Some years ago, I attended a talk by Bessel van der Kolk, a psychiatrist who is one of the world’s foremost thinkers on traumatic memories and post-traumatic stress disorder. I think it was about 12 years ago, and I think it was related to the September 11th attacks, but I’m not really sure about either of those things. What I do remember is that after some introductory words, van der Kolk seemed to get very angry about the subject of his talk—whatever it was—and began shouting profanities. He stopped, grinned, and predicted that no one would remember anything about his talk except his yelling and cursing—and he was right.
Van der Kolk made the point that memory is bound up with affect. Intense feelings create stronger memories and make them more accessible later. The speaker’s sudden burst of rage left an indelible memory trace, while the rest of his talk faded away.
Students’ mnemonics tell us something important about memory. They also tell us about the doctors who use them, and highlight the subversive nature of medicine.
For her memory’s sake, the medical student takes advantage of the benefits of affectively charged material. Medical students need mnemonics, given the endless lists of symptoms, diseases, body parts, and functions for which they are responsible. Peter of Ravenna, a 15th-century mnemonist and author, suggested that students “excite” their memories by using images of “beautiful virgins” to help encode them. Perhaps it is not surprising, then, that medical mnemonics are scandalous and sexist. Students’ mnemonics, many of which are passed on from one generation to the next, tell us something important about memory. They also tell us about the doctors who use them, and highlight the subversive nature of medicine.
Soon after she pulls on her first double set of latex gloves and plunges them into the body cavity of a corpse, the medical student is confronted with the 12 cranial nerves. Emanating directly from the brain, the cranial nerves underlie the five senses, the muscles of facial expression, our blood pressure and pulse, our digestion and elimination, and our capacity to speak and to swallow—in other words, nearly everything. So august are the cranial nerves that they are denoted by Roman numerals, and bear Greek and Latin names. Thus they are a challenge to remember.
These are the 12 cranial nerves:
Cranial nerve mnemonics use 12-word sentences, each word of which begins with the same letter as the cranial nerve it represents. One old chestnut reads: “On Old Olympus’s Towering Top, A Finn and A German Viewed A Hop.”
Decades after graduating from medical school, that still rings a bell. But infinitely more memorable is the following, recalled by many doctors old and young: “O, O, O, To Touch And Feel A Girl’s Vagina, Ah Heaven!”
A corollary describes whether each of the cranial nerves is a sensory nerve, a motor nerve, or both: “Some Say Marry Money; But My Brother Says Big Boobs Matter Most.”
The two mnemonics combined tell us that cranial nerve IV, the trochlear, is a motor nerve, while the glossopharyngeal, nerve IX, has both sensory and motor functions.
Before responding—as one should, because it’s true—that these mind-benders are degrading to women and contribute to a culture which allows male physicians to see women as sexual toys, the reader might consider what makes the “dirty joke” so useful for student doctors. Most important, it works. Even before the birth of Christ, a textbook of rhetoric written in Latin instructed students to memorize speeches with memory aids that were lewd, unbelievable, or hilarious. When van der Kolk shouted angrily during his talk, he demonstrated the effect of affect on memory—but he also played a joke on us. He tricked the audience as we sat there attentively, like a big brother who jumps out from behind a curtain and yells “boo.” Feeling a little frightened, and then a little foolish, helped the message sink in.
When I started medical school, I was astonished at all of the things I didn’t know. It struck me as strange that I had never even wondered about most of what I was learning about my body. The volume of information that is new to the medical student is itself an indicator of how alien our bodies can be to us. Learning about the body is a subversive act in a society that shames us for wanting to know. For the medical student, digging into the body—both literally, in anatomy lab, and figuratively, in the classroom—can threaten the balance she has achieved between intellectual curiosity and the culturally determined need to remain ignorant. The material to be learned is vast and psychologically challenging, and as George Legman wrote in his analysis of folk stories, The Rationale of the Dirty Joke: An Analysis of Sexual Humor, jokes help us deny the import of unacceptable realities.
In the first years of medical school, the student will discuss sexual functions with men old enough to be her grandfather, and perform digital rectal examinations to feel their prostate glands, and observe young women in childbirth and sew their torn vaginas in its aftermath. For some students, the first nude body they ever see will belong to a cadaver. Medical school confronts the student with the living and dead body and its sexuality. The student uses humor to make this tolerable, as Legman pointed out:
This is perhaps the principal function of the creation of humor, and certainly of the accepting of things as humorous, such as cuckoldry, seduction, impotence, homosexuality, castration, death, disease, and the Devil, which are obviously not humorous at all.
There is one more thing that kidding around does for the medical student: it helps her be a kid for a little while longer. In Jokes and their Relation to the Unconscious, Sigmund Freud wrote that “With the hilarious nonsense of ‘sprees’, college cries, and songs, the student attempts to preserve that pleasure which results from freedom of thought, a freedom of which he is more and more deprived through scholastic discipline.” The dirty joke frees the mind and rebels against convention. For example, at the time The Rationale of the Dirty Joke was published, telephone exchanges like “BUtterfield 8” were being replaced by numerical prefixes. The student who resented what Legman called the “total numeralization and soul-eating of modern technocratic culture”—of which medical training is certainly a part—could liberate herself by making up new phone exchanges, like “FUckhead 7”—a type of joke that Legman collected in his book.
When Peter of Ravenna suggested that mnemonists employ images of young virgins in memory palaces, he added, “This precept is useless to those who dislike women and they will find it very difficult to gather the fruits of this art.” Fortunately, medicine is not as monolithic as it used to be, and new mnemonics have arisen which prove him wrong. The website Minddrills.com has collected dozens of cranial nerve mnemonics. One of my favorites: “On Occasion Oliver Tries To Anally Finger Various Guys. Vaginas Are History!”
Whether a vagina is heaven or history, its importance to the medical student at this particular moment is that it represents the vagus nerve. The mnemonic insures that she remembers otherwise random words. The joke helps her feel free. Most significantly, it helps her accommodate to what she is seeing, smelling, and touching every day—bodies. The medical student faces facts—many, many of them—and defends herself with wit.