Healing Through Literature

by Leslie Hill

Photo by John Russell

Christine Shih cared for a range of patients – adolescents in a student health center, premature babies, elderly eye patients and adults with leukemia – then turned her attention to a different set: the Elizabeth Darcys and Fanny Prices populating the Regency-period English countryside in classic novels by Jane Austen.

The Setting

Shih has always been self-taught when it comes to literature, and learned to read on her own at age 3. Reading became like breathing, literature like food, and even today Shih always has a small book of poetry tucked in her purse.

A music scholarship took her to Louisiana State University, but she quickly realized the music profession demanded a lot of competition for unpredictable rewards. A degree in behavioral psychology offered the practicality she was looking for, but that seemed to point to graduate school in psychology and Shih worried about being pigeonholed in mental health. Her future husband, Kent, had her talk with a friend who was doing her pediatric medical residency.

“She said ‘If I could do it all over again, I would have done a pediatric nurse practitioner master’s degree at Vanderbilt,’” Shih recalled. “It was because of the flexibility it could give me when I became a mother and flexibility over time because the nursing profession is unending.”

Photo by John Russell

Shih took that advice to heart, enrolling in the Vanderbilt University School of Nursing bridge program in 1997 while her husband completed his residency in Internal Medicine at Vanderbilt University Medical Center.

It was at VUSN that Shih first saw an intersection between her new profession and her lifelong love of literature. Enrolled in a nursing theory course taught by Barbara Petersen, Ed., CNM, FACNM, now a professor emerita, Shih decided to write an interdisciplinary paper on author Louisa May Alcott and her experience as a Civil War nurse.

“I was reading a biography of Alcott at the same time I was taking this class, and I realized it was a very interesting time in her life. I wanted to write about her from the perspective of a nurse and how her literary interests might have been inspired by her actual life experiences.”

Though it wasn’t a typical subject for the class, Petersen encouraged Shih to run with the idea.

“You never realize when you are planting that seed. My philosophy of teaching has always been to serve as a coach and sounding board. The idea of pushing the edge is such a part of VUSN’s philosophy and how we got to be the wonderful place we are. When someone has a spark of idea, my belief is yes, go with it and see what happens,” Petersen said.

“Some teachers just really make you as a student blossom, and Dr. Petersen was that for me,” Shih said.
Petersen said it is often forgotten that nursing graduate school is a true scholarly endeavor.

“Sometimes we lose sight of that because we’re so focused on helping patients reach their potential. Though we emphasize nursing practice, it is based on evidence, research and study. We’re a graduate program in every sense of the word, and we’re developing the ability to express, whether that is through writing, verbal communication, presentation skills or technology.”

Petersen encouraged Shih to submit the paper for publication, but she was busy preparing for her family and pediatric nurse practitioner board exams and a move to Baltimore. A seed was planted but in the wrong season of life.

The Plot Thickens

Shih kept reading voraciously but honed her skills as a practicing nurse, first at the Johns Hopkins University Student Health Center and then on the Johns Hopkins Cancer Center leukemia/ hematologic malignancy team. She ran a pilot study treating people with leukemia in an outpatient setting, did Phase I and II research in hematologic malignancies, and taught other nurses and medical residents.

After returning to Nashville and the birth of her daughter in 2005, Shih made the decision to stop practicing and stay home to raise her.

“I have cherished being home to raise my daughter, and at the same time it has been challenging for me to ignore the wheels turning in my mind, thinking ‘What should I do next?’ That’s when I started thinking about writing again.”

In order to understand her family background, Shih also began an intense period of research into Borderline personality disorder, a condition characterized by unbalanced emotions, which leads to impulsive actions and chaotic relationships.

“I’m the child of two Borderline parents and always had a big question mark about my parents and what is wrong with them. Researching the Borderline brought a whole new understanding of personality to me.”

Then she was encouraged by a grief counselor to read a book that “opened up all my windows,” as Shih put it – “Understanding the Borderline Mother” by Christine Ann Lawson. In it, Lawson illustrates aspects of the Borderline personality using fairy tale stories like Cinderella, Snow White and Alice in Wonderland. Shih started making similar connections in her favorite novels – “Jane Eyre,” “Mansfield Park,” “Wuthering Heights,” and “Les Miserables.”

“It was like a light went on and I began to see the Borderline everywhere, especially in Jane Austen’s work,” Shih said.

For much of 2007 and 2008, Shih absorbed every bit she could on Borderline pathology in order to better ascertain its presence in literature.

“Consider a line.  Above is dementia and below is sanity. A Borderline’s thoughts traverse that line like a sine wave, become abnormal, then normal, then abnormal, then normal. The resulting behavior creates confusing misunderstandings in the way they talk to people and treat them,” Shih explained.

This fluctuating thinking is the way a Borderline’s mind protects them from their great fear of abandonment, often followed by depression.

Point of View

In her research, Shih treats literary characters and their authors like living, breathing patients.

“Nurse practitioners apprehend something outside the norm and gather data through the assessment of that aberrancy. I view it as a scientific approach,” she said. “Borderline specialists will tell you it’s not difficult to identify Borderline behavior, but you have to know the pathology. That’s where years of exposure and experience come in, as a child of Borderline parents.”


Christine Shih’s Reading List
For a true picture of the borderline personality… Read more »

Shih said one of the hallmarks of Borderline behavior is a continual pattern of abandonment. Think of the orphan Jane Eyre, living under her tyrannical aunt, or Heathcliff running away and vowing revenge when he mistakenly believes Catherine loves someone else.

Abandonment is glaringly present in Jane Austen’s own life, as Shih found in her biography and letters, leading her to believe Austen was the child of a Borderline mother.

From a few weeks after birth until the “age of reason” around age 2-4, Mrs. Austen had a village family raise seven of her eight children, basically making them foster children during their formative years.

Because Austen never developed a Borderline personality but was surrounded by it, Shih said she developed an incredible eye for the disorder’s idiosyncrasies. A lesser-known work of Austen’s, “Lady Susan,” reads like a case study of a Borderline personality.

“It’s a very thorough psychological profile. She gathers all the evidence and puts it out there in a very empirical, scientific way. She would have made a wonderful psychologist if she lived today. I would argue that she would be a novelist and a psychologist and would be a leader in both fields,” Shih said.

Lady Susan is an absolute villain, but she is an excellent actress, manipulator, and “the most accomplished coquette in England,” enchanting those around her with her manners and wit, she said. She demonizes her daughter Frederica, saying she “was born to be the torment of my life” and “She is a stupid girl and has nothing to recommend her.” In actuality, Frederica is sweet, shy and absolutely terrorized by her mother.

In the novel, told entirely in letters, Lady Susan is hunting for a new husband for herself and one for her daughter. In the end, she is forced to marry the man intended for her daughter because everyone else has detected her schemes and abandoned her.

“This is Austen at her very best. She’s so razor sharp and doesn’t mess around. I’ve never read a psychological profile more interesting than Lady Susan,” Shih said.

Character Development

Little scholarship has been published on Lady Susan, with only one paper looking at the pathology of the titular character and diagnosing her as an anti-social personality. Shih disagreed because the essay did not address the mother/daughter relationship  (the dominant relationship in the novel), which gives many of the necessary clues to enabling a proper diagnosis, and began to form her argument that Lady Susan was a psychological profile of the Borderline personality.

At the same time, around the end of 2008, Shih learned that the Jane Austen Society was holding a bicentennial conference at Austen’s home in Chawton, England, with the theme “New Direction in Austen Studies.”
Shih knew she had a new direction in Lady Susan, but was anxious to apply.

“First of all, I’m an unknown without even a degree in English. And second of all, it was a totally out of the blue perspective on one of Austen’s lesser-known novels. But I thought if I can teach at Hopkins, then I have the ability to present new ideas in other scholarly environments.”

It was accepted, and Shih presented on the first day of the conference in June 2009, launching her new career among the literary elite.

Once Shih had a working draft of her essay she was thrilled to be able to reconnect with Barbara Petersen, who helped her prepare for the conference and even gave Shih a VUSN pin commemorating the school’s centennial.
“She wanted me to connect myself with the School of Nursing at the conference. It gave me an academic association that many scholars could recognize at the conference.”

Shih’s presentation was well-received, and she said people stopped her for the remainder of the conference to hear more about her ideas.

“I was surprised and intrigued to find a fully trained nurse giving a paper on Austen,” said Juliet McMaster, F.R.S.C., Distinguished University Professor Emeritus in the department of English and Film Studies at the University of Alberta. “Christine, I can see, is a highly qualified and gifted practitioner in her own profession, and so has more to give in revealing Austen’s understanding of psychological patterns that weren’t even recognized in her own day, never mind given a name or assigned a treatment.”

A Different Kind of Book Club

You will never find Shih in a coffee shop surrounded by thick books and scattered papers. She needs absolute quiet when she works, something that is at a premium when caring for a toddler. But now that her daughter has started kindergarten, Shih is hard at work on her next project, a book explaining Borderline personality disorder and its pervasiveness in literature.

Photo by Martin Cherry

When she’s not researching, Shih uses the healing elements of her nursing experience in a book club for other people with Borderlines in their life. Calling it “bibliotherapy,” the group reads fiction to learn more about the disorder and how to better interact with people afflicted by it.

“I’m using the relationships in Austen’s novels as the springboard into discussing our relationships with the Borderline. Through that, we work to develop a better understanding and empathy for the Borderline,” Shih explained.

“The sad part for the child of a Borderline is they really are isolated individuals. They feel like they live on an island. So the other interest in doing this group is to bring together children of Borderlines so that they have sound, strong friendships that literally take the place of their family relationships.

The group meets about once a month for a potluck supper and discussion at Shih’s home. They start the evening swapping recipes and catching up on each other’s lives. They are eager to discuss the assigned novel and share their opinions on the study questions Shih prepares for them, such as “Does Lady Susan love her daughter?” and “Which characters are like real people in their own lives?”

Discussing the night’s novel inevitably leads the group members to drawing parallels in their own lives.
Shih is in her element helping the group make these connections and sharing her deeper knowledge of Austen’s life and work. She has amazing tidbits to share, that there are about 160 of Austen’s letters in existence and the writer spent about one-fourth of her budget on postage.

The group is growing exponentially, and Shih plans to create a workbook that other bibliotherapy groups could follow.

“My job has been to take the clinical understanding of the Borderline and move it into a general understanding of the Borderline that anyone can grasp, understand, be able to see and identify, and be able to work through.”


Though Shih would like to return to a clinical setting one day, she is focused on her book on the Borderline and also has ideas for novels and children’s literature.

Shih has presented essays at the Jane Austen Society of North America, The Jane Austen Society and The British Society of Eighteenth-Century Studies held annually at Oxford University, Oxford, UK.  She plans to submit essay proposals for each conference on an annual basis, and in the near future hopes to broaden her scope of author work with the Bronte Society, the Dickens Society and the Society of Children’s Book Writers and Illustrators.

“My vision is that this is the beginning of a long engagement in literary criticism, and in Austen’s work in particular. I believe I’m the only nurse practitioner contributing to literature on an academic level, and I hope I’m developing the groundwork for how other nurse practitioners can enter the field and contribute,” Shih said.