ways to connect, for students, not just “the mind, brain, and body” but also the built environment, history, philosophy, and society.

By the early 2010s, Sonnenberg was teaching in both the School of Architecture and the Plan II Honors program. What he wasn’t doing, yet, was focusing on those students who were most like the younger version of himself, aiming toward a career in health but fascinated by the humanities, unsure whether those two things could be meaningfully entwined.

An opportunity to more directly reach those students emerged through discussions with Brent Iverson, Dean of the School of Undergraduate Studies (UGS). In 2015, Sonnenberg began teaching a large lecture course, through UGS, on the doctor-patient relationship.

“It covers the full range of what a doctor can do,” said Sonnenberg, who has now taught the course seven times, typically to 100-150 first-year students. “We talk about nutrition, built environment, war and violence as health care problems. We talk about medical ethics, the Hippocratic oath, the oath of the Geneva Convention, the First Amendment. We talk about the Veterans Park and Pavilion. We do role-playing exercises. The whole spectrum.”

Sonnenberg soon spun off a version of this course for Plan II juniors, and also began applying for grants to do something much bigger.

His hope, which was fulfilled with the recent NEH grant, was to weave all of this work together into a multi-course humanities and medical ethics program for undergraduates. The grant, which was awarded in 2017, enabled Sonnenberg and an “all-star team” of colleagues from across the university to design what is now called “Patients, Practitioners and Cultures of Care.” Currently a five-course sequence, it will launch in fall 2020 as an official Bridging Disciplines Program, sponsored by UGS. The designation will allow students from any School or College in the university to apply to earn a certificate by completing a 19 credit curriculum that will include courses created for the grant and already being taught across the university, as well as research and internship experiences.

Sonnenberg will teach one of the courses, a seminar that will look at interdisciplinary perspectives on health, healing, and the humanities, and he will have a hand in crafting the curriculum for the certificate. The full Bridging Disciplines Program will include courses on health and the built environment; death and dying; communicating with patients; the historical, social, political, economic and cultural foundations of Western medicine; and more. Faculty are being drawn from the College of Liberal Arts, the School of Nursing, the Steve Hicks School of Social Work, the Moody College of Communication, the School of Architecture, the Dell Medical School, and other schools and colleges as well. 

The readings for the courses, collectively, represent an extraordinarily broad and deep education in (mostly 20th and 21st century) social, cultural, and scientific critical thought. Students may read Thomas Kuhn on the history of science, Robert Caro on the great and terrible urban planner Robert Moses, Michel Foucault on the asylum, Elisabeth Kubler-Ross on death and dying, and the poetry of William Carlos Williams and Rafael Campo. They’ll explore the linkage between modern medicine and the construction of the modern self. They’ll interrogate their own beliefs and values about death. They’ll be asked to define and refine what they believe, again and again, across courses and disciplines.

This kind of coordinated, humanities-based education, said Sonnenberg, isn’t just an opportunity for future health professionals to enrich their thinking with humanities content, before they get on to the real work of putting sick people back together. It’s about equipping them to thrive in the rapidly changing health care landscape, to adapt to new challenges, and to reinvent themselves and how they practice over the many decades of their careers.

“As health care providers, we have a special perspective on the human condition,” he said. “We are with people when they give birth, are sick, die. New technology doesn’t lessen the importance of such a perspective. If anything, it means that we need to be more human, more empathetic, more capable of seeing and understanding people in as full a way as possible. That’s what these courses are designed to do, to help anchor students in the humanities so that they can go out and face the world from a position of strength and depth.”