Public Republic

Katerina Stoykova-Klemer

Photo: RatRanch

Scientific articles typically fall into one of two categories. They are either pseudo-scientific pieces that, in order to be accessible to the general reader, have been uncomplicated to the point that the scientific value has been diminished; or, they are dense with information and specific terminology, but unreadable by all but those who have sufficient technical background to appreciate the content.

Atul Gawande, however, casts a wider net with his New Yorker article, “The Itch,” capturing both the technical and random audience. Gawande is able to broaden the appeal of his work by the creative use of language, structure and examples, along with a unique combination of the three.

“The Itch” illustrates how itching, which seems benign to most people, can become a lifelong and potentially life-threatening ordeal for others. Since the cause of chronic itching is poorly understood and controversial, there is no proven course of treatment. The author suggests that alternative therapies may provide relief, no matter how unconventional they may seem.

The language and style of the author’s writing are very important contributing factors to the readability of the article. Gawande uses simple language. He does not assume that the reader is familiar with any medical terms, and if he uses a term, he explains it fully and concisely. For example, he writes, “Persistent outer-arm itching that worsens in sunlight is known as brachioradial pruritus, and it’s caused by a crimped nerve in the neck” (Gawande 1).

Gawande incorporates conversational elements into his style. His sentences at times seem informal, on occasion starting with “and” or “but.” He often uses “you” or “your” to give readers the feeling that he is addressing them directly. He uses humor to add levity to an otherwise serious subject, making it more entertaining. The following quote illustrates these aspects of Gawande’s writing: “And, even more puzzling, how is it that you can make yourself itchy just by thinking about it?” (3).

The author additionally employs a journalistic style by incorporating quotes from doctors and patients, which is typical of a profile or an interview. The effect is that, in places, the article reads more like a news story: “‘They kept telling me I had O.C.D.,’ M. said” (Gawande 3).

Moreover, Gawande enriches his essay by adding material from various other sources, including poetry, prose, philosophy, and medical history. Poetry from Dante’s Inferno illustrates the discomfort of itching. A quote from Montaigne discusses the ages-old pleasure-pain relationship of itching and scratching.

The author presents the idea proposed by philosopher George Berkeley that “the objects of the world are likely just inventions of the mind, put in there by God” (Gawande 4). He presents a definition for itching attributed to a 1660 work by the physician Samuel Hafenreffer. The diverse nature of these sources serves not only to give a sense of the breadth of the issue, but also to increase the appeal of the subject matter to a broader set of readers.

A second device that Gawande uses to make his article more accessible is the careful selection and exposition of two medical case studies. In each instance, he presents a lot of background information on the main characters and develops the case as if he were writing a journalistic profile. This seemingly extraneous information has the important purpose of investing the reader in the lives of the characters.

The main example is the story of M., whose case threads through the entire essay. Unveiling details about M. serves the additional purpose of giving the reader a yardstick with which to measure the magnitude of issues that can result from chronic and insatiable itching. Gawande has chosen as his main character someone who has been able to overcome a heroin addiction and has managed to contain the effects of HIV.

These are problems that most people may find insurmountable. Since it was the itching, however, that M. was never able to resolve, the reader gets the sense that itching can be an even more terrifying ordeal.

A secondary example is the story of a man, H., who benefits from the experimental mirror therapy that the author describes. One of the main points that Gawande makes with his work is that contemporary medicine could benefit from stepping outside the bounds of conventional wisdom. However, the gap between M.’s case and the mirror therapy he describes may be too large of a jump for most readers to make, including the scientific audience.

Therefore, the case of H. bridges this gap by providing an example in which someone who has had an insatiable itch, amongst other ailments, has obtained relief from this alternative treatment. This example leads one to the conclusion that perhaps it isn’t so far-fetched to expect that mirror therapy could help M., as well.

The third device that Gawande uses to maintain the interest of the reader is the structure that he has applied to the content. The essay is divided into six approximately equal sections, which alternate between case studies and general medical discussions. The first section introduces the primary character and her plight to its worst point, while the second section switches tone to take the reader through the physiological history of itching.

Subsequent sections continue this back-and-forth switching of content and tone. The case studies provide a more human interest side to the issue, while the medical discussions provide more scientific information. By portioning the science in this manner, Gawande is likely able to hold the reader’s interest longer, and therefore push more facts and data across than if presented as a continuous exposition.

Another important aspect of the essay’s structure is the author’s ability to maximize the effectiveness of the narrative by carefully choosing where he begins and ends each section. In the first section, Gawande ends with the shocking discovery that M. “had scratched through her skull during the night—and all the way into her brain” (2).

The second section ends with the rhetorical question, “how much of our sensations and experiences do nerves really explain?” (Gawande 3). These hooks stimulate the reader to continue through to the end. Additionally, the author resumes breaks in the storyline precisely where he left off. This allows the reader to maintain a sense of continuity throughout the piece.

Gawande’s work, “The Itch,” is both an entertaining and an informative scientific article. Through his unique use of language, examples and structure, the author is able to effectively capture the attention of even non-technical readers. In this way, he is able to convey what might otherwise be considered dry material and to make it interesting and enjoyable to read.

Works Cited
Gawande, Atul. “The Itch.” The New Yorker June 30 2008. The New Yorker. July 18 2008 .