Co-edited with Lawrence Switzky and Alice Flaherty, the forthcoming volume posits a new framework for understanding medicine in relation to performativity, enactment, and imagination. In this critical and timely intervention, Goldman and her fellow contributors ask: how can we reconceptualise of and sustain more ethical forms of care when we understand medicine as a performative, relational practice?
In the first part of the workshop, Goldman introduced the concepts of the medical contract and the imaginative contract: these contracts are distinct but nevertheless coexist in every clinical encounter. These contracts are not alike, and Goldman doesn’t propose to draw an analogy – it is instead a performative intervention that the book proposes, a way of naming and understanding what is already happening. She explained that care happens not through documents and data, but through an embodied repertoire of such performative behaviours and aspects as gestures, timing, tone, silence, and repetition.
According to Medicine as Theatre, care is both imaginative and enacted, not interpretive, and much of this argument is substantiated by Arthur Kleinman’s critique of narrative medicine and the idea that patients are to be read like a book. Kleinman suggests that we impose a temporal limitation on the “illness narrative”, as stories can open, but do not sustain, care; the deciphering of the patient is, additionally, a physician-centred, bureaucratic exercise. “Stories do not care for patients, people in relation do,” Goldman explained.
Medicine as Theatre instead proposes that care focus on presence, witness, and action. In order to think about this further, workshop participants reflected on times when they had felt cared for, noting the importance of actions that made this matter. In a reversal of the understanding that empathy primes action, Goldman drew on recent neurological studies that suggest that actions instead generate the feeling, suggesting the primacy of the performative to improving care and medical outcomes.
Then, in an exercise led by Parkins to illustrate the theatrical dimension to this relationship between empathy and action, workshop participants were led through a series of performative exercises that drew on the techniques of Michael Chekhov, developed in part as a response to the famous methods of Konstantin Stanislavski, which required actors to draw from their own memories and experiences to embody an emotion – and which could be emotionally exhausting and traumatic for an actor to endure. Chekhov instead focused on the physical body and sensation over psychology in order to safely and effectively draw out the emotions that the actor needed to embody for their role. Through this exercise, participants were asked to think about what might happen to care if we consciously activate this performativity.
What other roles, then, do we need to rethink in medicine when we think of care as being performative? The rest of the workshop explored how to think of the physician, the patient, and the host of ensemble actors – supporters, carers, and wider communities – involved in the process of care. The physician must be decentred, and the patient’s own agency emphasised. As argued by Deborah Ocholi’s chapter in the book, medical schools must not discipline the linguistic and gestural repertoires of students who are subjected to a “hidden curriculum” which professionalises them in ways that inhibit the physician-patient relationship. As argued in the book, a patient’s agency is distorted, but not negated, by illness. Workshop participants thought about the triangular, performative relationship between physician, ailer, and carer to think about how performance, not narration, demonstrates and facilitates care. An example Goldman gave was the performance of a carer complaining of something to a doctor on behalf of the patient, while the ailer demurred. This kind of collaborative role shifting allows for the carer to voice the complaint, while the ailer can be brave.
The talk was striking for how Goldman conceives of her work as a collaborative project as a methodological extension of her focus on the interpersonal, community-focused model of care whose especial intervention is to unhide the overlooked role played by actors such as carers. She emphasised and drew from the other contributions to the volume that have enriched her retheorising of performative care: such collaboration is ongoing, and she eagerly solicited contributions from workshop participants for their knowledge and experience. She closed the workshop by drawing from book contributor Doris Sommer, thinking about how the form of improvisatory forum theatre has provided a space for the collaborative enactment and facilitation of community solutions, and may well be beneficial to incorporate into medical schools to further draw out the performances of care that theatre might inspire in medicine.
Ultimately, Goldman argues, by reorganising the role of the physician and divesting from the concepts of empathy, mastery, and closure that have dominated popular thinking on effective medicine, we can bring out what is really needed in the practice of care: presence, the rituals of supportive care, and the agency of the patient and the community, whereby the patient becomes not the subject of a health intervention, but an active co-creator of their future. By exceeding the curative script and instead deliberately defining care as a durational, shared, staged encounter involving patients, caregivers, clinicians, institutions, and communities, we can stage new possibilities and solutions.