Academic Medicine

Academic Medicine:
doi: 10.1097/ACM.0b013e3182629532
Medicine and the Arts


Berry, Sarah PhD

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Author Information

Dr. Berry is visiting assistant professor of English, Hobart and William Smith Colleges, Geneva, New York; e-mail:

Weaving the colonial history of Antigua with Annie’s struggle to individuate from her mother, Jamaica Kincaid’s novel Annie John is a rich source for teaching the ways in which culture, gender, race, and class shape illness and healing experiences. Students tend to see the novel’s conflicts as clear oppositions: man and woman, England and Africa, biomedicine and Obeah. In the characters’ struggles over health and identity, students notice that men, English culture, and biomedicine align while women, African culture, and Obeah healing resist them, and they construct a rigid set of binaries to interpret Annie’s illness and treatment. This framework is valuable for understanding difference and power. To support it, students cite moments that seem definitive: Ma Chess and Pa Chess are polarized over Obeah and biomedicine; Annie’s mother defers to her husband by placing Dr. Stephen’s vitamins and purgatives in front of Ma Jolie’s ointments on the shelf in the sickroom.

But approaching the novel through schemes and isolated quotations alone can preclude consideration of the ways in which the novel works as a living story—its internal grammar, its webs of meaning, wave-like recursions, sly silences, and repetitions. Its hum of resonance. Even in this excerpt we can hear this hum. Take, for example, the images of blackness lacing these three paragraphs—mourning clothes, warm soot, an inked comma, night, mildew. They evoke sensations, emotions; death and remembrance; decay and gestation. The commas suspend our breath in sympathy with Annie’s suffocation (and what happens to the terrifying soot in those pauses after the phrases “little comma,” “bigger comma,” printed in black ink on the page?). Listen closer: these images of blackness resonate with lived racism; they are counterpoints to Johnnie’s “rosier and rosier” turn to whiteness under the English treatment. The narrative tissue of race echoes back again in the women’s fierce hold on an African identity: Ma Jolie’s Obeah, Ma Chess’s allusion to Anansi the spider, a trickster figure who lives in the ground. The hum intensifies as African oral tales reverberate against European written literature: Johnnie’s rosiness and worm call up both William Blake’s poem “The Sick Rose” and Franz Kafka’s story “The Country Doctor.” All of these sensations, images, webs, tensions, and keys to Annie’s social experience reverberate across the whole story of her growth up to and during her illness.

Using a whole-text approach, too, allows us eventually to realize that Annie’s first-person tone of intimate confession hides profoundly indeterminate meanings, withheld causes, unsayable things. Why are the death of a child and the death of a marriage linked? Why must Annie revert to infancy in order to reach adulthood? What is the connection between rainfall and an illness, which exactly coincide in time? Why does the sickness simply leave “one day,” and why does Annie narrate over her healing by shifting our attention to home repair and the activities of family members? Why does English medicine seem to lead to Johnnie’s death while neither harming nor healing Annie? How does Ma Chess know when to come to Annie, and when the warm soot is terrifying her? To hear these questions form in Annie’s gaps and silences is more important than to isolate answers. Mind and body, reason and emotion, self and other, text and oral tale are not separable in the hum of Annie’s illness, as they are not in her wellness.

Evidence-based reasoning is equally important in scientific medicine and literary study. But when we open up ourselves and our students to a story—hearing the sound the novel’s breath makes and getting used to its smells—we learn more about listening than determining. By showing students how to attune to the ways in which each narrator creates her own vocabulary, logic, and method of telling, we can encourage their understanding of patients, colleagues, and themselves more globally in two senses. First, while Annie’s experiences of race, gender, and cultural relationships are specific to postcolonial Antigua, the novel also asks us to think about the ways in which we experience illness and manage healing in a global context. We are all speakers who articulate ourselves at the nexus of multiple cultures, communities, social positions, and stories.

But listening for the hum of resonance across an entire narrative also stimulates in students an appreciation of global health and healing in the clinical sense of the whole system or person. By resisting the closure that a scheme seems to offer, by not stopping inquiry after finding apt quotations, we make more connections across a story while also capturing its nuances, ambiguities, and unanswerable questions. Annie’s story gives us plenty of each: She physically grows during her illness, even as she reverts to a neonatal then fetal stage; Ma Chess heals with neither biomedicine nor Obeah, but through her constant physical presence and intensive maternal care; and when the rain stops, Annie is well again. Kincaid’s novel dangles our expectations (for linearity, transparency, cause and effect) before us and then, if we listen for its gorgeous hum, instead tells us something closer to the truth of one particular life.

© 2012 by the Association of American Medical Colleges


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