KNOWLEDGE of the humanities helps to create and to A modify the human values and judgmental attitudes that affect almost every aspect of the professional nurse’s performance. Nurses have to relate to people with varying values and lifestyles, and, as Marie Czmowski (1974, p. 192) has noted, “nursing educators must assist students in the clari- fication of their own values in preparation for nursing prac- tice in a society undergoing rapid change and plagued by value crisis.’’

Holly Skodol Wilson (1974) makes a special plea for nursing as the most humanizing element in the health care system: “In a society of machines, in institutions of healing run by machines, the nurse has a vital part to play in pre- serving the human aspects of patient care.” (p. 414) Wilson says that “by the almost exclusive emphasis on natural and social sciences a crucial element has been left out of the image of reality presented - the constitution of human nature. . . . The humanities suggest a special potential for

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contributing a side of learning that is by no means contrary or opposed to the spirit of science, but rather one which is complementary.” (pp. 407-408)

However, the question is not whether nursing educators will require the humanities in their degree programs; most universities and colleges have basic humanities requirements for all students. The real issue is how administrators and educators can best use the humanities to benefit the nursing student. Too often nursing educators have used the distinc- tions between disciplines as an excuse for rubber-stamping extra-departmental programs when they should be involving themselves in restructuring and redirecting those programs as interdisciplinary projects so as to maximize their potential for improving students.

Some work has already been done concerning the general needs of nursing students that can be met by the humanities. Wilson maintains that, in addition to the expected nursing curriculum, the student needs “1 ) an opportunity to confront and develop awareness of her own value system; 2) an ability to separate herself, her values, and her experiences from those of others; 3 ) and a means of accepting, allowing, and integrating the different values and behaviors of others within herself. . . . As professional nursing curriculums are now conceived, there is little emphasis on providing learning experiences that will prepare the sensibilities of a student nurse to face [previously unmet] situations.” (p. 415)

For instance, nurses must learn to respond to the needs of a dying patient experiencing the grieving process without either closing themselves off from the client’s feelings or experiencing the anguish and anxiety themselves. Wilson notes that responding to a work of art requires the ability to separate oneself from the work and to achieve a position

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of critical distance from it. “The process of separating one- self enables the reader or listener or audience to delineate more clearly the otherness of the experiences with which art deals. Once the student understands the terms of the work, she can focus on discovering her own personal re- sponses, values, and feeling.” (pp. 415-416)

We would like to show how Wilson’s excellent general ideas about instruction in the humanities can be applied to nursing education. Although Czmowski recognizes the need for directing the nurse’s value formation and the functioning of values in nursing practice, she relies almost exclusively on analytical discussion and role playing as the tools to achieve this end. (1974, p. 203) Unfortunately, neither method is completely effective. Analytical discussion removes values and actions from their experiential context, and the student is often left with a set of abstractions which she cannot easily apply. Role playing relies on the imagination and knowledge of students - and teachers - who may never have ex- perienced anything comparable to the situation they are involved in re-creating. For instance, it is virtually impossible to communicate a real sense of the schizophrenic patient’s perspective of a nursing situation by either of these methods. Literature, on the other hand, is man’s ultimate tool for com- municating experience in a comprehensible and structured way.

Language has three primary modes: 1 ) as a technical symbolism to communicate facts; 2) as propaganda to change perceptions regardless of the facts; and 3) as a means of communicating an actual sense of experience, often through non-logical associative processes. (Perrine, 1973) Because of the way the professional nurse, in both clinical and ad- ministrative settings, must use language in her work, nursing

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generally subscribes only to the use of language as a technical symbolism and tends to group together the propagandistic and literary uses of language. However, the rejection of the non-logical or emotional aspects of thought and life, which often cannot be presented convincingly in an analytical fashion, is not a clarification of reality but an essential falsification of it.

Nurses are taught to evaluate clients in terms of normative behavior that can be assessed “objectively.” Their mistrust of personal, more subjective feedback from the client himself is partly a result of how they have been taught to regard non- technical language. The case studies nursing educators have used to teach students about clients are adequate for relaying the idea of “what happened.” But educators have ignored literary works that describe similar situations and suggest the dynamics of the psycho-social relationships which motivate the subject’s behavior, or in other words, “why it happened.” The case study often takes the client’s perception of his own situation for granted, but literature generally presents a thorough examination of the subject’s perceptions and ex- periences. Case studies, whatever their claims, are inevitably presented from the practitioner’s point of view, whereas literature is firmly centered on the perceptions of the subject.

Franz Kafka’s novella The Metamorphosis is, for example, an examination of a modern businessman’s alienation from his private needs. Gregor Samsa, a man in his late twenties, works at a job he dislikes in order to support his sister and mother and his father who retired early because of poor health. The conflict within Gregor is irresolvable and might normally manifest itself in affective symptoms such as cata- tonia. Kafka goes one step further and externalizes Gregor’s psychological-emotional state in the first line of his story:

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“When Gregor Samsa woke up one morning from unsettling dreams, he found himself changed in his bed into a monstrous vermin.” Socialization teaches us to deny the ego the “selfish whim” of personal gratification, but the ego will eventually reassert itself: Gregor is so distraught with guilt over his desire to quit his job that he externalizes his desire as belong- ing to a “monstrous vermin.”

Kafka communicates the precise details of Gregor’s ex- perience : his loneliness, his complete helplessness despite his best efforts to rectify the situation, his increasing sense of alienation from his family, who refuse to recognize their roles in his metamorphosis. As it turns out, the father is capable of working, and the family are able to find the means to support themselves without Gregor shouldering all the bur- den. When Gregor finally dies, his family breathe a collective sigh of relief and set about the proper business of finding a husband for the daughter.

The Metamorphosis goes far beyond conveying a vivid sense of the inner reality of a psychologically disturbed per- son. It reveals the common, everyday situational traumas that are often inflicted unknowingly by family and employer on a sensitive individual. The family could have saved Gregor if they had been willing to recognize his need to find more satisfying work as more than just a selfish whim. Kafka’s story could be used to great advantage in conjunction with R. D. Laing and A. Esterson’s case studies of family situa- tions in Sanity, Madness and the Family, which they believe contribute to schizophrenic behavior. Such course work would benefit not only nurses working in psychiatry, but also those involved in community health care, family practice, or any aspect of hospital nursing that involves the nurse’s interaction with the client’s family.

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The pathological family situation in Joseph Heller’s recent novel Something Happened is described in less gro- tesque, more physically realistic terms, The protagonist, Bob Slocum, conducts a lengthy introspective enquiry into the genesis of his problems without solving them, but his failure is very enlightening to the reader. Slocum is a middle-aged, upper-middle-class business executive with a young son who is “growing away” from him, a teen-age daughter who both loves and hates him violently, and a wife who drinks to forget that he doesn’t love her. The novel vividly examines a con- temporary man’s alienation, his precarious sense of identity, his incapacity to love, and his general fears of loss, betrayal, old age, and death. His relationship to his external world, although completely normal on the surface, is as grotesque and warped as Gregor’s, and nothing that Slocum can do in his external world seems to have the power to abate his inner fears.

The possibilities for employing literature and film to clarify and communicate experiences valuable to a nurse’s education are boundless. The poetry of Sylvia Plath and the self-portrait of her mental breakdown in The Bell Jar are ideal for this purpose. Harold Pinter’s play, The Home- coming, is difficult to comprehend from traditional literary perspectives but is surprisingly accessible when viewed from the standpoint of group dynamics. An excellent study of the problems of aging is presented in R. W. Murnau’s classic silent film, The Last Laugh, which uses innovative subjective camera techniques to create an old man’s perspective for the audience.

Perhaps an over-obvious place to begin a course in the use of literature in nursing is One Flew Over the Cuckoo’s Nest. Milos Forman’s film is preferable, for this purpose, to Ken

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Kesey’s novel because Forman minimizes the novel’s use of literary allegory and distorted perspective and concentrates on the practical situation of life in the psychiatric ward. Perhaps many nurses will be shocked at the suggestion that they could learn anything from this obviously one-sided portrayal of the conflict between the patients and the institution, epitomized by Big Nurse Ratched. Such surprise is the result of self- protective blindness.

The film, One Flew Over The Cuckoo’s Nest, shows Nurse Ratched as a highly efficient and capable head nurse. Further- more, she is an extremely intelligent woman who, one might assume, resents the fact that she is trapped in a man’s world and accordingly extracts retribution, if unconsciously. The horrifying truth is that Nurse Ratched is able to justify every one of her actions as correct nursing procedure which should be beneficial to both the institution and the majority of the patients. A medical board of inquiry into the spate of violence that results in death and lobotomy would no doubt find Nurse Ratched blameless. Yet the audience is overwhelmed and outraged by her guilt.

Nurse Ratched’s failure has nothing to do with any defi- ciencies that could be rectified by many current nursing curriculums: Nurse Ratched was undoubtedly an A student. She does not, however, appear to have real insight into her own values and is completely unaware of her misplaced hatred for her patients that is brought to light in her conflict with McMurphy. Nor does she possess the ability to separate herself, her values, and her experiences from those of others, despite the glass wall of her office that physically separates her from them. Finally, she does not possess the means of accepting, allowing, and integrating within herself the dif- ferent values and behaviors of McMurphy and others. In

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short, Big Nurse is a perfect example of a nurse deficient in the kind of insight Holly Skodol Wilson says comes from a humanities education.

Many colleges and universities require all their students to take introductory literature and humanities courses. The use of career-oriented materials such as those described in this article would not detract from the specified objectives of the literature courses, especially those designed as aids to teaching composition and basic literary analysis. Ob- viously, the type of course we are suggesting could be ex- pected to enhance the student’s interest in what often seems a somewhat irrelevant educational experience. The end result of this interdisciplinary concept would therefore be beneficial to both departments and especially to the student.

Nursing educators must stop excusing themselves from the responsibility of trying to participate in the initiation of such programs because they involve an “alien” department. Learn- ing in itself is not compartmentalized, but affects the whole individual - and, for that matter, the whole of society. After graduation, the nurse practitioner must grapple with complex and controversial questions of value such as euthanasia and abortion. If she is to be a facilitator in the decision-making process, she must be aware of her own feelings and values toward these issues, as well as those of other individuals and groups.

REFERENCES

Czmowski, Mane, “Value Teaching in Nursing Education,”

Perrine, Laurence, Sound and Sense, New York: Harcourt, Brace,

Wilson, Holly Skodol, “A Case for Humanities in Professional

Nursing Forum, 13, No. 2, 1974, p. 192.

Jovanovich, 1973, p. 4.

Nursing Education,” Nursing Forum, 13, No. 4, 1974.

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