“Just because we have birds in us, we don’t have to be cages.”

—Dean Young

If you’d welcome the risk of your own undoing, meet René Magritte. The strangeness of his work subverted us. But it also sparked a new teaching strategy: that of facilitating medical learners’ encounters with composites, artworks consisting of incongruent elements. We’ve seen these encounters yield several benefits: learners often reexamine their habitual ways of perceiving, question the basis of their different emotional responses to art and to patients, and seek greater coherence between the disparate parts of their emerging professional identities.

It was an overcast Wednesday when we visited the Menil Collection, a world-renowned art museum in a leafy Houston neighborhood. As medical humanities professors, we infuse medical training and practice with content from many disciplines, including literature, philosophy, and the visual arts, though we have no special training in the latter. Several times annually, in exhibit spaces and classrooms, we discuss art with trainees–but that Wednesday, we went to the Menil without our students. Like carnival ringmasters tired of the same old show, we went searching for new acts.

In the Surrealism gallery, we saw sculptures by Ernst and Tanning and passed paintings by Lam and Tanguy. Walking on, we discovered a room devoted exclusively to Magritte, which included a tarnished sculpture, about five feet tall. We found it weird and striking.

Before consulting the placard, we did what we expect of medical learners: observe the work silently, then pose questions and assemble evidence to support an interpretation. This process, we’ve found, courts a lively mixture of discomfort and wonder, and by adopting the same approach we expect of students, we’d be testing the waters. 

“How would you describe this thing?” one of us asked.

And off we went, talking about the sculpture’s texture and composition. We squatted to observe the figure’s posture, which seems poised between rest and ready-to-act. From there, we examined the trousers and shoes: not exactly attire for hard labor or a strenuous hike. Perhaps this is a traveler or someone pausing to rest during a stroll.

“Any thoughts on what the figure’s hands are holding?”

The satchel, we noticed, seems too small for a multiday trip. It looks like canvas or leather. Peering closely, we saw that the bag is cinched with thick sutures. Similarly, the tip of the figure’s cane is hovering just off the ground, as if they were about to stand. Maybe the traveler just finished a picnic and is ready to resume their journey.

“What strikes you as surprising about this sculpture?”

What puzzled us most is that the figure is human-shaped, but with two exceptions. Where we would expect to find a head, an empty hat rests on a cape, and instead of a torso, we saw an open birdcage with two birds eyeing each other–one squats inside the cage while the other perches on an external platform. The cage, we thought, could be a clever twist on the human ribcage, but we weren’t sure what to make of the missing head. After speculating for a few minutes, we could no longer bear the suspense. We consulted the placard.

Le thérapeute,” read one of us (W.N.), affecting a charming French accent. “Which they translate as The Healer.”

The figure appeared in a new light: the composite is some type of therapist, gripping what might be a medical bag.

The next step seemed clear: given the piece’s title, shouldn’t we wonder what this sculpture suggests about a healer’s identity or work? Maybe not. Like the odd titles of paintings around us in the Magritte gallery, this sculpture’s title, we thought, might have been chosen to confound viewers. For example, instead of representing a healer, could the sculpture also function as a critique of the profession? We were facing a riddle, which we sought to solve from our admittedly biased perspective: teachers interested in prompting discussions about medical practice and illness experiences.

We tried to start fresh by focusing on specific features. To help us make sense of the sculpture, we considered the two birds to be of particular importance, given their central position. “What do birds symbolize?” we asked. Freedom, for one. Resilience. Detachment. The human spirit? And these particular birds, which resemble doves, could also allude to peace. Such associations, we realized, were complicated by the cage’s presence. But, once again, what might any of this have to do with being a healer? To answer, we reverted to our specific agenda: finding fodder for conversations with medical learners. We began speculating, just as we would invite trainees to do.

“Well, medical training has boundaries,” one of us threw out. “Like a cage. So, what if each bird is the healer at a different stage of a career?” In that case, the bird inside the cage, we imagined, could symbolize the healer who’s still in training. With its body stretched and canted forward, this internal bird looks ruffled. And for good reason: it must endure training’s rigors and constraints. However, as a shelter, the cage is also beneficial: to some extent, it protects the trainee from making mistakes that would harm patients and the profession. Viewed in this way, the cage is both restriction and refuge.

Similarly, the external bird could be seen as the healer in a mature phase of their career. Having advanced beyond the bounds of training, this healer is perched comfortably outside the open cage door. While the internal bird is seated near where the human figure’s heart would be—an allusion, perhaps, to the prominence of the trainee’s individuality—the mature healer is “external,” in the sense that their personality has been thoroughly blended with their professional persona. This bird sits at ease because it has succeeded in learning the practices of seasoned healers. Gazing back at a younger self, this mature healer could be reflecting on lessons learned.

We pressed on to consider the figure’s other shocking feature: the absence of a human head. Working in settings of high-tech, evidence-based teaching and practice, we are primed to think of healing as primarily an intellectual endeavor. And yet, there we were: gazing at a headless figure labeled The Healer. How could we make sense of that? And then a more unsettling question struck us: what if decapitation was the point? In other words, had the figure’s human-like shape fooled us into thinking that the birds and cage carry some significance for healing as a personal act when, instead, they suggest human irrelevance? For example, what if the birds symbolize natures healing power—a force to be liberated from professional dictates and red tape? We needed more time to ponder.

These kinds of encounters in art museums are unsettling precisely because they disrupt or make strange our habitual ways of perceiving. Arno Kumagai and Delese Wear point out that art can defamiliarize ordinary objects and ideas. These two leaders in medical education highlight the value of literature and the visual arts for prodding learners to rethink their “taken-for-granted assumptions, unconscious biases, and unquestioned attitudes that may distort and dehumanize relationships and interactions in medical care” (974).

Kumagai and Wear do not propose a specific method for selecting works of art that might spark experiences of defamiliarization. Instead, they advocate broadly for exposing learners to works that will lead to a “confrontation with the unknown,” provoking in them “a state of cognitive disequilibrium” (974). It was in that spirit of openness to confrontation with the new and the vexing that we went to the Menil. And in the end, our experience with Magritte’s sculpture revealed a reliable way of making strange: namely, encountering composite works of art. What’s essential to a Magritte composite, says the artist Desmond Morris, is the fact that it combines “two different things as one,” such as a birdcage and human figure (159). In this way, composites generate unique meanings: they are, irreducibly, amalgamations—not separate parts. The amalgamation’s meanings will always exceed what its individual parts signify on their own. When Magritte fused incongruent objects to produce his composites, he took familiar items and synthesized new entities, transforming the known world (Chadwick). As a unique synthesis, a composite reliably offers a strange experience—an encounter with something found neither in nature nor in a world of mass-produced items.

The concept of a composite work of art is itself fittingly ambiguous. To see this, consider three forms that composites can take, across different genres and mediums. In Frida Kahlo’s self-portrait, The Broken Column, a fractured pillar replaces her spine. Here, as in Magritte’s The Healer, a body segment is replaced by an object. In the film Lars and the Real Girl, alternatively, the composite is a relationship: a delusional man believes he has a human girlfriend, but “she,” in fact, is a sex doll. And, in another cases, a composite is the result of function. For example, in George Saunders’s story, “The Semplica-girl Diaries,” the “labor” that immigrant workers perform is that of being displayed as lawn ornaments. In each case, a composite is created in a different way: a new part, a new relation, a new function.

Such variety, we’ve found, is useful in teaching. Visiting art museums with trainees, we often rely on museum educators to select works that stimulate defamiliarization. On one trip, they chose a composite: Grupo Mondongo’s Calavera 4. Composed of iconic images from history, mythology, and pop culture, the calavera rests atop a Pac-Man gameboard. Trainees marveled at the sculpture’s complexity, which quickly turned into a scavenger hunt as they called out familiar images. Amid the boisterous shouts of recognition, the art educators used Visual Thinking Strategies—just as we did, regarding The Healer—asking, “What is going on in this image?” “What do you see that makes you say that?” and “What else can you find?” (Housen 2002). These questions urge trainees to observe more carefully. Instead of rushing through, they linger. With time and encouragement, they can develop “thinking dispositions,” which enable them to detect subtle meanings (Perkins 1994, 4). For example, a closer look at the calavera reveals the Tower of Babel, currency symbols, See/Hear/Speak No Evil monkeys, religious icons, clocks, and more. Next, as medical humanists, we asked related questions about language barriers, insurance companies, medical ethics, spirituality, and dealing with time pressures. Afterwards, trainees compared their experience of viewing art to medicine’s clinical gaze, which reduces humans to biological objects (Foucault 1974). We encouraged them to counteract that dehumanizing gaze by finding similarities between the mixed emotions they felt while considering the calavera and what they feel during patient encounters they find challenging.

For many trainees, experiences like the one described above are not idle exercises. For them, interactions with composite works of art have the potential to play a significant role in their professional identity formation, aiding their quest to integrate this new identity with their pre-training self. Many medical students and residents experience their own identity as a troubling composite of a pre-training self and the professional they are becoming. Medical students, for example, often undergo a process of identity formation in which they “refine, reject or internalize new values, practices and behaviours while reexamining pre-existing ones” (Sarraf-Yazdi et al 3516). Similarly, any composite work of art will contain surprising elements or novel combinations while alluding to features that have been replaced or suppressed. For a trainee, freedom to reflect on those disjointed components could serve as encouragement to contemplate aspects of their pre-training self that they want to retain and perhaps even integrate with medicine’s professional norms (Bhatia-Lin et al). This particular kind of self-reflection, we hypothesize, can be prompted more directly by teaching with composites than with works in other forms. If that’s correct, composites could come to secure a special niche in medical humanities pedagogy.

Because it is titled The Healer, Magritte’s composite is perfectly primed to send medical learners sorting through their own potential incongruities. For them, what directions could such self-exploration take? Pondering its missing head, learners might reflect on the role of medical knowledge—and how healing demands heart, not intellect alone. Or they might be led to wonder about areas of their own lived experience that training has stifled or excluded. Similarly, by discussing the birds and the open cage door, they might resolve to shelter certain aspects of self—and name others they’re ready to let go. In these ways, composites confront them with the challenge of wholeness. “Illness in the postmodern age,” David Morris observes, “is understood as fragmentation, and what we seek from the process of healing is to be made whole” (67). Like patients, many medical learners look ahead to the end of training and wonder about the persons they’ll become—what unity of self they might retain or construct. For them, healing themselves might depend crucially on the ability to find meaning in disjointed pieces.

Works Cited

Bhatia-Lin, Ananya et al. “What Will You Protect? Redefining Professionalism Through the Lens of Diverse Personal Identities.” MedEdPORTAL: the journal of teaching and learning resources vol. 17 11203, 2 Dec. 2021, doi:10.15766/mep_2374-8265.11203

Chadwick, Whitney. “René Magritte and the Liberation of the Image.” Art International, vol. 23, 1979, pp.11-17, 36.

Foucault, Michel. The Birth of the Clinic: An Archæology of Medical Perception,  trans.  A. M. Sheridan Smith. Random House, 1974.

Housen, A. C. (2002). Aesthetic thought, critical thinking and transfer. Arts and Learning Research Journal, 18.1, 99–131.

Kumagai, Arno K, and Delese Wear. “”Making strange”: a role for the humanities in medical education.” Academic medicine : journal of the Association of American Medical Colleges vol. 89, no. 7, 2014, pp. 973-77. doi:10.1097/ACM.0000000000000269

Lafitte, Juliana, Manuel Mendanha, and Agustina Picasso (Grupo Mondongo), “Calavera 4,” 2009. 

Museum of Fine Arts, Houston, Houston, Texas. https://emuseum.mfah.org/objects/105433/calavera-4. Accessed February 2, 2023.

Morris, David B. Illness and Culture in the Postmodern Age. University of California Press, 1998.

Morris, Desmond. The Lives of the Surrealists. Thames & Hudson, 2018.

Perkins, David N. The Intelligent Eye: Learning to Think by Looking at Art. Getty Publications, 1994.

Sarraf-Yazdi, Shiva et al. “A Scoping Review of Professional Identity Formation in Undergraduate Medical Education.” Journal of general internal medicine vol. 36, no. 11, 2021, pp. 3511-3521. doi:10.1007/s11606-021-07024-9

Image source: Raw Pixel

Keep reading

%d bloggers like this: