Limbic Listening: The Myth of Philoctetes
A myth retold by Sophocles.
On the Greek island of Lemnos, Philoctetes lives alone in a cave with an incurable wound and an invincible bow. Years before Philoctetes had inherited his magical bow from Hercules and set off with the rest of the Greek heroes to conquer Troy. When they stopped at the tiny island of Lemnos to make offerings to the Gods, a snake rose out of the dust and struck Philoctetes. The symptoms of his wound were repulsive to the Greeks: a festering “evil smell”; “burning flux oozing from the ulcers of his louse-ridden foot”; pain exacerbated by a cyclical suppurating accumulation of fluid which burst through the wound and produced animal groans from Philoctetes and the “unsleeping sleep of all men who are sick."(1)
Odysseus claimed that these symptoms made it impossible to pray to the Gods, and the Greeks abandoned Philoctetes at Lemnos. Ten years later Odysseus and Neoptolemus return because they have learned that without Philoctetes’ magical bow they can never conquer Troy. The climax of the play, however, is not their ultimate victory over the Trojans but the preceding moral victory: Neoptolemus, son of Achilles, sees that the wound and the bow are inextricably bound and that they must be taken together to save the Greek army and to heal Philoctetes.
The literary critic Edmund Wilson interprets Philoctetes as a myth for the struggles of the modern artist. Philoctetes represents the artist, blessed with the bow of creativity. Yet inseparable from this is the pain that permeates the dissolute boundaries of the artistic imagination. It is the art we love and need, but the personal pain of the artist that repels us. For Wilson, the literary critic represented by Neoptolemus can heal this divide between the artist and society by treating Philoctetes “not as a monster, nor yet as a mere magical property which is wanted for accomplishing some end, but simply as another man, whose sufferings elicit his sympathy and whose courage and pride he admires.”(2)
The phenomenology of our human "sufferings" has been described across diverse literary and philosophic traditions. The Buddha viewed afflictive emotions as “tides of conceiving,” (3) like ocean tides obscuring our own minds. William Styron wrote that the suffering of his depression made his brain like “outmoded small-town telephone exchanges, being gradually inundated by flood-waters: one by one, the normal circuits began to drown, causing some of the functions of the body and nearly all of those of instinct and intellect to slowly disconnect." (4) A dramatic dialogue from Philoctetes elucidates how the burden of suffering communicates itself, perhaps requires its own language. This is just before Philoctetes' wound bursts:
What is this sudden thing that makes you cry out and
Groan so much?
You know, my son!
What is it?
You know, my boy!
What is the matter with you? I do not know.
How can you not know? Ah-h-h-h-h-h!
The burden of the sickness is grievous!
Grievous indeed, and indescribable!
What shall I do?
Do not take fright and betray me! It has come in person
After a time, perhaps because it is weary of wandering, the
There is so much in this simple dialogue. We can feel the frustration of Philoctetes first with Neoptolemus for not intuiting his “burden”; then with himself for being stuck in “indescribable” pain. And then the subsuming nature of sickness: it “comes in person,” or overcomes his person, “perhaps because it is weary of wandering.”
Wilson, who vitally linked the myth of Philoctetes to the modern sensibility of the artist, also suffered from episodes of depression and had to be treated in a sanitarium. Yet his cycles of creativity and the constancy of his work allowed him to see that internal suffering could be sublimated into the act of writing. Perhaps the most beautiful quality of his life is its disparity from his intellectual work - as a thinker he oriented us to modernism and moved diverse fields, from the study of the Dead Sea Scrolls to the literature of the Civil War. Gruff and often abusive to friends and family, he wrote with a love for ideas that can light up even the loneliest scholarly mind.
Wilson loved through language and this combined with his direct experience of depression allowed him to see clearly the suffering of Philoctetes, stripped of language by the disease process. Here the figure of Philoctetes overlaps with both the artist and the patient, and we can see that Neoptolemus, the archetypal critic for Wilson, serves the same language function as the archetypal physician: to listen, to understand the pain of the wound and the healing potential of the bow.
*What is so haunting about the myth, so resonant for us as physicians and patients, is Philoctetes' isolation from society, symbolized by the incurable wound and his entrapment on the island of Lemnos.
Even to Neoptolemus, Philoctetes is unreachable through language. When Neoptolemus feels his first rush of compassion toward him, the chorus warns:
“Take care that for all the indulgence you show now you do
Not appear a different person when you have had enough
Of contact with the sickness!”
The refrain also reflects a traditional teaching in medicine: we could not function effectively as physicians, if we were to be subsumed by "the sickness" of our patients. Yet medical models with their clinical vernacular and resolute human boundaries, literary and spiritual models with their semiotic and sweeping pathways to the imagination, may fail to "contact" the experience of "sickness" in a fundamental way: fail to live through it, to convey the guttural insides of the disease, to inhabit the isolation of being a patient.
There is a Hasidic story told by Rebbe Nahman of Bratzlav which explores this dialectic. It is about a prince who goes crazy and thinks he is a rooster. He confines himself to pecking around on the floor beneath one of the grand dining hall tables. The king calls in all the doctors and healers in the kingdom but they do not know how to treat the prince, how to make him human again.
Then a Hasidic mystic comes. He gets under the table and acts like a rooster, is a rooster, and talks to the prince in the language of roosters.
The mystic begins to cure the prince by using himself as an example. One Hasidic aphorism tells us that “the greatest sin of man is to forget that he is a prince,”5 but here the mystic gently leads the prince back to health by telling him not to forget that he is a rooster. “You mustn’t ever believe that it is enough for a rooster to behave like a man to become human; you can do anything with man, in his world and even for him, and yet remain the rooster you are.” And the prince is healed and “resume(s) his life as a prince.”(6)
Perhaps the power of this story lies in the mystic's recognition of the limitations of language, of the prince’s inability to process and communicate information in a normative style. Language is our way of moving through things, translating and moving through experience, defending against it, opening to it, attacking the layers that attack us. When this adaptive capacity becomes impaired through the pain and dilapidation of illness, our patients become like the prince. They are forced down into the old brain—for the mystic, the rooster brain, for physicians, the limbic and subcortical regions not wired for symbolic language.
Silence can be a powerful and therapeutic form of language but it requires a capitulation to time, a giving of it, that we as physicians often cannot find. Silence is more often the domain of mystics and poets. It cannot be mapped out the way that molecular mechanisms are traced to manifesting disease states, but it is a critical, empirical aspect of listening.
The interdependency of silence and listening is described in an interview with Mother Theresa. The interviewer asks her what she says when she is praying to God. She replies, “I don’t say anything, I just listen.” Then the interviewer asks, “What does God say?” And she says, “God doesn’t say anything, He just listens, and if you don’t understand that, I can’t explain it to you.” (7) Still, if as Mother Theresa suggests, there is no pedagogy for listening except the act of listening, how are we to convey these skills to physicians in training?
This brings us back to the myth of Philoctetes and pain as a determinant of communication between patients and doctors. Philoctetes is a classical tragedy, but not like Oedipus or Antigone with a violent or shattering end. The tragedy of Philoctetes has already happened before the play begins—it is the effects of Philoctetes’ wound, his abandonment at Lemnos, and the failure of the Greeks to palliate or tolerate his pain. It is also significant that Odysseus cites their inability “to make burnt offerings” and “pour libations” as the cause for leaving Philoctetes, because these rituals imbued with iterative prayers represent the highest form of communication for the Greeks. Philoctetes is displaced from this communicative process because when his wound bursts he cannot speak and his animal groans repel the Greeks. Yet Neoptolemus can translate this limbic language. We see through him that listening is first a process of feeling not thinking, a process Philoctetes attributes to Neoptolemus as the palpable expression of “being pained by my suffering.”
It is the role of the physician to understand the pain of patients directly, to see like Neoptolemus that they must be cared for before they can be cured. Language inclusive of silence and non-verbal, limbic modalities is our conduit into compassionate care and as the myth of Philoctetes suggests a critical determinant of healing. It is through this language that we can retrieve patients from isolation and reawaken them to the generative possibilities of human relationships.
This manuscript was written in honor of Dr. George B. Murray, author and pioneer of "Limbic Music,"(8) and in loving memory of Dr. George H. Herring, III, September 6, 1958 ~ January 1, 2011. It was published in Academic Medicine in 2013; 88: 214-215.
1. Sophocles, Lloyd-Jones H. Sophocles. Vol 20-21, 483. Cambridge, Mass.: Harvard University Press; 1994.
2. Wilson E, Dabney LM. Literary Essays and Reviews of the 1930s & 40s. Vol 177. New York: Library of America; 2007.
3. Goldstein J. The Tides of Conceiving and the Unconditioned. Wendell: Dharma Seed; 1995;MP3. Available from: http://www.dharmaseed.org/teacher/96/talk/1355/.
4. Styron W. Darkness Visible: A Memoir of Madness. Modern library ed. New York: The Modern Library; 2007.
5. Heschel AJ. God in Search of Man: A Philosophy of Judaism. Vol JP7. New York: Meridian Books; 1959.
6. Wiesel E. Souls on Fire: Portraits and Legends of Hasidic Masters. 1 American ed. New York: Random House; 1972.
7. Goldstein J. One Dharma: The Emerging Western Buddhism. 1st ed. San Francisco: Harper; 2002.
8. Murray GB. Limbic music. Psychosomatics. 1992;33(1):16-23.