Desmond O’Neill: René Magritte and the art of geriatric medicine

Desmond O'NeillThe addition of a cultural focus to scientific congresses is increasingly common. More often than not the event relates more to the city chosen rather than the subject matter of the congress. However, given that most great art relates to the human condition, it is difficult not to find interesting resonances between the art and our medical sciences. This is particularly the case with geriatric medicine, where practitioners are dealing with life in its most complex, enriched, and challenging form.

The annual congresses of the European Union Geriatric Medicine Society have proven to be lively affairs over the last decade, with a ferment of trainees, early career and established academics presenting increasing amounts of exciting research.

Our congress in Brussels last week attracted delegates and presenters from all continents, barring Antarctica. Not only were we entertained by Haydn divertimenti at the opening ceremony, played by a professor of geriatric medicine and colleagues, but the organizers also arranged for an exclusive evening opening of the Magritte Museum.

This privileged access to the temple of one of the great masters of elliptical communication—the term Surrealist seems unnecessarily constricting—was an absolute treat. Beautifully displayed in chronological fashion over three floors, with a black background as subtly humorous rebuke to the universal white of modern galleries, we wandered around at leisure with discreet but insightful commentary at various points by the expert staff.

Clustering and detaching from and into impromptu groupings, it was clear that the exhibition, the sequential progression of the art and the array of artefacts, were striking a chord among us that flowered in late night discussions. The choice of locations for these seminars was also particularly apt for a conference of geriatricians, eventually fine tuned to either the Brasserie Mort Subite (Sudden Death) or the Café Delirium.

For most of us, previous exposure to Magritte has been limited to a number of widely diffused images. Exposed to longitudinal development of his work, the impact of Belgian nature and nurture became more obvious, with the influence of grotesqueries and bold expressionism of the uniquely unsettling James Ensor quite apparent in his earlier stages and surviving in an attenuated form throughout his life course.

For those with an interest in the complex nature of ageing, the progression of his style was marked on the one hand by a smoothing of some rough edges and brashness, and on the other by an increasing mastery of mysterious and contradictory juxtapositions which combine to a remarkable unitary form.

In themselves, these paradoxes seemed to illuminate the often contradictory elements of later life. His Empire of Light series, combining a daytime sky in the upper half and a nocturnal scene of a house in the lower half evoke Janus-like aspects of growth and loss in later life, but with light persisting through the house window and lamp standard providing a comforting glow even in the dark.

Some of the art works of his late period evoke playfulness and reflection on themes close to the practice of geriatric medicine. The striking Memory will definitely find a place among my slides, a pristine white classical head with a bloody stain to the forehead, against a background of a calm sky and a theatrical framing of apparently random objects. For, often in our work, an over-emphasis on memory loss can blind the care discourse to the many aspects of our nature that are preserved, as described in Anne Basting’s Forget Memory (1).

A droll sculpture, The White Race, is a nice reflection on what is not there, a neat trope for our techniques of being alert to that which is missing in taking a history from those with cognitive impairment. As we gaze, we slowly realize that the assemblage of body parts—noses, lips, ear, and eye—represents four of the five senses. And where is touch? With a smile we realize that it is a sculpture after all—though modern curatorship and security precautions means that a perspex box prevents us from a haptic conclusion to Magritte’s jeu d’esprit.

But the picture, from a trove of striking conscious and subconscious stimuli, which most married the worlds of art and geriatric medicine for me was The Art of Conversation. Comprehensive geriatric assessment (CGA) involves teasing out a coherent narrative from an extraordinary range of illnesses, disabilities, risk factors, treatment, side-effects as well as social and psychological factors. One scientific presentation at the meeting calculated that over 80 of these factors might exist in one patient alone!  Yet CGA is a highly effective technique for making sense of this diversity but it can be difficult to find an apt metaphor with which to illustrate it.

Magritte’s work shows two small figures facing an imposing, ancient and apparently random structure of large granitic blocks, bringing to mind the cognitive burden of assessing and making sense of so many factors. Slowly, however, we begin to discern patterns among the stones: once one is discovered, others begin to present themselves. First, perhaps, comes rêve (dream), and then lire (to read), followed by reveil (waking up).

The genius of Magritte is not just that these textual images are teased out by reflection and curiosity, but that they evoke something delicate and positive that points to a shared humanity. Reading, dreaming, and waking up are shared among the small figures, the now gentle and less threatening structure, and most importantly, also with us who can no longer be classified as passive spectators.

1. Basting AD. Forget Memory: Creating Better Lives for People with Dementia. Baltimore MD, Johns Hopkins University Press, 2009.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and an immediate past president of the European Union Geriatric Medicine Society.

To find out more, see the René Magritte page on the website.