Anywhere but here, anyone but you: a re-reading of Philoctetes from the foot of the bed

ABSTRACT

The mythological character Philoctetes has captured the imaginations of medical educators. The wound on his foot is a symbol of physical pain as well as psychological suffering. His suffering stems from isolation and mistrust as much as it does from a physical wound. This essay offers a re-reading of Sophocles’s version of the story that focuses on the second-personal relationships between Philoctetes and the inanimate and nonhuman elements of his exile. Following on philosopher Eleonore Stump’s defense of theodicy, a close reading of the play offers insight into interacting with hostile or reticent patients by listening to second-personal dialogic address. The theme of the “difficult patient” is addressed in conclusion, proposing that mistrust between practitioner and patient is still more prevalent than current medical education acknowledges and that clinical communication skills can be broadened by attending to the human use of second-personal relationships. The essay is grounded by a personal reflection on caring for a patient from the multiple perspectives of surgeon, Palliative Medicine doctor, and clinical ethics consultant.

KEYWORDS:

• Philoctetes
• second-personal
• isolation
• suffering
• difficult patient

Notes

1. This anonymized case story is a composite account of several patients over several encounters.

2. Diskin Clay, introduction to Philoctetes by Sophocles, trans. Carl Phillips (Oxford: Oxford University Press, 2003), 10.

3. Ibid., 9.

4. Felix Budelman, “The Reception of Sophocles’ Representation of Physical Pain,” American Journal of Philology 128, no. 4 (2007): 443–67.

5. Mark Powlson, “Philoctetes,” Journal of the Royal Society of Medicine 97, no. 2 (2004): 99–100 commenting on Horton A. Johnson, “The Foot that Stalled a Thousand Ships: A Controversial Case from the 13th Century,” Journal of the Royal Society of Medicine 96, no. 10 (2003): 507–8, which also includes a comprehensive bibliography of such diagnostic articles.

6. Richard M. Gottlieb, “Refusing the Cure: Sophocles’ Philoctetes and the Clinical Problems of Self-injurious Spite, Shame and Forgiveness,” International Journal of Psychoanalysis 85, no. 3 (2004): 669.

7. Theresa K. Smalec, “Scenes of Self-Recruitment: Ron Vawter's Entry into The Performance Group,” Theatre Journal 61, no. 1 (2009): 40–41; Budelmann, “The Reception of Sophocles’ Representation of Physical Pain,” 461.

8. Drew Leder, “Illness and Exile: Sophocles’ Philoctetes,” Literature and Medicine 9 (1990): 1–11; Sidney F. Parham, “Philoctetes’ Wound,” Literature and Medicine 9 (1990): 12–20.

9. Leder, “Illness and Exile,” 10.

10. Bryan Doerries, interview by Josephine Reed, “Theater of War,” National Endowment of the Arts, September 8, 2016, https://www.arts.gov/photos/theater-war.

11. Philoctetes Center, “About,” http://philoctetes.net/about/.

12. F. L., “Doctor/Patient Relationships and Sophocles’ Philoctetes,” Dialog: The Newsletter of the Philoctetes Center 3, no. 1 (2008): 7 http://philoctetes.org/documents/Philoctetes%20Dialogue%202008%20January.pdf. Unfortunately, the Philoctetes Center has closed due to lack of funding.

13. Abigail Zuger, “The Difficult Patient, a Problem Old as History (or Older), New York Times, March 6, 2007, http://www.nytimes.com/2007/03/06/health/06soph.html.

14. Eleanore Stump, Wandering in Darkness: Narrative and the Problem of Suffering (Oxford: Oxford University Press, 2010), 68.

15. Ibid.

16. Ibid., 75.

17. Ibid., 188.

18. Sophocles, Philoctetes, trans. Carl Phillips (Oxford: Oxford University Press, 2003). Line numbers are included at the end of each excerpt. I am grateful to an anonymous reviewer for pointing out the perils of using a modern translation of an ancient text to perform close readings that turn on single words. I choose to take that risk because this translation of the play is most readily available in our medical school, having been taught before, and physically present in paperback copies throughout the hospital. I will point out specific slippages between the Greek and English words as they occur in my text.

19. An anonymous reviewer points out that the compound adjective athyrostomos means literally “without a door on her mouth” and implies incessantness rather than incoherentness. For readers who wish to work directly with the Greek text, this edition is recommended: Sophocles, Philoctetes, ed. Seth L. Schein (Cambridge: Cambridge University Press, 2013).

20. Stump, Wandering in Darkness, 114–16.

21. The relationship between the symbols of the wound and the bow has been discussed memorably in Edmund Wilson, “Philoctetes: The Wound and the Bow.” in The Wound and the Bow: Seven Studies in Literature (Cincinnati: Ohio University Press, 1997), 272–95.

22. Clay, introduction to Philoctetes, 7.

23. The use of the second-personal to address elements of the natural or nonhuman world directly, as if it or they could understand him, is more commonly referred to in critical theory as the pathetic fallacy. In their introduction to their translation and edition of Philoctetes, Robert Bagg and James Scully differentiate this from anthropomorphism and describe an animism that is “a relation to the natural world that respects the self-driven integrity of that world” (The Complete Plays of Sophocles: A New Translation [New York: Harper Perennial, 2011], 186).

24. The actual descriptor for “double-mouthed” is dipylon or double-gated, which an anonymous reviewer points out accurately carries no connotations of a mouth and therefore of duplicity.

25. In the Greek text, the word for murder, phonai, is repeated here; there is no change in the word translated as “slaughter.”

26. Laura C. Hanson, “Communication Is Our Procedure,” Journal of Palliative Medicine 14, no. 10 (2011): 1084–85.