In 1948, Andrew Wyeth saw crippled Christina Olson crawling crab-like across the field outside her kitchen door. In the portrait he painted soon after, Christina’s upper torso is raised on emaciated arms, her one visible elbow a swollen knob, her hands clenched and gnarled. The image evokes a sense of yearning—simultaneously eerie and faintly salacious—that has made Christina’s World one of America’s most celebrated images.
Wyeth was not a physician. On first meeting the woman who became his wife, he told her that he was a pre-med student, though he never actually received any medical training. Nevertheless, he knew Christina Olson’s medical history as well as any personal physician, and incorporated it into his famous portrait with great clinical insight. If there is an art of medicine, then physicians are artists and must have something in common with traditional artists. Wyeth, in fact, is a role model to physicians—no more clearly than in his treatment of Christina.
Wyeth maintained purely clinical relationships with his models—intense, yet temporary and detached, except for Christina Olson. She was different. Wyeth first met her in 1939, when he was 22 and already a rising star in the art world. Betty, who had long been her friend, took Wyeth to meet Christina in her dilapidated fetid house, just to see if he would go in. Wyeth did, and for the next 28 years, he studied Christina, painted her, and fretted over her until her death in 1968 at age 74. He found uncommon dignity and strength in her situation, where others saw only the horror of her disability and the squalor of her household. Once, when he brought Robert Montgomery to meet Christina in her home, the actor fled the house and vomited after just a few minutes inside, repulsed by her, the scabrous black walls and ceiling of her home, and years of accumulated grime.
The etiology of the disorder that robbed Christina first of the use of her legs and then her arms and hands has been a subject of speculation since Wyeth’s masterpiece first reached the public. Although polio has been her standard diagnosis, more likely she was afflicted with Charcot-Marie-Tooth disease, a genetic disorder characterized by a progressive wasting away of the muscles, paralysis, and loss of sensation beginning in late childhood or early adulthood. Christina’s disorder had all of these features. (Polio produces a sudden, non-progressive paralysis unaccompanied by a loss of sensation.) Only once did Christina allow herself to be scrutinized by the medical profession. In 1919, when she was 26, she spent a week in the Boston City Hospital before being sent home without a diagnosis and told “to just go on living as [she had] always done.” Wyeth gave her a diagnosis in his painting no less informative than the one a physician might give her today. Moreover, it would be hard to imagine that the time, attention, and compassionate understanding bestowed upon her by Wyeth was not a greater comfort to her than anything provided by the Boston City Hospital’s team of doctors.
The flip side of Wyeth’s attention, of course, is a form of exploitation. One might argue that he used his subjects for his benefit more than for theirs. Christina’s World made Wyeth an American household name and launched his commercial career. It also made Christina the most famous model in modern American art, but a freakish curiosity as well. One Sunday morning after the New York Metropolitan Museum of Art bought and began promoting the painting, for example, a total stranger entered her house, came right up to where she was lying helpless, and asked her for her autograph. Wyeth’s personal view on the subject was sensitive as well as pragmatic. Although he firmly believed that his work justified the means, he also admitted that, “Unconsciously, we artists do a devastating thing. You’re really raising hell with models mentally and emotionally.” And he was drawn to the downtrodden, not just Christina Olson and Helga Testorf, but others, such as Karl Kuerner, a mean drunk who brutalized his children, and Kuerner’s strange wife, who cleaned compulsively while speaking to herself in her native German. In his ongoing quest to capture the fleeting quality of life—“death beyond the joy,” as he put it—he also studied and painted Walt Anderson, who citizens of his hometown dismissed as a sad drunk; Willard Snowden, an alcoholic drifter; and James Loper, a mentally disabled boy. If he had been a physician, he likely would have recognized that the part can never be well until the whole is well and made time in an impossibly busy schedule to help his patients shoulder the suffering and uncertainty of their illnesses, the grief of painful life events and the loneliness of death. He would have been well schooled in the science of medicine but also acutely aware of its limitations.
Prior to the mid-nineteenth century, medicine had little to offer patients other than its art. Past generations of physicians could offer their patients only compassionate understanding and crude attempts to assist the healing power of nature. Recently, however, science and the scientific method have empowered doctors with what many believe is an almost unlimited capacity to cure disease. But for many patients, medical science has yet to provide either comfort or cure, and for these, clinical data generated by scientific investigations has served only to create a widening gulf between them and their physicians. Science has made it possible for physicians to mend an increasing number of sick bodies, but has no cure for sick souls. New drugs and procedures created by medical science have brought harm along with benefit. Medical care guided by science alone, especially at life’s end, can lead to brutality. If there is a cure for these ills of the medical profession, it may only be found in its art.
Andrew Wyeth’s life and work, and the patient he made famous, speak to the nature of health care providers who do practice the art of medicine. Like Wyeth, they touch the lives of countless people in ways that defy scientific analysis, and though their effects cannot be measured, they are profound nevertheless. Such physicians are at once masters of the science of medicine and ever-vigilant critics of its limitations. Though implacable enemies of disease, they also accept death as a normal part of life. Their unique talent is their ability to be scientific toward disease and humane toward the patient.
Dr. Philip Mackowiak is the Carolyn Frenkil and Selvin Passen History of Medicine Scholar-in-Residence at the University of Maryland School of Medicine, and the author of Diagnosing Giants: Solving the Medical Mysteries of Thirteen Patients Who Changed the World.