Clinical Approaches to Drama: “Cripple Billy” in Martin McDonagh’s The Cripple of Inishmaan

Abstract

There has been an increasing tendency among practicing physicians and health care professionals to pay a close attention to the study of literature and literary narrative. They have started to investigate how the study of literature could help them with skills such as attentive listening, responsive engagement and critical thinking. There has been an important cooperation between the literary scholars and the medical professionals in the field of literature and medicine. The cooperation has highlighted the power of literary texts that help the medical and pre- medical students to develop practical skills. Literature—both in discussion and in writing—can instill habits of attention and empathy which are of immense significance for clinical encounters where the relationship between the patients and the healthcare professionals is quite pivotal. Furthermore, cognitive psychology has realized that the study of literature can foster stronger empathetic responses to patients’ needs. Literature helps in finding ways in which one can garner strong empathic response in order to better understand the nature of their patients. The insight gained by literature on the human nature enables the medical student to perform their jobs in a much better and more aware way. This also raises the standard of their performance. In the medical study and training, examining experiences of illness through both presentation and content such as is found within literature develops the professional skills required for communication, ethical responses and accurate diagnoses. This paper will explore the benefits to patient-physician interactions of such presentation and content as can be read or enacted within The Cripple of Inishmaan by Martin McDonagh.

Keywords:

• Index Terms—Literature and medicine
• narrative features
• clinical skills
• drama and theatre
• Martin McDonagh
• The Cripple of Inishmaan

1. Introduction

The study of literature has been shown to improve a wide range of academic and social skills including attentiveness, engagement and response, and critical thinking. As well as their clear benefit to the study of literature, these skills are crucial to the effective performance of healthcare professionals and thus there has been a recent increase in academic studies concerned with ways in which these skills could be improved by practitioners within the healthcare profession. Not only can the study of literature engender this type of skill set, but the study of the Arts in general can provide a similar proficiency, this would include theatre and drama practice. By studying theatre, from either a literature or performance angle, this set of skills including engagement, empathy and understanding can be cultivated and applied to other situations. It is pertinent to mention what Johanna and Linus in their paper Medical Professionalism: What the Study of literature can contribute to the conversion have to say.

“If competencies have not provided a meaningful format for teaching medical professionalism, nevertheless it is a fundamental contention of the PRIME scholars that professionalism must involve the application of virtues to the practice of medicine. We believe that the study of literature, with its emphasis on the discreteness of specific texts, has an important role to play in assisting learners in professionalism formation. One crucial way in which this occurs is by developing in learners the habit of close reading, a fundamental literary skill.” (Johanna and Lois, 2015, 6)

It was Aristotle who first highlighted the importance of theatre in the ancient Greek world. The term he coined while examining how the audience responds to a certain tragic event has become a very important medical term in the modern world. While introducing us the term “catharsis”, Aristotle writes,

“A tragedy is the imitation of an action that is serious and also, as having magnitude with incidents arousing pity and fear, where with to accomplish its catharsis of such emotions.” (Aristotle, Poetics, Poetics, 1449b24 ff.)

Catharsis, Aristotle says, is a process of “feeling and happens when the audience relates to the characters on the stage. He also refers the term as “the purification of the soul and the body”. (Aristotle, Poetics) According to him, there are emotions that a tragic story invokes in in the audience when they relate to the characters on the stage, a strong sense of empathy is one of the strongest one.

Often the study of drama in relation to medical training is thought of as a form of role-playing, scenes created for the purpose of teaching and training allowing for medical students to learn by interacting with the scene. “Act Together”, for example, is a programme designed by the Institute of Theatre and Social Change at USC School of Dramatic Arts in California, run by USC’s director, Brent Blair. The programme aims to improve the performance of healthcare professionals who deal with vulnerable patients through the performance of carefully-scripted scenes. Blair hires actors, playing the roles of patients, to work with doctors, nurses and medical technicians to develop the performance pieces. The healthcare professionals are then asked to use their experience to step into the scene on a number of occasions and give different performances with improved outcomes each time. “The audience,” Blair says, referring in this case to the healthcare professionals, “has changed from being passive to feeling active, useful and engaged” (Engel, 2019). In the same fashion, published plays and performances by well-known playwrights can be seen to produce similar results in terms of engaging healthcare professionals on a new level with the needs of patients in their care.

“Theatre techniques seem to be effective and increasingly used as interactive teaching tools in undergraduate medical education. This simulation method of learning does not only enhance the students’ comprehension of the doctor-patient relationship, but it also improves their communicational skills and gives them the ability to engage more with the patient. Although theatre teaching as an educational model has numerous advantages in education, which have been described in literature, the interactive educational environment it provides from the stage, as well as its appeal to the audience, have not been evaluated. (Keskins et al., 2017)

While this is typically the idea that one may conjure when thinking about theatre and drama practice in relation to medicine, it should be made clear that there are multiple other ways in which the study of theatre and medicine converge. It can be by the use of “training methods common to performance” (Willson, 2006) in order to instil confidence in students, using “pre-performative” skills such as physical awareness, stamina, calm, balance, concentration, voice skills, interpretation of a narrative and many other skills beyond those previously mentioned. This is often seen to aid in the improvement of a doctor’s presentation towards patients, this would be due to the idea that much like theatre a medical consultation is in fact a live event, a one-off, unique and unparagoned moment within history (Willson, 2014).

2. Underpinning approaches

The relationship between literature and medicine has been a prolific and recurrent topic in English literature since the 1970s, when medical schools started to include the study of literary texts in their programmes in order to aid the examination of concerns related to health, the body and other medical issues. According to Gavin Francis,

“It’s said that literature helps us to explore ways of being human, grants glimpses of lives beyond our own, aids empathy with others, alleviates distress, and widens our circle of awareness. The same could be said of clinical practice in all of its manifestations: nursing to surgery, psychotherapy to physiotherapy. An awareness of literature can aid the practice of medicine; just as clinical experience certainly helps me in the writing of my books. I’ve come to see the two disciplines as having more parallels than differences, and I’d like to argue they share a kind of synergy.” (Gavin, 2017)

Literature is replete with representations of illness, disabilities, addiction, ageing and contagion, which have grasped the attention of scholars from both fields and which have led to a wide range of interdisciplinary research, helping physicians to develop skills in medical practice and ethics (Charon, 2000). Ann Jurecic talks about the rise of illness narratives and the evolution this will bring to contemporary criticism (2012). In a similar manner, Downie discusses the idea of “whole person understanding”, the idea that literary material such as novels, plays, poems or films has the potential to have a substantial influence on a student or doctor and have a considerable effect in their development of intuitive understanding (Downie, 1991). An idea that brings emphasis to our societal desire to have medical professionals that are not seemingly devoid from emotion, who are able to empathise and not be entirely removed from the situation. In comparison to a more scientific approach, that is predominantly concerned with finding pattern, uniformity and similarity, the idea of a “whole person understanding” concerns itself more with uniqueness and the individual within their own particularity. An idea that if we can understand to some extent how a person is thinking or feeling, as a medical professional one can better respond and give an individual a much more pleasant experience as a whole. Interest in medical humanities and narrative medicine has thus seen an increase in terms of scholarly research and publications over the past twenty years. A number of titles, including Narrative Medicine: Honoring the stories of Illness (Charon, 2006), Medical Humanities in Theory and Practice (Kapusta & Lytovka, 2017) and Critical Dialogues in the Medical Humanities (Domìnguez-Ruè, 2019), have served to open up new vistas in the study of literature and medicine.

Ronald Schleifer, a professor of twentieth-century literature and culture, and Dr Jerry Vannatta, a professor of internal medicine, both from the University of Oklahoma, have recently written Literature and Medicine: A Practical and Pedagogical Guide (2019), which investigates the importance of storytelling and narrative to medical students, physicians and healthcare professionals.

Most recently, literary texts have been studied as an area of vicarious experience, useful for healthcare professionals to develop cognitive responses. Such cognitive responses, according to Schleifer and Vannatta, represent the enhanced practice of empathy and the transportation of experiences of narrative to which literature gives rise (Schleifer & Vannatta, 2019). This gives rise to Downie’s concept of “whole person understanding”, allowing imaginative sympathy with concern of the particularity of situations, which in turn garners a level of empathy. Empathy, in this regard, does not refer to the idea of imagining the same experience happening to oneself. It rather involves the skill of picturing situations and difficulties which the patient is undergoing (Schleifer & Vannatta, 2019). As a skill necessary for physicians and healthcare providers, empathy can be acquired through a number of different routes, but notably for the purpose of this essay, through engagement with narrative and literature which also provide models of ethical behaviour. Engagement with narrative takes the form not only of reading and storytelling but also of drama and cinema. Exposure to any form of narrative can create a mental state in which a person is immersed in the story and the world of the narrative through the characters and imagination of the plot. The theory of narrative transportation suggests that the more immersed a reader is in a story, or an audience is in a play, the more likely they are to engage with and empathise with the characters. Thus, “the reader is in a state of detachment from the world of origin, and transportation theory suggests her attitudes and intentions change in relation to the narrative” (Schleifer & Vannatta, 2019, 5).

While recent research investigates this relationship mainly through fiction and (auto)biographical writings, this essay explores the issue through drama and theatre by examining some of the features of narrative, as introduced in Schleifer and Vannatta’s book.

In any written or performed narrative, the form of presentation is as important as the content and the details of the story. Schleifer and Vannatta suggest that:

“Inexperienced readers of literature often focus primarily on the content rather than the form, thinking that what a text “is about” exhausts its meaning and power, and in so doing they neglect to focus upon how it is structured and organised, and what meanings and feelings its structure suggests and provokes.” (Schleifer & Vannatta, 2019, 15).

Thus, the performance of a play for example, is in and of itself as important as the written dialogue. The emotion and unsaid feelings that one infers from a theatrical performance is just as important if not more so than what can be gained from the discourse itself.

The same could be said to apply to inexperienced healthcare professionals. In the first chapter of their book, Schleifer and Vannatta pinpoint 13 narrative features which can contribute to an understanding of the fundamental skills needed for interpreting clinical stories. Paying close attention to the manner of the patient or the discourse used to deliver their story reinforces social skills instilled through an understanding of literary narratives. Schleifer and Vannatta also make the connection clear between this feature and other narrative features such as twice-telling and patterned repetitions which are often present in literary narratives. As another feature, the “unsaid” in storytelling also relates to such artistic parallelism as literary narratives teach readers, and by extension caregivers exposed to these narratives, to attend to characters’ implicit thoughts and concerns. To discover the “unsaid” necessitates a focus on the relationships among actors and the configuration of a set of facts which constitute the narrative (Schleifer & Vannatta, 2019). The study of narrative features achieves narrative competence, an understanding of the “unsaid” and empathy and, accordingly, results in a more humane medical practice.

In drama and theatre in particular, a story is delivered largely through communication, the body, emotions and responsive reactions. Dramatic texts present a narrative which is both watched and read. Lighting, music and actors’ and directors’ input in the performance amplify the delivery of the story. Theatre has the potential to provide a varied and evocative approach in which it is possible to investigate the ideas surrounding identity, control, sexuality and ownership according to Willson (2006). The questions provoked by Arts such as theatre, are questions that are of concern to patients and hospital ethics, and exploring these questions and ideas outside of the medical gaze can furnish students with a lateral reflective way of learning. This evidently can be achieved by the witnessing of thought provoking narrative theatre. While medicine has a very target driven and evidence based culture, theatre can help medical students to “develop the skills required to touch, to listen, to see and to hear, encouraging students to challenge, subvert and question institutional hierarchies” (Willson, 2006). This essay draws on the dramatic text with minimal reference to indications of characters’ responses through stage directions in order to hold a focus on some of the narrative features proposed by Schleifer and Vannatta.

Plays within the Irish theatrical tradition have increasingly offered up narratives of characters who are mentally or physically ill, disabled, aged and suffering from addictions. Even those who are not central characters in the plays provide experiences of illness with the accompanying social and personal anxieties. Plays such as Brian Friels’ Aristocrats and Conor McPherson’s Port Authority have at their centre the complicated issues of ageism; female elderly characters await death in Tom Murphy’s Bailgangire and Martin McDonagh’s The Beauty Queen of Lennane; and mental malady is healed, or not, through therapy in David Ireland’s Cyprus Avenue and Tom Murphy’s The Gigli Concert. Orphaned from birth, a young, crippled boy called Billy takes centre stage in Martin McDonagh’s The Cripple of Inishmaan. Drawing on Schleifer and Vannatta’s approach, this essay highlights the twice-told, the unsaid and disclosure as narrative and literary features and goes on to explore how these features find significance in the medical context through Billy’s physical disability.

3. The Cripple of Inishmaan

Set in the early 1930s on the remote islands off Ireland’s west coast, Martin McDonagh’s The Cripple of Inishmaan is a 1996 play which explores the experiences of the inhabitants of Inishmaan when a Hollywood crew arrives to film life in the islands in neighbouring Inishmore, and the villagers vie for a role in the film. The play centres around the disabled 17-year-old orphan Billy who has been brought up by his aunts, two spinster shopkeepers, after the death of his parents. Billy travels to the United States for a Hollywood screen test only to discover that the experience was not as he dreamed it would be. Through its focus on the character of Billy, the titular “cripple”, the play is full of features that develop the conjoined areas of narrative and medicine. This essay traces situations and scenes from Billy’s life in relation to narrative features which will contribute to a more efficient understanding of the medical and personal concerns of patients.

The concept of the narrative and the interpretation of the narrative is of particular significance when looking into the importance of plays such as “The Cripple of Inishmaan”. The skill of interpretation in this context is seen as a very unscientific idea, something that can be consistently differing and down to the individual and their particularity. There is a recognition that “scientific objectivity” can often demand that doctors are completely divorced from what is the reality of the lives of their patients as well as their patients own bodily experiences. Willson further discusses how a more “poetic and social understanding of the body can sit beside a clinical one without compromising either but instead enriching both” (Willson, 2014, 31) This idea opens up the possibility that by engaging with the theatrical arts, doctors and medical professionals can nurture their interpersonal skills as well as their interpretive prowess. This suggests that reading or watching a play such as The Cripple of Inishmann, that contains a depiction of illness or disability, can aid those within the medical profession not only with empathy but with their interpretive skills as well. Witnessing and learning the emotional and personal motivations of characters from different backgrounds who are very different from themselves can be of use and a transferable skill to help in how they “perform” medicine.

By looking closely at and using The Cripple of Inishmaan as a working example, we can decipher the potential that theatrical practice has to influence and help those seeking to enter the medical profession with their training, and those already within the medical profession to maintain high levels of patient care.

The beginning of the play emphasises the feature of twice-told stories as an example of patterned repetition in narratives. “Literary acts of telling stories twice,” Schleifer and Vannatta argue, “is the larger source of the discursive art of literature that creates all kinds of parallelisms of language, event and meaning” (Schleifer & Vannatta, 2019, 17). The concept of twice-told stories provides a parallel with Schechner’s ideas about “twice behaved behaviours”. Schechner asserts that performances mark identities and tell stories, among other things, and that performances of ordinary life are composed of these “twice behaved behaviours” or “restored behaviours”. These behaviours are performed actions that the individual has trained to do. Years of lived experience equates to a person “training” and learning appropriate behaviour and how to perform in relation to social and personal circumstances (Schechner & Brady, 2017). Studying that narrative, and the pattern of repetition within it, can be used as a way to inform an individual’s restored behaviours, acting as a way of learning about social and personal circumstances in order to better perform their role as a medical professional.

The play displays patterned repetition through the characters’ different renditions of the story of Billy’s parents and the way in which they died, provoking contradicting emotional responses from Billy. “It is this insistent doubling—twice-telling both the past story and the present tense encounter” as Schleifer and Vannatta confirm, “that allows readers to more fully experience and grasp the dynamic of form and content in narrative” (Schleifer & Vannatta, 2019, 17). The death of his parents is twice-told at the end of the play, at which point the reader learns the most believable version of the tragedy. Such a narrative could have a profound impact on those working with people with disabilities within a healthcare setting. When medical students are exposed to such scenes, for example, it can lead to an increased understanding of how patients can feel based on what they hear from people in their communities. Narrative comprehension teaches medical students to appreciate the details and understand the different perspectives of narrated stories. Malays in The Ethics of Truth Telling in Health Care Setting writes,

“One of the most pre-disposed values to being truthful is associated with respect for the patient as a person who is able to make decision. This is because, to determine a course of action and governance of care for a patient, the patient requires nothing less than truthful information. The provision of truthful information to patients is one way to enable them to make correct decisions which benefit their overall health. Without knowledge of the truth, it would be uncertain whether patients can make informed decisions and would lead to failure of health professionals to respect them as autonomous individuals. Lying is held to be a breach of the autonomy of the person, and this contradicts concepts such as patient empowerment, shared decision-making and patient-centred care. This is essentially significant to a health professional obtaining informed consent, whereby the potential risks involved in the proposed treatment and intervention need to be disclosed truthfully. To consent to any health intervention, a person requires sufficient and truthful information to make an informed and conscious choice; arguably, patients cannot make effective decisions without truthful information.”

Such engagement with literary narratives develops empathy as a cognitive response, which is particularly useful in building a strong relationship between patients and healthcare professionals. Schleifer and Vannatta also draw upon the scientific foundation of empathy in their explanation of what is called by neuroscientists “mirror neurons”, which are responsible for feeling and commiserating with another person’s pain and suffering (Schleifer & Vannatta, 2019, 4). In The Cripple of Inishmaan, empathy is experienced through the names used to address Billy. To call a person “cripple”, “one-leg man” or “bad-leg-boy” is devoid of sentiment:

Isn’t your name Billy and aren’t you a cripple? (McDonagh, 1997, 13)

I should’ve guessed that. Who else shuffles? (ibid., 33)

Billy recedes from society, favouring isolation and “looking at cows” (McDonagh, 1997, 7) in the meadow in order to escape social rejection and to liberate himself from his sense of entrapment in the company of others.

Empathy can be found within theatre in many different ways and from many different perspectives, one way in which empathy is actively created within the practice of theatre is by the use of Stanislavski’s “emotion memory”. This technique involves an actor finding a real lived experience from their own memories, one in which they felt a similar set of emotions to the character, using those feelings and emotions to bring life into the character and develop a “sincerity of emotion”. Stanislavski perpetuates that the witness can only share sympathetic feelings, but by searching out emotion memory real human feelings can be born into the character (Stanislavski & Hapgood, 2013). The concept of very actively putting oneself into another’s shoes is an effective way of garnering empathy, and the study of theatre, whether it be a play or the script itself, can give rise to these types of techniques. Empathy is a large part of the dramatic arts, and this can be a particular advantage when it comes to medical training.

While researchers recognise empathy as being in two distinguished forms, emotional and cognitive, it is the cognitive empathy that is important within medical training. Skill, as opposed to emotional empathy which is more innate, it refers to the individual and their ability and their ability to perceive and discern the emotions of others.

“empathy is comprised of one cognitive dimension and another affective. While the first improves job satisfaction and work engagement and reduces the intention of quitting the organization voluntarily, the affective dimension does not generate a positive impact on the nurse’s wellbeing. Thus, empathy, especially the cognitive attributes (understanding, communication, suitable response), modulates the influence of stress and becomes essential to the quality of the therapeutic relationship and the experience of nursing professionals Furthermore, it protects these workers from developing burnout. perceive and discern the emotions of others. “(Martos et al., 2021,4)

Research has understood that it is in fact “not the extent that a person feels concern for another person, but rather a perceiver’s motivation and ability to create a coherent mental representation of the target person.” (Myers & Hodges, 2009) Put simply, cognitive empathy is primarily about someone’s ability to put themselves into someone else’s shoes and understand how they might feel or be thinking. This type of empathy is a way for us to become better communicators as it helps us to best reach the other person in the way we impart information. Within medical literature cognitive empathy is emphasised as being the form of empathy most important and relevant to the clinical interaction, as it enables medical professionals to understand how their patients are feeling without the need to share those emotions. (Smith et al., 2017)

For a disabled person like Billy, dreams and future plans are subjects of constant deprivation and ridicule. His disability also denies him the affections that are otherwise normal in the life of a young man who needs to love and be loved—Billy will “never be getting kissed. Unless it was be a blind girl” (McDonagh, 1997, 8). Billy must hide his romantic feelings for Helen, the girl who continuously insults him. At the end of the play, Billy chances asking Helen to walk with him, but her words and reaction are a doubled source of agony, “I’d have to be waiting for ya every five yards. What would you and me want to be out shuffling for?” (108). She continues to reject his advances and when she finally relents, she agrees to walk with him on condition that they are not seen by anyone. When Billy shows an interest in the town gossip Johnnypateenmike’s news about the Hollywood team coming to Inishmore to make the film “The Man of Aran”, his remaining hopes for his life are mocked, increasing his sense of abandonment and uselessness. Billy therefore decides to spare himself the unbearable pain of mockery and develops a plan to secretly go to Inishmore and audition for a role in the film, hoping that his luck will take a miraculous turn. Since the director desires the casting of authentic characters, Billy is selected at first and departs to Hollywood without saying goodbye to his aunts. It is also worth noting that Billy is able to take from his experiences his own lessons in terms of the ethics of communicating with other people. This can be seen in his encounter with Bartley, who he berates, saying “You shouldn’t laugh at other people’s misfortunes” (McDonagh, 1997, 89). Billy is the target of everyone’s insults because of his disability, yet the way people in his community behave, misjudge, and undermine is, in fact, an actual disability as Billy himself says to BabbyBobby, “there are plenty round here just as crippled as me, only it isn’t on the outside it shows” (McDonagh, 1997, 92). Through the story of Billy, therefore, the audience, readers and spectators are transported into the lives and minds of the characters in the play and invited to reflect on the treatment of others, and in particular those with disabilities, in a new way. For a medical student, imagining the plight of the patient, in this case a cripple with no expectations of love or employment, helps them to develop empathy and learn to treat all patients with greater respect. This thus leads to patients’ treatment being both socially and physically more effective.

Some truths and facts in narratives are not explicitly mentioned by writers but are rather implied in the telling of the narrative, a fact that is often brought to the attention of healthcare professionals through their patients’ stories. This feature is usually named “the unsaid” in storytelling but can also relate to truth-telling in medical training as an ethical practice as well as to reading between the lines in terms of the stories told by patients about their conditions. Healthcare professionals encounter situations in which language is deputised, and attention to fragments, silences, pauses and bodily reactions are needed. The unsaid and the ethics of truth-telling are important issues within The Cripple of Inishmaan. Scene Seven of the play starts with the sound of Billy’s wheezes, as he appears alone on a chair in a rundown room in Hollywood. Billy, wracked with agony, shivering and shattered, delivers a soliloquy of complaint addressed to the deceased mother he has never known, which reflects his unsaid thoughts and delusions (McDonagh, 1997, 74). His pain lingers and his dream vanishes, and he winds up with a broken body and a broken heart as he questions whether “they let cripple boys into heaven at all” (75). Diagnosis is a logical process that requires attentiveness to the patients’ reactions, sounds, and words and lines that the providers link to one another to create a meaningful whole. Literature, then, “teaches us to attend to such facts, and it offers a method that can be brought to the patient-physician encounter” (Schleifer & Vannatta, 2019, 34).

Discussion of the “unsaid” lends itself to the discourse of ambiguity. Much like a piece of art or a play in a theatre, clinical practice can contain its fair share of ambiguity with which those in the medical profession are required to be able to navigate. A study has shown that “a physician’s ability to acknowledge patients” emotional distress is an essential first step in initiating a discussion of medically challenging issues with no unequivocal solution.’ (Bentwich et al., 2017) With this being said about ambiguity, it has been proffered that visual art can have a contribution to the development of medical students’ tolerance to ambiguity. (Bentwich et al., 2017) Using these ideas, it can be interpreted that the device of the “unsaid” within a play such as “The Cripple of Inishmaan” in which there are many instances that leave us, as the audience, wondering and postulating about the meaning behind the words and actions of the characters. Here, the ambiguity of the ’unsaid’ is the narrative device that has the ability to aid medical students in their tolerance of ambiguity.

We, as an audience, can see this idea of the “unsaid” during Billy’s escape to the meadow to gaze at cows which in turn reflects his unspoken rejection of his demeaning treatment and name-calling and a desire to be treated as he sees his peers treated. As a reaction to this hostility, Billy lowers his head sadly every time he is subjected to such treatment. The unsaid also manifests itself as Billy reminisces about school and children laughing at him. Billy is left mired in emotional and physical pain, simply muddling through a meaningless life of endless doctors’ visits. He has suicidal thoughts, during which he attempts to end his life in the same way as he believes his parents did, in order to escape his dreary existence. Pouring his heart out during a nervous breakdown, Billy says:

Going drowning meself I’d often think of when I was here, just to … just to end the laughing at me, and the snipping at me, and the life of nothing but shuffling to the doctor’s and shuffling back from the doctor’s and pawing over the same oul books and finding any other way to piss another day away. Another way of sniggering, or the patting me on the head like a broken-brained boy fool. The village orphan. The village cripple, and nothing more (McDonagh, 1997, 92).

When observed by healthcare providers, the way in which Billy expresses his distressing present life and memories can broaden their experiences with patients and induce a feeling of rapport. Our understanding of the demanding impact of doctors’ visits and medical appointments from the perspective of the patient and the increased risk of suicidal ideation is a skill that can be developed by healthcare practitioners by engaging with similar narrative situations.

“People long for their physicians as well as their families and friends to sit with them and support them in their struggle. True healing requires answers to these questions. Cure is not possible for many illnesses, but I firmly believe that there is always room for healing. Healing can be experienced as acceptance of illness and peace with one’s life. This healing, I believe, is at its core spiritual. (Puchalski, 2001)

The task of understanding a patient’s story entails attentiveness to such unspoken details and enhanced management of the personal, not just physical, aspects of the patient’s care.

While there has been a focus throughout this article on gaining empathy and a deeper understanding of a patients’ circumstances based around narrative devices and drama practice, it would be a miss not to discuss the effects of the story itself. Particularly, “The Cripple of Inishmaan” not only serves as a way of gaining understanding about a different culture and type of person, but it also has a storyline steeped in both truths and lies. The very idea of truth-telling within medicine encompasses a broad range of ethical issues, including patients’ rights.

Billy eagerly seeks the truth from his aunts, his doctor and Johnnypateenmike about the death of his parents and the cause of his disability, listening to unconfirmed gossip about his parents from the people around him. Billy knows that his parents drowned in the sea on their way to America, but in a conversation with Helen, hears that in fact, his parents drowned themselves, attached to a bag of stones, when they discovered Billy’s physical condition. In terms of his own disability, the doctor eventually confirms to Billy that it was caused by a disease in utero and not because his father punched his mother, saying “Don’t go romanticising it” (McDonagh, 1997, 96). Later, Johnnypateenmike tells Billy that his parents had killed themselves in order to release the insurance money needed to save him. It is not until the end of the play that his aunts disclose the awful truth that Billy was the one tied to a bag of stones and that Johnnypateenmike was the one who saved him. Billy responds to Johnnypateenmike’s version of the story by saying “I needed good news this day” (103). To him, the truth, or what he now thinks is the truth, is always less hard (104).

Billy himself resorts to lying to avoid hostility. Exploiting the fact that Babbybobby’s wife died of tuberculosis, Billy forges a doctor’s letter which states that he has the same condition, in order to convince Babbybobby to take him aboard his boat to Inishmore. To avoid further humiliating confrontations and verbal abuse, Billy also lies that he turned down an offer from Hollywood in order to reunite with the people he loves. He hides the reality that Hollywood rejected him and denied him the part because, to them, it is “better to get a normal fella who can act crippled than a crippled fella who can’t fecking act at all” (McDonagh, 1997, 92).

Billy’s case raises the question of truth-telling as a professional and ethical issue as opposed to the act of withholding information or justifiable lying, especially after he shows acute symptoms of tuberculosis at the end of the play. The play ends with Billy’s aunts wondering whether Billy should eventually be told the real story of his parents. In the end, they decide that it would be cruel to add to his suffering and agree to keep the secret and that the truth might as well be revealed some day. Billy has suffered enough, through his being constantly demeaned and patronised, his disability and rejection by the Hollywood crew, his broken heart and his inevitable forthcoming death. Questions such as whether a physician is justified in withholding information, or if too much information can be harmful are often brought up in medical ethics. The desire for the physician to “do no harm” and the obligation to tell the truth can be a balance that is not easy to obtain. (Sullivan et al., 2001) Therefore exploring these issues through theatre can aid in increasing understanding in a way that does not have the jeopardy of a real patient involved. The ethical issues that this raises for the medical profession require an understanding of the full extent of such dilemmas and their consideration in clinical practice. Literary study can, therefore, contribute to physicians’ consideration and understanding of ethics, and therefore expertise in terms of narrative ethics.

4. Conclusion

Disability forms the central element of The Cripple of Inishmaan. While the play chronicles Billy’s tryst with disability and illness, it is also foregrounding the treatment to which Billy is subjected by his family and community at large. However, Billy is not the only character in the play through which illness and the experience of being ill is analysed. Babbybobby’s wife died of tuberculosis and Johnnypateenmike’s mother exhibited problems related to drinking and old age. The mental state of carers is also dramatised through Billy’s aunt, particularly through his aunt Kate who is left forlorn and talking to stones when Billy goes to Hollywood. With this play having so many different viewpoints to ponder, it is a great example of how a thought provoking play can create an impact on its audience and cause the audience to question their own attitudes to people with disabilities and illness. Considering Willson’s idea that Arts such as theatre can provoke questions about identity and ownership, among other topics, “The Cripple of Inishmaan” can be observed as doing just that. A play with such a diverse voice about disability that it can indeed be used to aid the nurturing of interpersonal skills and interpretive prowess within medical students and beyond.

In its focus on the narrative of illness, the play offers a perfect venue for study and presents features of narrative in literature and medicine which both instructors and students are asked to apprehend in their clinical encounters with patients. Even the specifics of the narrative itself brings forth the questions surrounding the medical ethics and moral ethics involved in truth telling within the practice of medicine. It is recognised that the desire within the medical profession for scientific objectivity can insist that doctors are disconnected from both their patients’ lives and their patients’ individual bodily experiences. The use of Artistic practice within medicine completely negates this and acknowledges the desire for medical professionals to have empathy and compassion alongside the ability to interpret an individual’s bodily experience alongside their need for scientific objectivity without compromising either.

Looking at drama practitioners such as Stanislavski and Schechner, it can be observed that when attempting to study and perform a play there must be a level of empathy in order to understand the subject and present them accurately. It can also be observed that performance runs throughout every day life, and by the study of art such as theatre it can become easier for us to understand societal expectations, which then inform our performance.

In medical study and training, attending to literary features by means of examining experiences of illness through forms of both presentation and content, such as those read or enacted in The Cripple of Inishmaan, develops the professional skills required for communication, ethical responses and accurate diagnoses in patient-physician interactions. Engaging with narrative of illness and pain is good practice of skills that healthcare professionals are advised to be cognizant of. Future research on the cooperation between storytelling and medicine could extend the explanations which focus on theatrical performances to practises of thermotherapy.

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Additional information

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The author received no direct funding for this research.

Notes on contributors

Maha Alatawi

Maha Alatawi finished her Ph.D. in drama studies at University College Dublin in Ireland where she also worked as a tutor. She is currently an assistant professor at Prince Sattam bin Abdulaziz University in Saudi Arabia. She has two book articles published in The Palgrave Handbook of Contemporary Irish Theatre and Performance, and The Theatre and Films of Conor McPherson: Conspicuous Communities. A journal article published in May, 2021 by The Harold Pinter Review. She has a few abstracts accepted for publications as book articles. She has papers presented in conferences in Dublin, Galway, Madrid, London, and New York. She won the award for best paper/ best presentation in the conference in Madrid.