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'The Gospel of Judas and the Shaping of Christianity'

Religion scholars Elaine Pagels and Karen King's new book, Reading Judas: The Gospel of Judas and the Shaping of Christianity, interprets and translates the recently discovered gnostic gospel of Judas.

Pagels' previous books include, Beyond Belief: The Secret Gospel of Thomas and The Gnostic Gospels.

King's previous book is The Gospel of Mary of Magdala: Jesus and the First Woman Apostle.

31:43

Other segments from the episode on March 14, 2007

Fresh Air with Terry Gross, March 14, 2007: Interview with Elaine Pagels and Karen King; Interview with Jerome Groopman; Review of Salley Vickers' novel "The Other Side of You."

Transcript

DATE March 14, 2007 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Religion scholars Elaine Pagels and Karen King discuss
the gospel of Judas, which offers different version of Judas'
relationship to Jesus
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guests Elaine Pagels and Karen King are scholars of the Gnostic Gospels,
the gospels that were excluded from the New Testament and offer alternative
views of the life of Jesus and early Christianity. Pagels and King
collaborated on the new book, "Reading Judas," a translation and
interpretation of the recently published gospel of Judas. Pagels is a
professor of religion at Princeton University and is the author of several
books, including "The Gnostic Gospels," which won a National Book Critics
Circle Award and National Book Award. King is a professor at Harvard Divinity
School and the author of a book about the gospel of Mary. The gospel of Judas
was discovered in the '70s and published last year by the National Geographic
Society. In this gospel, which offers a radically different version of Judas'
relationship to Jesus, Judas is Jesus' favorite disciple. Although the gospel
is ascribed to Judas, it was written about 150 years after the death of Jesus.
Pagels says this gospel opens a window on the disputes of second century
Christians about the meaning of Judas' betrayal of Jesus and the meaning of
Jesus' teachings.

Ms. ELAINE PAGELS: What we're showing in this gospel is how stories about
Jesus were told by people who began to tell them and write them down. This is
in the New Testament and outside the New Testament, and what they knew is that
Judas had handed Jesus over to the people who arrested him. That's what they
knew. That's what the earliest account said. And then later, people
speculated, `Why did he do it? Why did he commit this crime,' as they saw it?
And some said, `Well, he did it for greed. He did it for money.' The gospel
of Judas says he did it because Jesus asked him to.

GROSS: And why did Jesus ask him to? Did the gospel explain that at all?

Ms. KAREN KING: It actually doesn't do as good a job as one would hope, but
it seems to know that Jesus died, and in this text, it is arguing very
strongly against the notion of the bodily fleshly resurrection so that when
Judas hands Jesus over, he is really handing him over in order to expose the
truth of the gospel, which is that it is the soul, the spirit-filled soul,
that will live with God forever.

GROSS: So what you're saying is that this gospel is another way of trying to
explain and make sense of Jesus' crucifixion.

Ms. KING: Yes, and one in which, like the Gospel of John, tries to emphasize
that Jesus is in control of the situation. That he is the one, as in the
Gospel of John, sent Judas out. He said, `Go and do what you have to do.'
Well, in this gospel even more we see Jesus in charge of the action and in
charge of what happens. And Judas in this case, however, is a knowing partner
with Jesus.

GROSS: What does Jesus say to Judas about betraying him and about turning him
in?

Ms. KING: What he says to him is `You will sacrifice the one who bears me.'

GROSS: What does that mean? You will sacrifice the human being who bears me?

Ms. KING: It means that what bears him is the fleshly body, that that is
what will be given over to the world out of which it came. In other words,
the material body's going to dissolve back into the material world out of
which it came. But the word `sacrifice' means to make holy, to set aside for
God and in some ways this action of Judas' then sets aside the flesh and
allows the nature of the material world to become clear. It isn't necessary
in order for Jesus to leave the body as a spirit because he comes and goes
throughout the text, so it's not--unlike some people are saying, it's not that
one needs to die in order to shed the prison of the body. The spirit is
always able to have intimate contact with God.

Ms. PAGELS: I'd like to go back, too, to the question, you know, why would,
you know, finding meaning in the death of Jesus. The fact is that as Karen
and I were thinking about it, we realize that this is what all of the gospels
do. I mean, these are people after the fact, after the fact of this brutal
execution saying, `What does it mean?' And "gospel" means good news so the
question is what kind of meaning can you find in this kind of story, and all
of the gospels look for that.

GROSS: Now, if you just look at the gospel of Judas, is Jesus' body
resurrected?

Ms. PAGELS: After the death of Jesus, we know that many people quit the
movement because they said they just thought they were wrong. They gave up.
Then, as you know, some people said he was alive and the stories about
what--how he was alive, some people said he was physically alive, some people
said they saw him in a dream or a vision or something like that. And so the
stories, many of them in the New Testament suggest that his body came out of
the grave and that became what most people think of as the Easter story, you
know.

This text takes a very different point of view and says, no, Jesus is alive,
yes, but it's not about a body getting out of a grave. It's about the spirit
that lives even when the body is killed.

GROSS: So, do you think if you were actually able to ask the person who wrote
this gospel that they would tell you they did not believe in the bodily
resurrection of Jesus?

Ms. PAGELS: Yes, what we love about this text, what is adventurous about
looking at gospels like this or the gospel of Mary or the gospel of Thomas, is
that they don't give you the answers that Christians think they expect, like
Jesus died for your sins or Jesus rose from the dead, you know, or this kind
of thing. They will say, yes, we're Christians but they take the gospel to
mean something quite different and we realize that there were many ways of
exploring it, and that's what we lost when we lost all these other texts.

GROSS: So there's no reference in the gospel of Judas to Jesus dying for the
sins of others?

Ms. PAGELS: Many Christians think that, you know--what does it mean to be a
Christian? It means you believe that Jesus died for your sins, that God loves
the world and sacrificed Jesus to show how much he loves the world. This is a
Christian who says, `Well, what kind of God are you talking about then? I
mean, are you saying that God wants to--God will not forgive sins unless his
own son is tortured and killed in a horrible way? I mean, is this a
bloodthirsty God like those gods that wanted human sacrifice like the Inca
gods or something like that? So this author says that's a horrible picture of
God.

GROSS: Well, in the gospel of Judas, there are passages in which Jesus, you
say, attacks the disciples, laughs at them and dismisses their worship,
telling them that they should stop sacrificing and stop justifying sacrifices.
What kind of sacrifices is he talking about there?

Ms. PAGELS: The author of the gospel of Judas is a very angry person, and we
were trying to understand where that anger was coming from, what it was really
about and we can only see that if we read the gospel of Judas in the setting
in which it was written at a time when many Christians were being put to death
by the Romans because they refused to sacrifice. They refused to sacrifice to
the gods of the Romans who supported the empire, and the Romans, you know at a
time when religion and politics were not considered to be separate affairs,
the Romans took this refusal to sacrifice as a act of political treason. And
yet, what the gospel of Judas is saying, `Here, here are Christians who are
refusing to sacrifice and yet these other Christians are bringing sacrifice
right back into the center of Christian worship by seeing Jesus' death as a
sacrifice for sins, by understanding that the martyrs are sacrifices pleasing
to God and by celebrating the common meal together. That was a very common
ritual practice among early Christian communities of a meal as the Eucharist
as a celebration of the sacrifice of Jesus' death, as a memory of Jesus'
sacrifice. It's this that makes the gospel of Judas so angry, and it's this
kind of understanding of sacrifice that the author opposes.

GROSS: So this is really like a very revisionist text.

Ms. PAGELS: It is, you know. It's interesting. You'd think--when you think
about Jesus, you know, what do you think? You can talk about teachings. You
can talk about healings. You can talk about miracles. You can talk about
walking on water, you know, or spiritual teachings. But when people talked
about his arrest and his execution, they were very often thinking about
themselves. They were thinking, `Well, what happens if I get arrested and I
have to be asked whether I'm going to sacrifice to the gods. And if I don't,
they're going to brutally kill me the way they brutally killed Jesus.' So
asking about the suffering and death of Jesus was often a way of talking about
the danger that they were facing...

Ms. KING: Mm-hmm.

Ms. PAGELS: ...themselves because they were Christians. And so when they
tried to find meaning in the death of Jesus, they were also trying to find
meaning if they themselves were killed, and some of them not only said, `Yeah,
it's meaningful to die for God,' but some of them said, `It's wonderful. It's
what God wants. God is delighted when, you know, the martyrs come.' There's a
Jewish saying that `beautiful in the eyes of God are the death of his saints.'
And this person is angry at that view and saying, again, `Do you think God
wants a bloody sacrifice of his own son or your children or mine or any of
us?' It's a very--yes, it's revisionist, it's harsh, it's startling, and it's
part of the intense arguments that were consuming Christian groups at this
time because of the danger they faced.

Ms. KING: You know, Terry, many of your readers I think when they hear this
are going to think of it as revisionist, are going to call it revisionist.
But I would say what they need to understand first of all is that the story
that we have now is from the side of those who won. You know, the winners get
to tell history, and what we're doing is not revising history. What we're
doing is filling it out. What these new texts are giving us are voices from
early Christians that allow us now to hear many sides of the debates and
struggles, the experiences that Christians were undergoing in this period. So
it is a fuller and richer picture of what was going on in this early Christian
movement, and the gospel of Judas gives us one kind of voice. We had not
really had voices before that allowed us to hear Christians objecting to the
heroization of martyrs.

Ms. PAGELS: Yeah, we always heard that, you know, it's a great thing to be a
martyr. You get the best rewards in heaven and you get bodily resurrected.
You know, this is a wonderful thing. We hadn't--the voices of peoples who
said, `No, avoid it if you can. I mean, God doesn't want that to happen.'
Those voices were stamped out and silenced. They were called cowards and
heretics.

GROSS: My guests are religion scholars, Elaine Pagels and Karen King. Their
new book about the gospel of Judas is called "Reading Judas."

We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guests are Elaine Pagels and Karen King.
They're the authors of the new book, "Reading Judas: The Gospel of Judas and
the Shaping of Christianity." Karen King is a professor of ecclesiastical
history at Harvard Divinity School, and Elaine Pagels is a professor of
religion history at Princeton University, and they've both written several
books.

How does the personality of Jesus described in the gospel of Judas compared to
the personality of Jesus as described in the gospels in the New Testament?

Ms. PAGELS: One of the things we love about it is that Jesus laughs. He
doesn't always seem to be laughing humorously, but it's a different picture of
Jesus that there's a kind of sharpness and a kind of fire in it.

Ms. KING: And I'm actually--often find myself distressed at this Jesus
because he seems like he's just mocking them, you know, rather than--he's not
the nice Jesus who is the God of love, you know, with the `bring the little
children to me,' and so on and so forth. When he sees the disciples
practicing the Eucharist, he laughs at them in a mocking kind of way. It's
not the Jesus that we have in the other gospels.

Ms. PAGELS: It's as though the author of this text is conjuring Jesus to
look at the Christians of his day and say, `You're not right. You're
completely wrong, and if Jesus were here, he would tell you,' just as
Dostoevsky conjures Jesus in "The Brothers Karamazov" and has Jesus, you know,
tell the grand inquisitor that he is getting it completely wrong. And so here
he's saying, `If Jesus came here, he'd laugh at the way you do things and what
you're saying about him. He would think it's mockery. He'd think it's
murder.'

Ms. KING: Yeah. This is the same kind of Jesus who chased the moneychangers
out of the temple. He's really angry with things that are being done in the
name of God and indeed things that are being done in his name that are wrong.

GROSS: Let me get to something really basic about this gospel of Judas and
that is, you know, Judas has always been seen as the betrayer. In fact, Judas
has become synonymous with somebody who betrays. But if you read the gospel
of Judas, he's not the betrayer, he's the disciple closest to Jesus. Jesus
shares the mysteries, you know, of the earth and the heavens with him, so how
does Judas come out--come off in this Gospel? Who is he?

Ms. KING: This author must know he's taking a radical point of view to take
the one most people think of as the betrayer and picture him as Jesus' closest
confidante, the one who comes to really understand the gospel of Jesus. At
the same time, it also challenges the 12 apostles who church leaders claim to
represent just like the pope today claims to represent Saint Peter, church
leaders were claiming to represent the apostles. Here the apostles are
attacked because they're a stand-in for the church leaders, saying, `You've
got it all wrong. The one disciple whom you hate, whom you malign, whom you
misunderstand, is the one who secretly understood the deeper mystery.

GROSS: Now are you able to like believe in any way that Jesus would have
wanted Judas to turn him over to the Romans so that Jesus could have this
exceptionally protracted and painful public crucifixion? I mean, can you
accept that like historically or religiously in any way?

Ms. PAGELS: I don't accept it historically. I think Jesus was arrested and
crucified and his followers because some of them maintained belief in him had
to find meaning in it, had to make the best of it.

Ms. KING: I think that Jesus may very well have known that what he was doing
was dangerous...

Ms. PAGELS: Yes.

Ms. KING: ...in coming into Jerusalem during the Passover, in speaking and
gathering large crowds around him, he may very well have had a sense that the
Romans were very nervous about this and would have regarded any activity that
looked like well, any...

Ms. PAGELS: An anti-Roman demonstration...

Ms. KING: Yeah. That looked like an anti-Roman demonstration. And part of
the issue, of course, is that we know that only 30 or 40 years later, there
was an uprising against the Romans, and this again is a period in which
politics and religion are not separate, and so someone who was a religious
leader like Jesus was crucified as a political revolutionary, and it's very
easy for me to think that he would have understood that that possibility was
there and continued to teach, but I think that's very different from saying
that he sought it or even engineered his own death. That I wouldn't hold.

Ms. PAGELS: It doesn't make sense.

GROSS: So you see this gospel as a way to make some sense of the crucifixion
but...

Ms. KING: Yes.

GROSS: ...not as an actual recounting of what happened?

Ms. PAGELS: That's certainly--and also as a challenge to the Christians of
his own day to say, `You're getting it wrong. This is not the message of
Jesus.'

Ms. KING: Mm-hmm, mm-hmm.

Ms. PAGELS: The message of Jesus is about healing and health and salvation.
It's about knowing who you are in God's eyes. It's not about sacrificial
death. It's not about Jesus dying for your sin.

GROSS: Now...

Ms. KING: I would say it's precisely talking about Jesus' death mostly in
order to understand the meaning of the deaths of Christians in his own day.
The martyrs who are being put to death at the hands of the Romans is the real
on-the-ground issue that the gospel of Judas is dealing with.

GROSS: Now you pointed out that the--early Christian history was written by
the winners, and so only the books chosen for the canon are the books that
everybody knows, and that's--you know, that's become like the only stories and
the other stories have been, you know, intentionally left out and called
heretical. Now take this like recently discovered gospel of Judas. Do you
see this as being the text of one disaffected guy who has a completely
different interpretation than everybody else, or do you think that this text
is representative of a larger group of Christians from the first century who
disagreed with the direction the church was heading and believed more in the
story the way it's being told in this gospel?

Ms. KING: When we first looked at it, it looked like the voice of a
dissident because it sounds so different at first. And then we realized that
it just brings us in the middle of a picture of groups of people who are under
the threat of being arrested and tortured and killed, and we see the very real
and difficult struggles and arguments that happened in those groups. Then we
realized, of course, that there are many other texts we found as Karen said
there are 50 other texts and quite a few of them have hints of the same
arguments, the same objections, the same challenges to the people who were
saying that martyrdom was a great thing.

Fathers of the church engaged in furious argument against people they call
cowards and heretics, and most of their voices are buried. Now we just have a
few of them. That's why they sound so much like loners.

GROSS: So you think there was a larger group that believed that Judas didn't
betray Jesus, that Judas was Jesus' favorite disciple.

Ms. KING: The discovery of all of these new texts that we're finding from
Egypt over the last years have made us see that these kinds of objections were
much more widespread than we had ever had any idea of.

Ms. PAGELS: Mm-hmm.

Ms. KING: It seemed that it was just the voices of a few marginalized
grouches, if you will, or people who were cowards and so forth, but, no, what
we're seeing now is it was indeed fairly widespread throughout the early
Christian movement.

GROSS: What impact do you think that this gospel and the other recently
uncovered Gnostic gospels are having on how Christianity is being understood
and practiced in various denominations?

Ms. PAGELS: Well, one thing it shows is that, you know, Christianity isn't
one thing. You know, it's many voices, many traditions, many conglomeration
of traditions. And it's always changing and being contended with and
struggled with and transformed with every generation. So it's never been a
static thing and many people say if you're a Christian, you have to believe
this or that or what I believe, of course. In fact, it's nothing of the kind.

GROSS: Elaine Pagels, Karen King, thanks so much for talking with us.

Ms. KING: Thank you.

Ms. PAGELS: You're very welcome.

GROSS: Elaine Pagels and Karen King are the authors of thee new book "Reading
Judas: Thee Gospel of Judas and the Shaping of Christianity."

We'll close this half-hour with a recording by actress and singer Betty
Hutton. She died Sunday at the age of 86. Her best-known movies include
"Miracle at Morgan's Creek" and "Annie Get Your Gun." Here she is with Howard
Keel from the soundtrack of "Annie Get Your Gun."

I'm Terry Gross, and this is FRESH AIR.

(Soundbite from "Annie Get Your Gun")

Ms. BETTY HUTTON: (Singing) "Anything you can do, I can do better. I can do
anything better than you."

Mr. HOWARD KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can. Yes, I can."

Mr. KEEL: (Singing) "Anything you can be, I can be greater. Sooner or
later, I'm greater than you."

Ms. HUTTON: (Singing) "No, you're not."

Mr. KEEL: (Singing) "Yes, I am."

Ms. HUTTON: (Singing) "No, you're not."

Mr. KEEL: (Singing) "Yes, I am."

Ms. HUTTON: (Singing) "No, you're not."

Mr. KEEL: (Singing) "Yes, I am. Yes, I am. I can shoot a partridge with a
single cartridge."

Ms. HUTTON: (Singing) "I can get a sparrow with a bow and arrow."

Mr. KEEL: (Singing) "I can live on bread and cheese."

Ms. HUTTON: (Singing) "And only on that?"

Mr. KEEL: (Singing) "Yeah."

Ms. HUTTON: (Singing) "So can a rat!"

Mr. KEEL: (Singing) "Any note you can reach, I can sing higher."

Ms. HUTTON: (Singing) "I can sing any note higher than you."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can. Anything you can buy. I can buy
cheaper. I can buy anything cheaper than you."

Mr. KEEL: (Singing) "Fifty cents."

Ms. HUTTON: (Singing) "Forty cents."

Mr. KEEL: (Singing) "Thirty cents."

Ms. HUTTON: (Singing) "Twenty cents."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can. Yes, I can."

Mr. KEEL: (Singing) "Anything you can say, I can say softer."

Ms. HUTTON: (Singing) "I can say anything softer than you."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can. Yes, I can."

Mr. KEEL: (Singing) "I can drink my liquor faster than a flicker."

Ms. HUTTON: (Singing) "I can drink it quicker and get even sicker."

Mr. KEEL: (Singing) "I can open any safe."

Ms. HUTTON: (Singing) "Without being caught?"

Mr. KEEL: (Singing) "Sure."

Ms. HUTTON: (Singing) "That's what I thought, you crook!"

Mr. KEEL: (Singing) "Any note you can hold, I can hold longer."

Ms. HUTTON: (Singing) "I can hold any note longer than you."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can."

Mr. KEEL: (Singing) "No, you can't."

Ms. HUTTON: (Singing) "Yes, I can. Yes, I..."

Mr. KEEL: (Singing) "No, you can't..."

(End of soundbite)

(Announcements)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Dr. Jerome Groopman of Harvard Medical School talks
about his book, "How Doctors Think," which is about how doctors
make decisions regarding their patients
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Why is it sometimes so hard to get an accurate diagnosis of your medical
problem? My guest Dr. Jerome Groopman has dealt with that question as a
patient and as a doctor. His new book about how doctors reach a correct
diagnosis is called "How Doctors Think." Dr. Groopman writes about medicine
for The New Yorker. He teaches at Harvard Medical School and is chief of
experimental medicine at Beth Israel Deaconess Medical Center in Boston. Dr.
Groopman says the most crucial part of the diagnostic process is that first
conversation you have with your doctor when you describe your symptoms.

Dr. JEROME GROOPMAN: We as physicians tend to latch on to the initial
information that we get from a patient. We're often working under time
pressure and we tend to make snap judgments and use shortcuts in thinking. So
the first information we get, what we first hear, very strongly guides where
our mind works and what conclusions we come to.

GROSS: I want to immediately get to a misdiagnosis, a really interesting one
that you begin your book with, and this is a woman who's lost so much weight
she's down to like 82 points. She feels sick after every meal. Describe what
her symptoms are.

Dr. GROOPMAN: This is a woman I call Ann Dodge, and she had seen more than
30 doctors. When she was 20 years old, she started to develop queasiness,
abdominal pain and really just disliked food. It became noxious to her. She
saw a number of physicians and the diagnosis of anorexia was labeled, was
affixed to her. And she had just a horrific, horrific course over the ensuing
15 years. Her bones degenerated. Her endocrine system became abnormal. She
became anemic. Her immune system collapsed. She had meningitis. She was
hospitalized four times in a psychiatric facility to try to get her to eat,
and she claimed she was trying to eat, and she was cared for by an internist,
a woman who specializes in eating disorders, but she kept withering away.

GROSS: And how was an accurate diagnosis finally made?

Dr. GROOPMAN: Well, her boyfriend, around Christmas of 2004, told her since
she had developed some diarrhea in addition to all this abdominal discomfort
to see a gastroenterologist. The internist wasn't very enthusiastic about
this. She had seen 30-plus doctors. She came to see a doctor in Boston, a
gastroenterologist named Dr. Myron Falchuk. And instead of just taking her
diagnosis, which every other doctor had received and accepted, he did
something different. He sort of cleaned the slate and he asked her to tell
her story from the beginning. He listened carefully, and he asked himself a
key question, `What if she's telling me the truth? What if she's really
trying to get down 3,000 calories a day, and she's still wasting away? And it
turned out that she had celiac disease, which is an allergy to gluten which is
a very important component of bread and pasta and cereal. So here she was
being forced to try to gain weight eating these carbohydrates, which were only
making her sicker.

GROSS: Well, you say that patients can really help their doctors when their
doctors are trying to come up with the right diagnosis of the problem. I
mean, outside of like reporting your symptoms and answering the questions the
doctor asks you, I mean, what can the patient do to really help with the
diagnosis?

Dr. GROOPMAN: Well, there are a number of thinking errors that we as doctors
make. We use shortcuts in our thinking. They're called heuristics in
psychology, and if a patient or family member or friend knows about these
kinds of mistakes, he or she can ask very appropriate and very focused
questions so that the doctor doesn't take a thinking detour. For example, a
very simple question to challenge a diagnosis if the person's not getting
better, like this woman, is `What else could it be? Could two things be going
on simultaneously?' Those are really critical kinds of questions that any
layperson can ask.

GROSS: Now a lot of medicine relies on making diagnoses through scans and
blood tests, but apparently you also need judgment there, too. I mean, as a
patient you often think these things are empirical. Either there's a tumor or
there's not. Either the blood test is positive or it's negative. But the way
you describe it, there's actually a lot of gray areas and judgment calls and
misdiagnoses in these areas that we think of as being empirical.

Dr. GROOPMAN: Well, this to me was one of the major discoveries when I wrote
the book that I thought MRI scans and CAT scans and other high technology like
you say was so reliable. It turns out that the error rate in radiology is
between 20 and 30 percent, and that almost paradoxically some of the higher
tech scans, because they generate so many images, literally overwhelm the
radiologist.

There's also a set of thinking errors that radiologists are prone to. It's
called search satisfaction. For example, they showed 100 board-certified
radiologists 60 chest X-rays, which they said were taken as part of a routine
yearly physical. One of the chest X-rays was missing the left collarbone
because it had been totally eaten away by cancer. Sixty percent of the
radiologists missed the absent left collarbone.

GROSS: That's pretty upsetting to hear that.

Dr. GROOPMAN: It was shocking to me, and it's been studied, in Michigan and
Pennsylvania, why this happens, and it turns out that the radiologist almost
subconsciously is focusing on the lungs and the heart, because that's usually
where the action is, and his or her mind doesn't systematically inspect and
consciously examine the bones and other parts of the body that are shown on
the chest X-ray.

GROSS: You know, hearing you describe the problems makes me wonder when
you're a patient and you get a scan and the scan comes back negative. How do
you really know that nothing was revealed, as opposed to the possibility that
the radiologist reading the scan didn't notice something.

Dr. GROOPMAN: This is a difficult problem, and I think it factors into the
scenario of what to do if you're not feeling better, if you're not getting
better. Clearly, if the treatment works and you're restored to health,
there's no question. But when you go back to your first doctor or you seek a
second opinion, it's imperative once you have the knowledge that the error
rate can be so high with these scans to ask that the scan be re-examined or
even repeated. And one of the most important things is that there's a
breakdown often in communication between the primary care doctor and the
radiologist. One of the experts in scanning of the abdomen told me that he
needs as much clinical information from the primary care doctor so he can
calibrate the scan correctly to try and pick up what might be abnormal. If he
just gets a vague diagnosis, like abdominal discomfort, it's very hard for him
with these high-tech scans to zone in on the area that may show what's wrong.

GROSS: My guest is Dr. Jerome Groopman. His new book is called "How Doctors
Think."

We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: My guest is Dr. Jerome Groopman. He has a new book called "How
Doctors Think," and it's about diagnoses and misdiagnoses, and he's also the
chair of medicine at Harvard Medical School and chief of experimental medicine
at Beth Israel Deaconess Medical Center, and he writes about medicine for The
New Yorker.

Now you had a pretty serious adventure with misdiagnosis. You were having a
wrist problem, a very painful wrist problem. What were your symptoms?

Dr. GROOPMAN: Well, I had some trauma to my wrist. I never learned to type
so I was banging away at the computer. My hand got caught in an elevator
door. I sort of probably have the klutz gene, and my hand started to swell,
become red and hot and really painful. And I saw a hand surgeon, did X-rays,
MRIs and so on. He didn't know what was wrong, and I was actually reassured
that he was so honest with me. But after a number of months as these symptoms
persisted, he said to me, `You have a hyper-reactive synovium,' which is a
mouthful of Latin. There is no such thing. He basically invented a
diagnosis. So I saw a second doctor who looked at my MRI scan and every
little abnormality he wanted to fix, so although he wasn't sure what was
causing all of the swelling and pain, he wanted to do three surgeries. I went
to a third doctor. These were all eminent hand surgeons. This surgeon was,
as I describe, almost on roller skates. He sort of zipped into the room, took
a quick look at my wrist. He said, `I think you have a form of gout.' Well,
that didn't show up on any X-rays. It didn't make sense, and I said, `Well,
it doesn't seem to be gout.' He said, `I'll figure it out when I operate on
you.' Then I got to a young hand surgeon who had just come to Boston and he
listened again to my story from the beginning, and he did something none of
the others had done. He looked at my normal hand and then he compared the two
doing plain X-rays while I moved my hand, and it turned out that the ligament
which attached two of the small bones had torn and it didn't show up on the
MRI. And he thought differently and creatively and openly. Didn't make a
snap judgment. And then he was also very honest with me. He told me that he
had never done this particular kind of repair before. So I went to yet
another hand surgeon who had and had the operation, and it was largely
successful.

GROSS: I think the most terrifying diagnosis you got during this was that it
was actually metastasized cancer. Somebody did a--one doctor did a scan of
your stomach and thought that they saw cancer there, by your ribs.

Dr. GROOPMAN: Yes. This was extraordinary. And it taught me several
lessons. One of the surgeons did a scan to look at my bones and so on.

GROSS: That's right. It was a full-body bone scan. That's what it was.

Dr. GROOPMAN: That's right.

GROSS: Yeah.

Dr. GROOPMAN: So one of the surgeons did a full-body bone scan, and it
turned out my wife and family were away skiing. I was home alone, and I get a
call around 8:00 at night and the surgeon says to me, `You know, there's no
real rush to fix your wrist because your ribs are studded with all of these
lesions that look like metastatic cancer.' And remarkably, within 20 seconds,
my chest began to hurt. And I'm reasonably well put together psychologically.
I'm not a hypochondriac or anything like that, but the terror of being told
that I had metastatic cancer underlying all of this translated itself into
real physical pain over my ribs. As you imagine, you know, I had a sleepless
night. First thing in the morning, I went to the radiology suite and had
X-rays done of my ribs, and they were completely normal. It was one of these
errors in reading a scan.

GROSS: So what lessons did you take away from this as a patient and as a
doctor.

Dr. GROOPMAN: Well, first, I had never experienced psychosomatic symptoms
before. And it shows you how powerful the mind can be in terms of expressing
itself in physical symptoms in the body. The second is that this doctor did
not doubt or question the results of the scan, and before you give someone a
diagnosis of such gravity, given what the error rates are in reading these
kinds of scans, I think it's imperative to carefully look, get a second
opinion, get further X-rays, and, of course, you don't tell someone home alone
at 8:00 at night, an oncologist nonetheless, that his body is riddled with
bone cancer.

GROSS: Let's look at the reverse side. We talked about a misdiagnosis that
was made of your symptoms. Let's look at a time when as a doctor you
misdiagnosed somebody's symptoms. Tell us about one of the times that that
happened and how it happened.

Dr. GROOPMAN: Well, I tell several stories because I've made my share and I
haven't forgotten any of them. When I was a resident, there was a woman who
was complaining of discomfort under her breastbone, and she was, you know,
persistently complaining, and I was young and impatient, and her voice sounded
to me like a nail scratching across a blackboard, and I became very irritated
with her, and I gave her antacids, and I made what's called an attribution
error. I stereotyped her as being a complainer and a hypochondriac. She
didn't have much relief, but I shut off my mind to thinking more expansively,
and then I was paged to the emergency room, and she came in in shock, and she
had a tear in her aorta, the main vessel that takes blood from the heart, and
I had missed it because I didn't think.

GROSS: What should you have been thinking?

Dr. GROOPMAN: I should have, first of all, had a level of self-awareness
about my own irritation. We are not perfect. There are patients we like
more, patients we like less, people who we enjoy their company, people who we
find difficult for whatever reason. But we have to be professional and we
have to monitor ourselves, so I first should have said, `You're clearly
irritated. Don't let that color your thinking. Don't stereotype her. Don't
make what's called an attribution error,' a term I've only recently learned.
And the second is I should have kept searching because her symptoms didn't go
away, instead of just shutting off my mind. I could have said, `What else
could it be? What other anatomic structures are in that region that deserve a
serious look?' And then I could have also asked, `What is the worst problem
you could be missing?' And, indeed, a tear in the aorta is one of the worst
problems that could be missed.

GROSS: Did you apologize to her?

Dr. GROOPMAN: I apologized to her family because she died.

GROSS: Right.

Dr. GROOPMAN: And it was awful, for me and, of course, most awful for them,
but I felt absolutely heartsick.

GROSS: What did you say to the family?

Dr. GROOPMAN: I said that I had missed this, that I felt terrible about it.
Many of my colleagues said, `You know, she was elderly, and she had this tear
and such people often do poorly,' and so on, but that was really very little
comfort. And I explained to them that I really felt that I had made a
significant error, and they very graciously and nobly accepted that.

GROSS: What are some of the ways that practicing medicine has changed for you
for better and for worse in the 30 years that you've been practicing as a
result of changes in managed care and in health insurance?

Dr. GROOPMAN: Well, I definitely feel, like all physicians, this tremendous
time pressure. And I don't like it, and my patients don't like it, and I try
to resist it as best as I can, but it's not simple. This kind of factory
mentality where people should be seen in 10 to 12-minute intervals. What's
also changed though for the better is I think people are much better informed.
That we as physicians have learned to partner with patients rather than stand
on a pedestal. I think it's key that patients and their family members know
what's wrong with them. What--how we think about their problem and feel
completely comfortable to ask us challenging questions, and that didn't exist
30 years ago.

GROSS: Well, I want to thank you very much for talking with us.

Dr. GROOPMAN: Thank you.

GROSS: Dr. Jerome Groopman is the author of the new book, "How Doctors
Think." He writes for The New Yorker and is a professor at Harvard Medical
School.

Coming up, Maureen Corrigan reviews a new novel about the relationship between
analyst and patient.

This is FRESH AIR.

(Announcements)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Book critic Maureen Corrigan reviews Salley Vickers' new
book, "The Other Side of You"
TERRY GROSS, host:

Writer Salley Vickers is a former psychologist. Her new novel is about the
unpredictability of the relationship between analyst and patient. Our book
critic, Maureen Corrigan, says Vickers' background invests the book with the
kind of observations only insiders can make. Here's Corrigan's review of "The
Other Side of You."

Ms. MAUREEN CORRIGAN: It always amazes me how a gifted writer can write a
splendid novel and then slap on a dud of a title. For instance, one of the
many awful working titles that F. Scott Fitzgerald favored for "The Great
Gatsby" was "Trimalchio in West Egg," a title that might well have torpedoed
the great American novel down to the bottom of the remaindered list. And what
possessed Salley Vickers to call her novel about psychoanalysis and emotional
regeneration "The Other Side of You"? It's a title befitting a bubble gum
rock song and doesn't do a smidgeon of justice to the sophisticated novel.
Get past it and you quickly realize that Vickers' dopey title has a high-brow
pedigree. It's taken from a passage in T.S. Elliot's "Waste Land" that
refers to the New Testament story in which two of the apostles after the
crucifixion walk down a road and feel the presence of a third person, the
risen Christ, alongside them. `Who is that on the other side of you,' asks
one disciple to the other, a monumental question that makes for a lousy title.
But since it's Vickers' only artistic misstep in this delicate, intelligent
novel, she gets absolution.

Vickers is a novelist in that subtle, British female tradition of Penelope
Lively and Iris Murdoch and Anita Brookner, all of whom write circumscribed
tales about characters whose placid exteriors mask roiling inner lives. There
are lots of shabby rooms decorated in shades of brown and gray in their
novels, suppers of whiskey and ham sandwiches, allusions to art and psychics
and philosophy. Characters are always thinking in these brainy Brit stories,
and it's the act of thinking, its intensity and surprising convolutions that
constitute these novels' real plot and chief allure.

In "The Other Side of You," the thinker is Dr. David McBride, a melancholy
psychoanalyst in his 40s who's married to a narcissist. When he was a small
boy, McBride witnessed the death of his six-year-old brother who was hit by a
truck. There's been a lack in him ever since and a fascination with death.
Speaking of his work, McBride says that his particular bent was the suicidally
disposed, because after all, like is drawn to like. When the story opens,
McBride, who's narrating in retrospect, recalls taking on a new patient, a
failed suicide named Elizabeth Cruikshank. Elizabeth is mousy, after all,
McBride quips, no one looks there best in the aftermath of a suicide attempt.
But when she smiles, McBride is reminded of a lovely old expression. It was
as if the moon had taken off her clothes and gone dancing. Over several hours
in one extraordinary evening session, Elizabeth unburdens her story to
McBride. She tells him of a passionate, doomed love affair with an art
scholar named Thomas. The affair was passionate, not chiefly because of the
sex but because of the sense that Thomas gave her of truly being known.
Here's McBride's insight about the ambivalent gift of being known.

(Reading) "On the one hand, it is what we fear most, that our shamefulnesses,
disloyalties, meannesses, cruelties, miseries, the sum of our hopeless,
abject, creeping failures be finally laid bare. But the very opposite is also
the case. I believed, or believed I believed, that we are in anguish until
someone finally finds us out. And the deeper truth is that human
consciousness can hold two contradictory states at once, and all our unmet
longings wear an overcoat of fear."

As I said Vickers is writing in the ruminative novel tradition where the
greatest plot surprises derive as in the passage I just quoted from unexpected
turns of thought. It's not so much what happens as how it happens. "The
Other Side of You" is intricately constructed so that Elizabeth's stories of
her affair with Thomas gracefully flow into McBride's realizations about his
dead brother, hollow marriage and daily work life at the mental hospital.

In the climatic final scene of the novel, McBride offers a scholarly
interpretation of two paintings by Caravaggio that depict the same gospel
story that give this novel its unfortunate title. As climaxes go, it's pretty
restrained. No one dies or even kisses. But the insight that McBride voices
is so startling, the effect on the reader is similar to a therapeutic
breakthrough, as though some shadowy slumbering truth has been joyfully
resurrected.

GROSS: Maureen Corrigan teaches literature at Georgetown University. She
reviewed "The Other Side of You" by Salley Vickers.

(Soundbite of music)

GROSS: If you want to catch up on FRESH AIRs that you've missed, you can
download podcasts of our show on our Web site, freshair.npr.org.

(Credits)

GROSS: I'm Terry Gross.

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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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