Views & Reviews Medical Classics

Christina’s World

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2142 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2142
  1. Desmond O’Neill, consultant physician in geriatric and stroke medicine, Dublin
  1. doneill{at}tcd.ie

It is among the most iconic images of American art. A young woman lies in the grass, raised on her arms in a pose of vigilant expectancy: across parched undulating fields lie a farmhouse and outhouses. Viewed across the treeless landscape, the figure and her unusual pose radiate vulnerability against this vast openness (www.moma.org/collection/browse_results.php?criteria=O%3AAD%3AE%3A6464&page_number=1&template_id=1&sort_order=1).

This is not purely happenstance. Christina Olson (1893-1968) had a progressive neurological illness that led to increasing immobility. She had chosen to crawl around the farm and grounds shown in the painting for many years before its creation.

This subtle masterpiece affords many insights into the narrative of neurodegenerative illness. Tellingly, we do not see someone with an illness but rather a figure who demands our attention, prompting us to wonder what she is thinking and how she relates to this environment. The artist, Andrew Wyeth, has thus gifted us with a key message from those with neurological disease: see me, not my disease.

A second perspective is that of the remarkable adaptation and compensation strategies of those with disabling disease. From an early age her mother sewed knee pads to protect her from falls, and even when very immobile Christina continued to engage in the social life of her rural town in Maine, where her baking was highly prized. To travel around by crawling might be considered by many to lack dignity—yet the beauty of this painting is that the poise and context radiate a secure dignity that no words could ever adequately explain.

Her underlying diagnosis remains speculative1 (Charcot-Marie-Tooth disease is probably the bookies’ favourite), reflecting a further facet of progressive illness of the nervous system—the choice of patients to limit engagement with diagnosis or treatment. Christina avoided assessment, agreeing only to an unsatisfactory admission for one week to Boston City Hospital. Despite frustrating the diagnostic philately of some clinicians, such resistance draws not only my admiration but also reflects encounters in everyday practice—and engenders professional humility about what we have to offer to our patients.

But the deepest achievement of Wyeth’s art is to intimate to us the world view of this remarkable woman. Wyeth was married to a close friend of Christina, and he made many drawings, watercolours, and paintings of her over a 30 year period of visiting Maine in the summer. In her stillness and immobility he communicates not limitation and isolation but wonder and eternal possibilities, and in so doing refreshes our sense of how our humanity inevitably transcends our physical limitations and geographical constraints.

Notes

Cite this as: BMJ 2012;344:e2142

Footnotes

  • Christina’s World

  • A painting by Andrew Wyeth

  • 1948, tempera on gessoed panel, Museum of Modern Art, New York

References

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