Understanding the Medical Humanities through To the Lighthouse
by Jessica Smith
The philosophical and literary studies of medicine have often been divorced from the practicalities of clinical knowledge, health policies, and improved treatments. However, this split is neither necessary nor constructive. From its very beginnings, medicine has constituted a vast territory, covering not only the physical but also the psychological, social, and spiritual dimensions of human existence. Whereas science discerns the mechanisms of disease progression and treatment, the humanities articulate the experiences of pain and suffering, relating them to human purpose, meaning, and values. It is in a medical context that the questions intersecting life, death, and meaning most often arise, making the losses inherent in illness and death a crucible of identity for all involved. Patients lose health; physicians lose professional certainty; families lose loved ones. In their losses, all face a disruption of self-concept as illness disorders such crucial aspects of identity: body, vocation, and relationships. In these situations of insult to one’s self-concept, the transformation of self, whether towards or away from their highest potential, is mediated by the grieving process. For a discipline that often tends toward the medicalization of suffering and disengagement from its soul-level implications, the humanities facilitate healing through the processes of telling and receiving narratives, which give voice to these life-altering experiences.
This paper focuses on grief as the point of intersection between clinical medicine and the humanities, a point that arises when a diagnosis dramatically upsets the narrative framing one’s sense of meaning and self. After an overview of the emerging field of the medical humanities, I will examine the nature of such grief in a medical context and outline the narrative endeavors of the humanities as a tool for expressing and interpreting these experiences, drawing on Virginia Woolf’s To the Lighthouse as a case study in the healing capacities of narrative.
Medical Humanities and Medical Education: A Brief Overview
In terms of their subject matter, the humanities reflect on the fundamental question, “What does it mean to be human?” through inquiry into “how people have tried to make moral, spiritual, and intellectual sense of a world in which irrationality, despair, loneliness, and death are as conspicuous as birth” (Cole et al. 3). Encompassing a wide range of disciplines with a high value for interpretation and self-knowing, the medical humanities include the history of medicine, bioethics, narrative medicine, medicine in literature, creative writing, disability studies, various social sciences, and the creative arts (Dolan 1). According to Thomas Cole, a historian of the medical humanities, the humanities may also be defined by their methods, dedicated not to scientific experimentation with reproducible results but rather to “understanding human experience through the disciplined development of insight, perspective, critical understanding, discernment, and creativity” (3).
After centuries of acceleration toward biomedical science, separated from the humanities, as the ultimate authority in medicine, the opening of Johns Hopkins University Medical School in 1893 was accompanied by worry over “excessive specialization, reductionist thinking, commercialism, and moral drift,” that is, “the dehumanization of medicine” (Cole et al. 4). Arguably, this is the origin of the medical humanities, when individuals began to articulate the reality of medicine as both an art and a science, calling for education of both the heart and the mind (Cole et al. 4). Not meant to yield specialists but intended to improve behavior, education in the medical humanities aimed at “produc[ing] a humanist physician,” one encompassing both “paideia — an educational and cognitive ideal[;] and the ‘good’ feeling — what we would call compassion — [that] is more akin to the Greek concept of philanthropia” (Dolan 4). In its current form, the medical humanities began to take shape in the late 1960s and 1970s, coming to be defined as a field that is both multidisciplinary and interdisciplinary as it draws from many disciplines to examine the development, practice, and reception of health care (Cole et al. 7).
Although the history of medicine was initially the most highly valued of the humanities in medical school curricula, the passage of time revealed the value of additional subjects in the humanities, such as literature and writing, to physicians and the practice of medicine. Woven with the dark threads of death and grief, literature is particularly valuable for contending with the losses inherent in illness and medicine, realities that are beyond the reach of science and technology. Through literary explorations of the personal and inter-personal ramifications of death and loss, the many forms of these experiences gain shape and depth beyond a physical diagnosis. As the medical realities of illness, loss, and death dredge up the identity-challenging questions of “who am I, where am I going, what am I leaving behind, what do I want to say to whom?,” stories, which are inherently relational and expressive, offer a means of sorting and ordering the new realities of the body in relation to self and others (Bolton 49).
At the intersection of literature and medicine is narrative competence. Pioneered by Rita Charon, a physician and literary scholar, narrative medicine is a means of medical practice based on the premise that a patient’s account of illness, “involving a teller, a listener, a time course, a plot, a point,” is akin to a story one might find in a novel (Charon 3). Through the development of the narrative skills of “recognizing, absorbing, interpreting, and being moved by the stories of illness,” which are “told in words, gestures, silences, tracings, images, laboratory test results, and changes in the body,” Charon contends that a physician will be equipped “to cohere all these stories into something that ma[kes] . . . enough sense . . . on which to act” (4). Narrative extends this capacity to cohere a life to the patient and their families as well. Whether utilized as a mirror for one’s experience of suffering or a means of reconstituting and mapping out a life that continues after loss, stories enable one to not only express their own experience but also author it. Through the practice of sharing and receiving stories, the dying, the bereaved, and physicians are equipped to take responsibility for their own life narratives, whether this responsibility entails one’s own reworking of a narrative interrupted by illness, death, or professional failure or helping another to better understand and relate to their life and self.
There are numerous challenges to the implementation of Charon’s narrative competencies in medical education and the professional development of physicians. However, even engaging with stories of death, suffering, grief, and loss can benefit both physician and patient. Literature, with its authority on the human experience, is a prime source of narratives that examine such experiences. In his essay “Religion, Poetry, and the Dilemma of the Modern Writer,” David Daiches observed the tendency of literary answers to questions about suffering and loss to be responses rather than solutions (Cole et al. 188). Instead of leading a listener or reader to a set, complete conclusion, stories offer a means of pondering a question, allowing the receiver to draw their own conclusions according to their particular needs and contexts. This open, explorative nature is particularly suited to contexts of loss and grief, experiences with unique manifestations and meanings for each individual life. While stories do not treat illnesses or cure diseases, physical healing is not necessarily a requisite for wholeness; as humans are material and spiritual beings, flourishing is also tied to the non-physical. Where medical interventions fail, whether to cure physical maladies, answer metaphysical questions, or provide the coherence of purpose that makes life worth living, narratives incorporate the physical and the spiritual together, not curing all suffering but making it cohere, so that an individual experiences peace and purpose despite the disorder. In this way, stories assert a unique healing ability, uniting the physical experiences of illness, death, and professional practice with their implications for the human spirit, for the lives that must continue after loss.
Loss, Grief, and Medicine
As illness disorders the body and physicians invade the body in their attempts to treat or cure disease, the coherence of self is threatened. In Narrative Medicine: Honoring the Stories of Illness, Rita Charon observes that “the self depends on the body for its presence, its location. Without the body, the self cannot be uttered. Without the body, the self cannot enter relationships with others. Without the body, “the self is an abstraction” (87; 88). As the means through which the inner life of the mind and soul is expressed in relation to others, the body is the locus of a person’s self, the medium through which an individual gains shape and depth as a person. While health affords one a lack of reason to dwell on their body and the relationship of their body to self and others, the disruption of the body calls attention to issues of autonomy, security, and identity. Certainly, the identity and value of a human being are not determined by their body; however, it is undeniable that the state of the body poses implications for an individual’s experience of themselves and their environment.
Illness, a disruption of the body, is a key intersection of the physical and spiritual dimensions of personhood and the scientific and relational facets of medicine. In clinical circumstances, the physical and metaphysical facets of the self may actively oppose one another, disordering the narratives an individual uses to make sense of the world and demanding the construction of new ones. Charon asserts:
Illness intensifies the routine drives to recognize the self. It is when one is ill that one has to decide how valuable life is, which relationships are most meaningful, and what terrors or comforts the end of life holds. When people become sick or disabled, they question their existence in new ways. They ask particular versions of universally asked questions about the self. Instead of “How can I be true to myself,” they ask, “What did I do to deserve this disease? What will become of me? Now that I am blind, or without legs, or can’t hear, or can’t talk, am I still me?” (Charon 87)
Through its ravaging and disintegrating effects on the locus of personhood, that is, the body, illness constitutes a significant loss. Physical capacities are tied to autonomy and identity, to psychology and spirituality, to the way one moves in and experiences the world as well as the way one is perceived by the world. The serious disruption of physicality demands that patients not only cope with the physical manifestations of disease but also reconstruct their sense of self and way of being in the world such that it is cohesive with the new limitations of their body. When the diagnosis is chronic, the disability is permanent, or the disease is terminal, the soul must be equipped to cope with the wasting conditions of the body for any sense of healing or wholeness to be attained. As an individual grieves the loss of the self, the strengthening of the soul is not a scientific endeavor so much as a spiritual and relational one, requiring the person to address the metaphysical questions of self that are tied to the body: what makes life meaningful enough to not merely exist but to truly live? Why and how should I proceed through suffering? Where can dignity and value be found amid dependence and deterioration? What does the loss of a particular capability or functionality mean for who I am?
The disruptions of the body are catalysts of disintegration, grief, and inquiry, not only for the person but also for those individuals journeying alongside them, whether family members or physicians. Serious diagnoses and disabilities place a burden of responsibility on those caring for the individual; end-of-life care often asks family members to immerse themselves in the suffering of another, to witness firsthand the destruction of disease. After an individual passes, it is those closest to them that must come to terms with the loss of another whose character, ways of being, and voice made up a significant part of their own, whose existence may even have defined their own. It is those who remain who must contend with the harsh injustices of suffering and death. As physicians become invested in their patients’ wellness, they may experience the consequences of illness and death in a manner similar to the patients’ loved ones, manifesting the emotional and psychological weight they carry. Additionally, physicians may also experience the ramifications of death and loss in relation to their vocation. While medicine is often characterized as the treatment or curing of disease, or the prevention of premature death, medicine is ultimately a healing art with physicians taking up the role of healer. Because vocation is directly tied to identity, in both our achievement-driven culture and in Christian theology, professional failure strikes at an individual’s essence, causing one to question not only matters of method, technique, and timing but more deeply, questions of meaning and purpose. Such questions require much more than further education or practice to answer. For experiencers and onlookers alike, significant disruptions of the body and the associated experiences of loss, grief, suffering, and death are accompanied by disorganization of the narratives that undergird one’s conception of their identity and relationship to the world.
While one story of the self may be interrupted by a severe diagnosis or death, the continuity of life demands that individuals restructure their self-concept and author the portion of their story that lies on the other side of chronic illness or death. To this end, medicine can draw on the authority of the humanities in interpreting, ordering, and expressing the human experience through story. In his book Bearing Witness: Religious Meanings in Bioethics, Courtney Campbell observes that “our stories are bearers of meaning; suffering disrupts or renders incoherent that narrative and radically changes the meaning and purpose embedded in the story” and may be “reflected in a loss of voice or narrative by which to communicate the experience” (366). Biological and technological treatments may restore physical function or stave off further physical degradation; however, such means of care fail to address the full ramifications of illness. While the stories of the body can be told through lab results, medical imaging, and prescriptions, these methods cannot unify the physical experience of bodily disruption with the emotional, spiritual, social, and existential experience of such disorder. For patients, their loved ones, and physicians, the story of the self as told by clinical medicine alone is incomplete.
While illness, death, and grief can be understood as disintegrating forces, these experiences can also be viewed through counter-narratives as revelatory forces for the way that they distill and expose the essence of the self. The tragedies of illness, suffering, and death also present an opportunity for one to make a declaration of identity and of what they believe to be important through their actions and attitudes. Charon notes that “although an illness might trigger dissociation from life, it can also distill the life, concentrate all its deepest meanings, heighten its organizing principles, expose its underlying unity;” as it “takes [life] away, illness also gives searing clarity about the life being lived around it (97). Though illness might derail identity and humanity, how one navigates their suffering and the suffering of others is the ultimate declaration of who they are and who they want to become. For an identity that is at once thrown into conflict and contradiction and distilled to its very essence, narrative is a unifying tool. It provides a means of making sense of incongruence and of leveraging the self. The qualities lying latent in the soul can be one’s most powerful instrument of growth and resilience, such that a deepening of character may occur. Against one-sided narratives of the human body as merely a site for suffering or pleasure, order or disorder, narratives that acknowledge the ties between physical experiences and the soul-level experiences of suffering and grief enable an individual to reconcile physical loss with their conceptions of dignity, meaning, and purpose.
Unfolding around and in relation to others, narratives serve the patient, their family, and the physicians through their communal nature. It is in the presence of another that our stories, our lives gain meaning and value, that we are invited and motivated to be formed in the image of Christ toward self-sacrificial love for another. Campbell observes that “narratives . . . presuppose a moral community with whom the story is shared and so bear witness of a shared quest for meaning and purpose” (44); by stories, a community is “called . . . to accountability about its ways of being and its ways of remembering its formative norms and precepts” (42). Without the invested presence of another, narratives cannot be rewritten and meaning cannot be derived. Requiring the engagement of one person with another, the acts of listening and processing are transformative for all participants. Through the storying of illness, loss, and death–and with it, values, sufferings, and identity, individuals gain coherence in their self-concept, incorporating their sufferings into the person they are becoming. Through the genuine, empathetic, invested engagement with stories of suffering and attentiveness to their own, physicians open themselves up to a deepening of character and live fully into their calling as healers. The collaborative nature of the process offers all participants the opportunity to construct meaning and challenges them to a higher standard of self-understanding and moral regard for others.
To the Lighthouse: The Narration of Loss and the Distillation of Identity
Death, grief, and narrative converge in Virginia Woolf’s To the Lighthouse, as she examines death-induced grief and loss through the Ramsay family and their guest, Lily Briscoe. Against the social tensions between masculinity and femininity and the existential struggle against the passage of time, Woolf portrays Lily’s struggle to come to terms with an identity disordered by death. It is the continuity of the narrative after death’s disruption that gives voice to Lily’s experience of grief so that it can be understood, felt, imbued with meaning and transformative power, and ultimately resolved. This novel serves as an apt case study for examining the healing capacities of narrative not only for its content but also as a model of expressing grief through story in and of itself, as its author “used the writing of fiction as a space to grieve” (Davis 8). While the conversation around Woolf and her experience of grief is complex, Woolf herself explains To the Lighthouse as an expression of the burdensome grief brought about by her mother’s death, asserting “I expressed some very long felt and deeply felt emotion. And in expressing it I explained it and laid it to rest” (qtd. in Davis 8). As Woolf reinterpreted her world in the wake of grief through narrative, setting her character Lily on the same path of relearning, she conveyed both the disruptive and revelatory facets of death and loss and illustrated the value of narrative for growing the self through grief.
Lily’s evolution of self begins upon the death of Mrs. Ramsay. On one hand, this evolution of identity can be examined in terms of her relationship with Mrs. Ramsay, a figure she greatly admired and loved. As Mrs. Ramsay occupied an intimate place in Lily’s mind and heart, her death is a significant disruption to Lily’s life, dredging up not only the simple questions of daily routine but existential questions of meaning and purpose. Mrs. Ramsay’s death forces Lily to restructure her narrative of reality. After Mrs. Ramsay’s passing, Lily finds herself asking “What does it all mean then, what can it all mean?” (Woolf 101). For Lily, Mrs. Ramsay’s death makes everything seem “so extraordinarily queer” that ordinary questions “opened doors in one’s mind that went banging and swinging to and fro and made one keep asking in a stupefied gape, What does one send [to the Lighthouse]? What does one do? Why is one sitting here at all?” (Woolf 101). Grappling not only with Mrs. Ramsay’s death but also the deaths of Andrew and Prue, Lily is caught in a state of disconnection, feeling no attachment to places she once loved. Instead, she experiences her circumstances as “aimless,” “chaotic,” and “unreal” (102). Carrying an individual further and further from the deceased, the passage of time renders the deceased stagnant, illusory, and eventually unreal. For the one contending with the loss, this experience of disconnection from a loved one is fraught with fear, guilt, and sadness, emotions that are painful but powerful in their capacity to induce deep reflection and transformation. As life with Mrs. Ramsay was “rubbed out” and made “unreal upon her death” (Woolf 116), Lily must discern how to relate memory to reality, how to unify Mrs. Ramsay’s unchangeable character and ways of being to her own evolving self, and how to derive peace and meaning from an event that is unfeeling and unjust.
In addition to the numbing dissociation brought about by grief, Lily also experiences the anger tied to her perception of the injustice of Mrs. Ramsay’s life and death. Even ten years after Mrs. Ramsay’s passing, Lily finds herself grappling with the bitterness and resentment brought about by the event. As she attempts to bring her painting, a representation of her sense of self, meaning, and purpose, to completion, Lily recognizes that “really, she was angry with Mrs. Ramsay” (Woolf 104). Standing there “at forty-four, wasting her time, playing at the one thing one did not play at,” Lily believes this waste, dissatisfaction, and futility to be “all Mrs. Ramsay’s fault” (Woolf 104). Confronted with grief that is at once distorting and clarifying, Lily expresses the frustrations that coincide with her feelings of powerlessness and her reluctance to accept that she must continue, even reconfigure, her own life in the wake of Mrs. Ramsay’s. How can she reconcile the beauty of Mrs. Ramsay’s character with the woman’s limitations? Not only must Lily deal with life without Mrs. Ramsay, but she must also process what Mrs. Ramsay’s death means for her identity, as Mrs. Ramsay’s essence dictated much of her own obligations, desires, and self-concept.
Lily’s growth through her grief evidences the value of exploring grief and loss through narrative. Upon returning to the painting she began ten years before Mrs. Ramsay’s death, she finds it unchanged. Ten years later, she still cannot decide whether to “move the tree to the middle;” ten years later, she still lacks a satisfactory sense of self and purpose. This stagnancy coincides with a lack of narrative regarding her grief and therefore, no personal growth and no new story of self and meaning to live out of. For a period of ten years, Woolf narrates the passage of time after Mrs. Ramsay’s death not through human experience but through the cycles of nature, which are unmoved by human concerns. Driven by the repetitive, indifferent, unthinking seasonal changes rather than a contemplative human response to loss, the narrative becomes a passive observation, losing its power as a tool for creating meaning. When Woolf reunites the audience with Lily at the end of this interlude, Lily is as unchanged as her painting. Having had her story interrupted, with the space for active processing of emotions filled instead by the narrator’s detached descriptions of nature, Lily’s loss has not taken on any significance, and she has not grown through her grief. As she first begins grappling Mrs. Ramsay’s death in the opening scene of “The Lighthouse,” Lily struggles to discern “for what really, did she feel, come back after all these years and Mrs. Ramsay dead?” and was left with the empty answer of “nothing, nothing — nothing that she could express at all” (Woolf 101). Having yet to process her grief, to weave it into the story of her life, Lily cannot access the reshaping of self that lies latent in experiences of loss.
As Woolf’s narrative eventually gives shape and voice to the emotions induced by the death of Mrs. Ramsay, the disruption of Lily’s relationships, expectations for the future, and identity, Lily eventually finds healing. It is not the event itself that transforms Lily or renews her sense of self but rather how she processes and eventually responds to the event and the associated grief. While the ultimate questions of “What is the meaning of life?” or “What does it all mean” (112) are not explicitly answered in Lily’s completion of her painting on the final pages of the novel, Lily finds resolution through a narrative journey that truly and deeply engages her loss, integrating her memories of life with Mrs. Ramsay with her present reality. In the same way, narrative provides a means for the patient, physician, and their loved ones to give meaning to an experience of loss, or to better understand its effects, thereby facilitating personal or professional growth. Through narrative, death—whether physical or metaphorical, takes on the significance and transformative power that nature cares nothing for and science fails to cultivate.
While important as a character in her own right, Mrs. Ramsay may also be thought of as a metaphorical expression of Lily’s identity, with her death representing its disruption and the distillation of its essence. At the onset of the novel, Lily puzzles over who she is and who she is becoming, as reflected in her quandaries over her painting. While she can “see it all so clearly, so commandingly when she looked [at reality], it was when she took her brush in hand that the whole thing changed” (Woolf 12). As she attempts to create, to bring her perception to actuality, “the demons set on her,” bringing her to “the verge of tears” and making “this passage from conception to work as dreadful as any down a dark passage for a child” (Woolf 12). Caught in between what she sees and what she feels compelled to portray, and more deeply, who she is and who she feels obligated to be, Lily struggles to “maintain her courage,” to “clasp some miserable remnant of her vision to her breast” (Woolf 13). While Mrs. Ramsay is alive, Lily wrestles with how to unify her vision and its representation, how to integrate the person she feels and desires herself to be and the concept of beauty and satisfaction with life that Mrs. Ramsay portrays.
It is Lily’s captivation with Mrs. Ramsay that produces this internal conflict. Lily admires Mrs. Ramsay to the extent that she experiences the urge to “fling herself . . . at Mrs. Ramsay’s knee” and express her love for the woman, for the life that she had created with the house and the children (Woolf 13). This admiration for Mrs. Ramsay exposes the weight of “her own inadequacy, her own insignificance,” the gap between all that Mrs. Ramsay embodies and whom Lily ultimately seeks to be (Woolf 13). Simultaneously, Lily acknowledges Mrs. Ramsay to be “unquestionably the loveliest of people . . . the best perhaps; but also different from the perfect shape” (Woolf 34). This tension is rooted in Lily’s strained connection to the feminine ideal exemplified by Mrs. Ramsay. Although Lily is enraptured by the beauty that Mrs. Ramsay exudes and embodies, identifying with that vision of womanhood as a woman herself, she also experiences the pull toward the intellectual and professional domain. For Lily, her painting is a means of achieving intellectual and professional satisfaction and achievement; however, Mrs. Ramsay “cared not a fig” for it and instead dedicated her attention to matters of marriage, children, and homemaking (Woolf 34). Mrs. Ramsay would assert that “an unmarried woman has missed the best of her life,” but Lily struggles to find this sense of meaning, purpose, and life satisfaction in the stereotypical feminine ideal, even as she worships its embodiment in Mrs. Ramsay. As Lily clings to Mrs. Ramsay and the ideals of beauty, gentleness, and grace, she claims this femininity as part of her identity. However, in her attempts to discern why Mrs. Ramsay diverges from the “perfect shape” despite all her loveliness (Woolf 34), Lily expresses discontentment with the identity that Mrs. Ramsay represents, a self-concept that perfectly adheres to a restrictive feminine ideal.
With Mrs. Ramsay’s death, Lily experiences the death of a part of herself she deeply desired to express, even as she struggled against it. As she suddenly loses many of the obligations and expectations that directed the person she sought to become and felt obligated to be, Lily is tasked with finding a new basis of identity. Although a part of her may have died, she must continue living and respond to the choice between fragmentation or healing. This concept of the death or rending of oneself is reflected in a two-sentence bracketed insertion describing the mutilation of a fish that interrupts the narration of Lily’s inner struggle: “[Macalister’s boy took one of the fish and cut a square out of its side to bait his hook with. The mutilated body (it was alive still) was thrown back into the sea.]” (Woolf 125). Uprooted and mutilated yet still alive — this is Lily’s experience, and it is the experience of many patients facing serious illness, disability, and death. As the fish was displaced from its natural environment, violently dismembered, and then returned to its former environment, alive but missing a significant part of itself, Lily experiences the disruption of identity and the obligation to continue living without a crucial part of herself. Patients, their loved ones, and physicians similarly experience losses of this nature, which may be constituted by debilitating illness, permanent disability, or death. While extremely brief and seemingly random, Woolf devoted an entire chapter to this word picture, thereby communicating the gravity of being alive yet missing a key part of oneself and the significance of this experience for Lily. For the fish, retrieving that mutilated piece of self is impossible. In Lily’s circumstances, the same is true; thus, the only option is to learn to live with the loss, a process that requires the evolution of the self.
The process of grieving and processing Mrs. Ramsay’s death, which may be interpreted as the metaphorical death of a part of Lily’s identity, returns Lily to her painting. Ten years prior, Lily sat before the canvas unsuccessfully trying to relate shapes and colors, perception and reality and obligation, unsuccessfully trying to express the contents of her mind and spirit. Mrs. Ramsay’s passing brings a refreshing clarity; suddenly, “it seemed as if the solution had come to her: she knew now what she wanted to do” (Woolf 103). As previously discussed, issues of the body, illness, disability, and death can act as distilling forces, exposing the essence of the self (Charon 96). The gravity of death and bodily disruption strikes individuals with questions of identity, meaning, and purpose, asking them to declare who they are when a part of the self is taken away. Coinciding with the death of a strictly feminine identity predicated on gendered expectations for marriage and family, Mrs. Ramsay’s death forces Lily to reconsider who she is becoming and where she finds meaning and purpose as it clarifies that the answers were not and cannot be found in Mrs. Ramsay.
While Mrs. Ramsay’s death separates Lily’s identity from a strictly feminine ideal, a strictly masculine ideal, as portrayed by Mr. Ramsay is objectionable. Lily associates “ruin” and “chaos” with Mr. Ramsay (Woolf 103). She thinks, “surely, she could imitate . . . the self-surrender” to Mr. Ramsay’s greed, exactingness, and selfishness (Woolf 104), but what would such a surrender mean for herself? Taking up Mrs. Ramsay’s identity and way of relating to others, specifically men, only leads her to further struggle, but capitulating to Mr. Ramsay’s insecurity and need for female sympathy only induces shame and internal conflict (Woolf 107). As she attempts to resume painting, to reconstruct her identity in the wake of its disruption, Mr. Ramsay’s mere presence renders her too fearful, hesitant, and agitated to begin (Woolf 109). Ultimately failing to find satisfaction in an identity defined by the remaining half of the partnership she so loved and admired, Lily begins to construct an identity that is true to the whole of what she experiences and values, that unifies not herself with Mrs. Ramsay or herself with Mr. Ramsay but rather the aspects of herself that each of those individuals embodies.
Realizing that the death of Mrs. Ramsay—and with it, the death of a purely feminine ideal— placed Mrs. Ramsay at her mercy by opening that identity to improvement, Lily finds herself triumphing over Mrs. Ramsay and the tension that Mrs. Ramsay induced in her (Woolf 121). As long as Mrs. Ramsay was alive, Lily’s art remained stagnant, representing an identity unchanged even as Lily grew older. Something about Mrs. Ramsay’s presence — that is, the obligations tied to the ideals she embodied — prevented Lily from getting to the marrow of who she was and wanted to be. In life, Mrs. Ramsay captivated Lily so much that she sought some device for “becoming, like waters poured into one jar, inextricably the same, one with the object one adored” (Woolf 34). Through Mrs. Ramsay’s death, Lily is more aptly able to recognize the woman’s shortcomings, subsequently leading her to a more satisfied and integrated view of her own self. With Mrs. Ramsay’s voice quieted by death, Lily feels that “she could stand up to Mrs.
Ramsay;” metaphorically, it is as if she can stand up to herself, casting off a part of identity that was associated with guilt and shame and that robbed her of a satisfactory self-concept (Woolf 122).
When Mrs. Ramsay occupied such a significant presence in Lily’s mind and heart, Lily could not reconcile her personal experience with who she felt pressured to be. When death disrupted this identity rooted in standards of femininity, Lily was suddenly forced to look elsewhere for a sense of self and purpose, failing to find it in the masculine ideal as defined by Mr. Ramsay. Reflecting Mrs. Ramsay’s capacities for creating, resolving, and unifying, Lily merges her grief over the death of the woman she loved and the need to make something meaningful out of it, finally finishing her painting. Ultimately, she finds satisfaction not in the material product but rather in the feeling that she has captured her vision. As Lily achieves resolution in an identity that unifies Mrs. Ramsay’s beauty, creativity, and grace and Mr. Ramsay’s dedication to rationality, intellect, and professional achievement, Woolf’s novel reveals the power of death to disrupt one’s sense of self and illuminate its essence.
To The Lighthouse provides a means and a model of unifying human identity, grief, loss, and death. In a strictly medical context, death is the end of life, the final line on an individual’s record of existence. However, through narrative, death diverges into a variety of new lives. Through narrative, death becomes a starting point for the examination of some of the deepest, most consequential, and transformative human experiences. Providing a structure by which to grapple with these issues of personhood, narratives are a mode of carrying on the stories that death begins and provide another voice to accompany an individual going through the resulting grief, pain, and loss. Whether Lily’s transformation is understood in the context of her relationship to Mrs. Ramsay or in terms of a metaphorical death of a part of herself, her disorientation and eventual resolution convey the revelatory nature of death and disruption of the self, the potential for beauty and growth inherent in those experiences. Making only brief, passing mention of Mrs. Ramsay’s death, as well as Prue’s and Andrew’s, through detached, bracketed insertions while thoroughly examining the continuation of life through Lily, Woolf emphasizes the notion that it is not necessarily death itself that is significant but rather the life that continues on in its wake if only that life is re-storied in a way that is coherent and meaningful.
Life, Loss, and Narrative
Through the character of Lily Briscoe and the narrative technique Woolf employed to examine death, loss, and identity, Woolfenables a more profound understanding of some of the most potent human experiences, experiences that pervade medical contexts and that all individuals will contend with over the course of their lives. Beyond the capacities of physical diagnosis that merely explains the nature of a disease’s progression, narrative unites the spiritual with the physical substance of the self, allowing one to understand how self-concept is affected by grief and loss. By enabling an individual to engage with and give voice to their fears, desires, grievances, and frustrations, narrative addresses the existential and relational aspects of disease and death that science cannot. As narrative is inherently communal, involving a teller and a listener, it facilitates the growth of new ties to others and shared meaning in the face of death. For the patient, the patient’s loved ones, and the physician, narrative provides a means of taking advantage of the paradox of death, loss, grief, and suffering, wherein an individual can experience significant soul-level growth and renewed purpose even as their physical self and capacities dwindle away, their best efforts fail, and their relationships are irreversibly altered.
In his memoir When Breath Becomes Air, a reflection on the human search for meaning amidst loss and the advance of death, neurosurgeon Paul Kalanithi shares his experience of being diagnosed with advanced lung cancer, enduring the physical, social, and spiritual losses of such a diagnosis, and facing death at age thirty-seven. In his experience of an identity disrupted, Kalanithi concluded that “the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence” (163). Although his doctor was unable to give him “back [his] old identity” through her medical care, she “protected [his] ability to forge a new one” by asking him to dwell not on survival statistics or treatment efficacies but rather on the unfolding story of his life, on his hopes for what he might yet contribute, his dreams for his family, and the things he most valued (166).
For Kalanithi, this forging of a new identity involved the literal construction of a narrative in the form of memoir, born out of the recognition that literature, with its attention to human relationships, moral values, and language, makes meaning out of brains and bodies and the processes occurring within. Not only was narrating the evolution of his identity and the grief and loss associated with his diagnosis and impending death therapeutic for Kalanithi, but also for those who engage with his story. Possessing longevity that the body lacks through both its inherent nature as a written work and its examination of matters of meaning and morality that all humans grapple with, Kalanithi’s narrative offers a model for engaging with grief and reshaping one’s identity. After his diagnosis, Kalanithi found that there was yet so much life to be found, even as it drained out of him; after his death, the narrative — and new identity — he forged bears witness to the power of story to imbue loss, suffering, and death with meaning.
In my personal experience, this year involved the deaths of my grandmother on my father’s side of the family and my grandfather on my mother’s side. While these deaths were related to old age rather than a devastating cancer diagnosis, the gravity of physical maladies in spiritual, relational, and moral matters was evident in the various tensions my family experienced as we processed our losses. My grandmother’s death involved a tangle of emotions and conflict as she essentially decided she no longer wanted to be alive, that life was not worth living in the face of the pain and indignity she was experiencing, subsequently leading her to hasten her death through her choices and behavior and to leverage the promises of Jesus and heaven as a defense of her choices. My grandfather’s death, ultimately brought about by COVID-19, through the exacerbation of underlying conditions associated with being 92 years of age, stirred up questions of social responsibility and the value of life against a deluge of voices that have attempted to justify various public health-related behaviors or minimize the gravity of the pandemic by referring to the fact that most individuals dying of COVID-19 are elderly and/or possessing underlying health conditions. Meaning. Morality. Social responsibility. The value of life and dignity in suffering. The tension between grief and hope, loss and peace. Though medical contexts provoked these kinds of questions, it is literary contexts, the stories of Scripture, the narrating of a life and its legacy, that provided my family hope and peace. It is stories that facilitated the reintegration of family and self-concept in the absence of two grandparents who have so profoundly shaped the lives of various members of our family. Intertwining the scientific and the sacred, narrative draws meaning out of death and gives structure to the complex interactions between the physical and the metaphysical aspects of a human life. Through story, life can continue through loss, not the same as it was before nor emptied of meaning, purpose, peace, or joy, but rather enriched by engagement with one’s truest self and deepest loves.
Bolton, Gillie. “Editorial: Death, Dying, and Bereavement.” Medical Humanities. 49-52, 2004,
Campbell, Courtney S. Bearing Witness: Religious Meanings in Bioethics. Cascade Books, 2019.
Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford Univ. Press, 2008.
Cole, Thomas R. et al. Medical Humanities: An Introduction. Cambridge University Press,
Coulehan, Jack. “Today’s Professionalism: Engaging the Mind but not the Heart.” Humanitas:
Readings in the Development of the Medical Humanities. Edited by Brian Dolan. University of California Medical Humanities Press, 2015. 236-255.
Davis, Brooke. “Catching the Light: Finding Words for Grief with Lewis, Didion and Woolf.”
Journal of Writing and Writing Courses, vol. 16, no. 2, Oct. 2012. EBSCOhost, https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mlf&AN=2015871132&authtype=sso&custid=s3457955&site=ehost-live&scope=site.
Dolan, Brian. “One Hundred Years of Medical Humanities: A Thematic Overview.” Humanitas:
Readings in the Development of the Medical Humanities. Edited by Brian Dolan. University of California Medical Humanities Press, 2015. 13-30.
Kalanithi, Paul. When Breath Becomes Air. Random House, 2016.
Woolf, Virginia. To the Lighthouse. Vintage Classics, 2004.