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Sonny’s Blues: A Template for Eliciting Patient’s Narratives

Marcus Mosley // In its portrayal of the evolution of one person trying to understand another’s narrative, James Baldwin’s short story “Sonny’s Blues” models a number of ways in which doctors can cultivate more productive relationships with patients, through both careful language choices and emotional attunement. In order to fully understand a patient’s narrative and correctly diagnose and treat them, doctors need to be attentive to both verbal and non-verbal cues. Observing a patient’s body movements in space can provide valuable information, like a lagging rigid gait (Parkinson’s disease) or a stooped and stiff position (Schizophrenic catalepsy). But it is facial expression that provides the most emotional context for a person’s narrative. In “Sonny’s Blues,” Baldwin keenly focuses on the use of the words “face” and “faces,” which combined are the second most-used noun in the story (41 times). This allows the reader to better gauge the emotional pulse of the story. Meanwhile, analyzing the syntax of the sentences provides a useful tool for determining effective and ineffective dialogical techniques to use in providing space for a patient to reveal their most authentic self.

In the opening paragraph of “Sonny’s Blues,” the narrator describes the faces of other people he is observing in a subway car as well as his own face as being “trapped in darkness” (122). Shortly thereafter, however, “face” is deployed in a more focused and descriptive way. The narrator describes his brother’s face as a young boy as being “bright and open” and having “a lot of copper in it,” as well as “wonderfully direct brown eyes” (123). The contrast between the present darkness in the narrator’s face and the past brightness in his brother’s face not only implies that his brother’s face is, for some reason, no longer “bright and open,” but also hints that the brother’s condition may be the cause of the narrator’s melancholic expression. Both assumptions are then confirmed, when the narrator says, “I didn’t want to believe that I’d ever see my brother going down, coming to nothing, all that light in his face gone out, in the condition I’d already seen so many others” (123). 

Here, a musical rhythm of the piece becomes apparent. If we imagine that each time the word “face” or “faces” is used represents a note, and that its emotional context determines whether it is high-pitched (positive particles/adjectives) or low-pitched (negative particles/adjectives), we can observe a consistent pattern of oscillation in nine sentences spanning roughly sixty paragraphs: “darkness;” “bright and open,” “wonderfully direct brown eyes;” “light…gone out;” “laughingly,” “smiled;” “terrible closed look;” “smiling;” “darken;” “vivid,” “laugh;” “darkening” (122-130).   

The monotony and stagnation of this up-down-up-down repetition resonates with the back-and-forth conflict between the narrator and his brother, which closely resembles the dilemma of when physicians and patients have competing views as to the best treatment plan. The narrator’s brother, Sonny, who is involved in the street life and was arrested for using heroin, is trying to find a purpose for his life and a way to alleviate his suffering. When a conflict arises between Sonny and the narrator regarding his appropriate course of action, the word “face” clues the reader into the possible solution:

My mother smiled as though she were amused at something she saw in my face. Then, “You may not be able to stop nothing from happening. But you have to let him know you’s there” (133).

Here, the narrator observes the “smile” on his mother’s face and interprets it as a response to something in his own face; that is, his mother can read him. She is attuned to his emotional state and responds accordingly—a skill that the narrator has not yet developed with regard to his brother.

This lack of attunement on the narrator’s part corresponds to some common mistakes that can happen in a patient-doctor encounter. After the funeral of the narrator’s mother, Sonny and the narrator are alone in an empty kitchen, and the narrator intends to find out more about his brother. The first thing he asks is, “What do you want to do?” (133). The beginning of the sentence uses a “wh-” pronoun, which makes it an open-ended statement. Doctors usually start conversations with this type of question, for example: “What brings you in today?” This is a great start as it allows a doctor to understand a patient’s expectations for the visit. Sonny replies, “I’m going to be a musician.” The narrator remembers that Sonny had previously brought a drum set, and replies, “You mean, you want to be a drummer?”

There are three flaws in this response. The first is starting the sentence with “You mean,” a gesture that corrects the person, implying that his/her previous response was not “good enough.” In patient-doctor dialogue, this can lead to the start of some resistance from patients. The sentence would be less violent if the verb had come before the pronoun: “Do you want to be a drummer?”

The second mistake is that even with this change, an assumption is made and new information is introduced into the dialogue when the narrator suggests the possibility of his brother becoming a drummer. Sonny responds that he doesn’t think he will be a good drummer, but thinks that he can play the piano. Because the narrator inserted new information based upon an assumption, Sonny is forced to refute that assumption (not controlling the narrative) and then give the correct answer. The narrator in this scene, like a doctor speaking to a patient, should not be the one introducing new information, if possible.

The third mistake is that the question is binary, demanding a yes or no answer. All of this can be fixed if the narrator adds a “wh-” pronoun and uses the same noun (musician): “What kind of musician do you want to be?” In response to Sonny wanting to play the drums, the narrator does not show nonjudgmental regard, but says, “Be serious,” a verb followed by an adjective (134). By contrast, as part of motivational interviewing, doctors nonviolently assess a patient’s “seriousness” by including a 1- 10 confidence scale with the question, “How confident are you?” This replaces the adjective before the verb and is also open-ended. Showing nonjudgmental regard, asking open-ended questions, placing adjectives before verbs, starting a sentence with a “wh-” pronoun, reflecting the same nouns (information) given, and placing verbs before pronouns are some linguistic tools that doctors can use in eliciting narratives from patients.  

This conflict around Sonny wanting to be a musician then builds up throughout the brothers’ conversation. Sonny, looking “trapped and in anguish,” tells his brother that he is thinking about leaving Harlem and joining the army (136). The narrator tries to reason with him, saying, “You haven’t even finished school….and if you really wanted to be a musician, how do you expect to study in the army?” (136). Sonny and his brother keep talking past each other, with Sonny saying he is not learning anything in school. The narrator says he knows how he feels but that he is going to feel sorry if he doesn’t finish school. He then says, “I swear I’ll help you do whatever you want to do” and “Will you please [finish school]? For me?” In the dialogue that follows, it is the absence of the word “face” that represents that there is no longer a dialogue, an up-and-down, but rather a disconnect:

He didn’t answer and he wouldn’t look at me.

“Sonny. You hear me?”

He pulled away. “I hear you. But you never hear anything say.” (137)

This conflict ends with Sonny sighing and giving in, saying, “I’ll try” (137). The narrator later reflects that “there wasn’t any way to reach him.”

This narrative provides a perfect lens to examine the dynamics between patients and doctors. Like the narrator, doctors display paternalism and employ the techniques of rationalization, bargaining, and guilt to prod noncompliant and “difficult” patients into adhering and accepting their prescribed treatment plan. Like Sonny, patients give up voicing their concerns and reluctantly give in. Doctors tend not to follow the advice of Sonny’s mother that the end goal isn’t necessarily trying to stop things from happening, but rather just being there and being present. Even with the relatively new approach of motivational interviewing and starting with a psycho-social history instead of a biological one, doctors like the narrator may even display empathy by saying, “I know how you feel,” but it is not real empathy because they are not present. This makes for frustrated patients and doctors, missed diagnoses, and poor prognoses. 

But there are ways out of such an impasse. Deep introspection is what finally opens the narrator’s eyes as to the experience and narrative of his brother. Later, when the narrator buries his daughter, he thinks about Sonny, reflecting that “My trouble made his real” (139). The narrator’s motivation to really understand his brother’s life is a result of realizing the inevitability and randomness of death. After this moment, the narrator becomes more present, observant, and nonjudgmental. In this part of the text, the word “face” is used several times, alone without any adjectives—“I watched his face.” “His face didn’t tell me.” “I just watched Sonny’s face.”—conveying a sense of being deeply present in the moment.

Furthermore, in the dialogue between Sonny and the “converted” narrator, the majority of the questions are open-ended. At one point, the narrator says, “something told me that I should curb my tongue, that Sonny was doing his best to talk, that I should listen” (142). Employing these empathetic techniques, the conversation is able to move beyond the superficial bickering and into what is really at the center of it all: suffering. Sonny tells his brother that it’s “repulsive” that people have to suffer so much and that he does not believe there is a way to stop suffering. Baldwin emphasizes the importance of silence and listening with an ironic (and clever) choice of words for the narrator. He writes, “I realized…..the fact that I had held silence — so long! — when he had needed human speech to help him” (143). This section of dialogue culminates with Sonny sobbing — finally opening up and showing emotion. 

In the closing paragraphs of the short-story, the narrator finally breaks into Sonny’s world gets invited to see him perform at a nightclub—or, as the narrator calls it, “his kingdom” (145). Baldwin uses music and Sonny playing on the piano as a metaphor for Sonny’s emotional evolution. 

All I know about music is that not many people ever really hear it. And even then, on the rare occasion when something opens within, and the music enters, what we mainly hear, or hear corroborated, are personal, private, vanishing evocations. But the man who creates the music is hearing something else, is dealing with the roar rising from the void an imposing order, more terrible because it has no words, and triumphant too, for that same reason (146).

This beautifully crafted sentence reflects the dialogue between Sonny and the “pre-converted” narrator — up-and-down, chaotic at times and at a standstill: “He and the piano stammered, started one way, got scared; stopped; started another way, panicked, marked time, started again; then seemed to have found a direction, panicked again, got stuck.” In the next sentence, the word “face” is used — the narrator says he has never seen Sonny’s face like that before. The narrator is finally able to not only see his brother’s face, but others’, too. In watching Creole’s face, one of the other musicians, the narrator—whose senses are opening up to the unspoken cues and gestures—says he sees something he hadn’t heard. In the story’s penultimate paragraph, the word “face” is used two more times. The first time is in regard to Sonny’s face while he is playing the piano: “Yet, there was no battle in his face now. I heard what he had gone through, and would continue to go through until he came to rest in the earth.” This represents the true culmination of understanding for the narrator. Not only does he understand the past and current pain of Sonny but also the pain, hurt, and struggles he will deal with for the rest of his life. The second time, the word “face” is used is in reference to the narrator’s mother: “I saw my mother’s face again, and felt, for the first time, how the stones of the road she had walked on must have bruised her feet” (148). Again, the narrator is able to observe the faces of others and truly empathize and understand their pain. 

The art of medicine is more than possessing scientific knowledge. It is also about listening, having a human connection, being present, and having the capability to experience the pain of others—being able to gaze into a patient’s face and understand more than they could tell you in words. Medicine is like jazz: it involves emotion, improvisation, listening, and being aware of the context of where others are coming from, as musicians must know the key others are playing in. Just as the same jazz piece and melody can gain new meaning each time, so can doctor-patient interactions. “Sonny’s Blues” provides a template for how physicians can—instead of bargaining, rationalizing, and manipulating patients into the desired treatment plan—be still and present, exhibit empathy (by looking inward), and engage in nonviolent communication.  

Works Cited

Baldwin, James. “Sonny’s Blues.” Going to Meet the Man. Ed. Vintage Books, 1957. 122-148.

Image credit: Penguin Books (via Amazon).

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