The story I hold about myself: the epistemology of Mr. Wright

“The patient must be willing to believe the story, and the doctor must tell it extraordinarily well.”- Anne Harrington on theatre, belief, storytelling and narrative.

The play “The Story of Mr. Wright” was conceived, directed and written by Christian Barry and Anthony Black of Halifax’s 2b theatre together with the cast, five Saskatchewan artists of the Globe Young Company, and inspired by a CBC podcast by Dr. Anne Harrington. Bioethical elements of paternalism, doctor’s authority, informed consent and the doctor-patient relationship are the backdrop to a story about what we can believe. In the post-production discussion Dr. Harrington made the point that “’The Story of Mr. Wright’ is a twenty-first century play.” Being set in the fifties provides a setting for a story in which doctors wield almost total authority over patient’s treatments, creating an opportunity to imagine enacting the placebo effect in ways that would not be possible today. However the core of the play is the question of what power can the mind have over the body, and bodily diseases and experiences. Harrington described it thus; “It’s the story of our times, the power of our minds.”

The old chestnut of epistemology is Justified True Belief and the play “The Story of Mr. Wright” seem to me to be in some sense an exploration of what justified true belief could mean in relation to the placebo effect. The question of what power our minds have is intertwined with a related question—what can we know, and how will our knowledge affect us? The final scene of the play is an epilogue in which an actor recounts what he says is a true story about his uncle. He describes how his uncle was diagnosed with cancer, and then goes to see a production of “The Story of Mr. Wright”. The idea of the power of the mind to control bodily experience takes hold of his uncle, who then refuses chemotherapy in favour of focused meditation. The uncle is found, shockingly, to be cancer free, and in jubilation the actor describes running through the hospital and falling on a ‘danger’ sign; a fall which leaves him with a scar. The last line of the play is “Do you see it?” as the actor raises his shirt to show the audience a scar that is not there.

But do we see it? Do we believe it? Can we make ourselves know that our minds can cure us, if holding this knowledge will in fact make us well?

Throughout the play the cast tell micro stories. For each story the house lights come up, the actor appears to drop out of character to address the audience as themselves, and to tell a story from their life. The ambiguity of these stories, and of the final offer to show us an invisible scar, speaks to the question of what we can choose to believe.

It seems that if we can believe in these stories, and in the studies and anecdotes offered by Harrington, by audience members who asked questions during the post-play discussion, and by the actors in the play, that we would be justified in believing in the placebo effect for purely instrumental reasons. The placebo effect is well documented, and the beneficial effects of the placebo effect are only available to those who believe in the efficacy of the treatment they are receiving. Thus, it is simply pragmatically rational to believe if we can. In turn our ability to believe is both dependent and linked to the question of truth. If we believe, and if we are justified in so believing, and if our justified belief allows for the placebo effect, is our justified belief then true? And so we come back to the question of justified true belief. It seems that if we believe, and are justified in so believing, then it may be true that our justified belief creates truth out of itself.

Anne Harrington made it very clear in her discussion that she is not endorsing trickery or lies in medicine, but rather that her focus is on the elements of theatre or narrative that can be employed to make medical practice more effective.  As she asked, if wearing a lab coat leads to benefits in patient health, why not wear a lab coat? However the epistemological question of whether wearing a white lab coat contributes to curing an illness remains; it seems that it is only our belief in the story of the competent doctor in a pristine white coat that promotes our healing, and the justification for this belief is only that so believing may be beneficial to our health, and the only truth to be found is in the results that our potentially justified belief creates.