Medical Humanities current issue

Medical humanities and the on-going search for reliability, authenticity and humility

Kirklin, D. — 2011-11-23T07:39:25-08:00

Sometimes editors plan themed issues, sometimes they just happen. With this issue it's a little bit of both. A core of five papers (four companion, one unrelated) together set out to challenge some of the most fundamental premises on which medical humanities has established itself over the last few decades.

Starting with a paper by Johanna Shapiro, and moving on to papers by Angela Woods, Estelle Noonan and Claire Hooker, Paul Macneill, and John Harley Warner, our authors are refreshingly forthright, and certainly don't pull any punches.

Shapiro begins by suggesting that narrative medicine may be in danger of losing its way. She acknowledges the contribution of scholars in using theories of textual analysis to develop a "more nuanced and multifaceted appreciation" of patient narratives, but goes on to suggest that doing so risks "the unintended effect of de-legitimising the patient's voice because of concerns regarding its trustworthiness".

The...

Illness narratives: reliability, authenticity and the empathic witness

Shapiro, J. — 2011-11-23T07:39:25-08:00

Several scholarly trends, such as narrative medicine, patient-centered and relationship-centered care, have long advocated for the value of the patient's voice in the practice of medicine. As theories of textual analysis are applied to the understanding of stories of illness, doctors and scholars have the opportunity to develop more nuanced and multifaceted appreciation for these accounts. We realize, for example, that a patient's story is rarely "just a story," but is rather the conscious and unconscious representation and performance of intricate personal motives and dominant meta-narrative influences. Overall, this complexifying of narrative is beneficial as it reduces readers' and listeners' naïve assumptions about reliability and authenticity. However, the growing body of scholarship contesting various aspects of personal narratives may have the unintended effect of de-legitimizing the patient's voice because of concerns regarding its trustworthiness. Further, the academy's recent focus on transgressive, boundary-violating counternarratives, while meant to right the balance of what constitutes acceptable, even valuable stories in medicine, may inadvertently trivialize more conventional, conformist stories as inauthentic. While acknowledging the not inconsiderable pitfalls awaiting the interpreter of illness narratives, I argue that ultimately, physicians and scholars should approach patient stories with an attitude of narrative humility, despite inevitable limits on reliability and authenticity. While critical inquiry is an essential part of both good clinical practice and scholarship, first and foremost both types of professionals should respect that patients tell the stories they need to tell.

The Lady in Pink

Brown, R. M. A. — 2011-11-23T07:39:25-08:00

From the cancer patient to the surgeon

By Rachel Brown

There was a young lady who said

As she lay—quite exposed—in a bed

"When poking around

I think that I've found

A lump that has filled me with dread"

So they kneaded and massaged and squeezed

And sampled a smidgeon to freeze

And he told her quite straight

That her cancer was late

But he'd cut it all out—if she pleased.

Then she said to the surgical team

"I think that your plans are extreme

Though you may be the best

You are only the guest

Of boobs owned and grown by a queen."

But when he had done what they do

She found that her outlook was new

When her breast disappeared

Her foot reappeared

She'd a vertical view of her shoe

And she thought—now he'd done with his knife—

She was going to...

The limits of narrative: provocations for the medical humanities

Woods, A. — 2011-11-23T07:39:25-08:00

This paper aims to (re)ignite debate about the role of narrative in the medical humanities. It begins with a critical review of the ways in which narrative has been mobilised by humanities and social science scholars to understand the experience of health and illness. I highlight seven dangers or blind spots in the dominant medical humanities approach to narrative, including the frequently unexamined assumption that all human beings are ‘naturally narrative’. I then explore this assumption further through an analysis of philosopher Galen Strawson's influential article ‘Against Narrativity’. Strawson rejects the descriptive claim that "human beings typically see or live or experience their lives as a narrative" and the normative claim that "a richly Narrative outlook is essential to a well-lived life, to true or full personhood". His work has been taken up across a range of disciplines, but its implications in the context of health and illness have not yet been sufficiently discussed. This article argues that ‘Against Narrativity’ can and should stimulate robust debate within the medical humanities regarding the limits of narrative, and concludes by discussing a range of possibilities for venturing ‘beyond narrative’.

The bleeder

Lemieux, L. — 2011-11-23T07:39:25-08:00

Red inky words scrawled aggressively across the paper,

he's looking over my shoulder thinking don't worry

blood's not red it's blue/purple except air oxidises it just so fast that

our imperfect eyes don't see

I reply you're scientifically right I'm sure but it's pretty red

when you've severed an artery accidentally and it's pump pump pumping away

reach in, find the bleeder, hold it down tie it off use cautery make it stop stop stop

I don't believe for several long seconds that I can do it and I'm terrified

but I'll tell you this man looking over my shoulder

hope also turns red when it hits the air.

Competing interests

None.

Provenance and peer review

Not commissioned; internally peer reviewed.

Medical humanities as expressive of Western culture

Hooker, C., Noonan, E. — 2011-11-23T07:39:25-08:00

In this paper we articulate a growing awareness within the field of the ways in which medical humanities could be deemed expressive of Western cultural values. The authors suggest that medical humanities is culturally limited by a pedagogical and scholarly emphasis on Western cultural artefacts, as well as a tendency to enact an uncritical reliance upon foundational concepts (such as ‘patient’ and ‘experience’) within Western medicine. Both these tendencies within the field, we suggest, are underpinned by a humanistic emphasis on appreciative or receptive encounters with ‘difference’ among patients that may unwittingly contribute to the marginalisation of some patients and healthcare workers. While cultural difference should be acknowledged as a central preoccupation of medical humanities, we argue that the discipline must continue to expand its scholarly and critical engagements with processes of Othering in biomedicine. We suggest that such improvements are necessary in order to reflect the cultural diversification of medical humanities students, and the geographical expansion of the discipline within non-Western and/or non-Anglophone locations.

The arts and medicine: a challenging relationship

Macneill, P. U. — 2011-11-23T07:39:25-08:00

This paper discusses various justifications for including medical humanities and art in healthcare education. It expresses concern about portrayals of the humanities and art as benign and servile in relation to medicine and the health professions. An alternative is for the humanities to take a more active role within medical education by challenging the assumptions and myths of the predominant biomedical model. Another is to challenge quiescent notions of the arts by examining examples of recent provocative work and, to this end, the paper considers the work of performance artists Stelarc and Orlan who have subjected their bodies to modifications and extensions. Their work challenges, and potentially undermines, conceptions of the body, medicine, and humanity's relationship with technology. Similarly, other artists, working with biological cultures, have raised controversial issues. Recent work of this kind defies easy understanding and resists being pressed into the service of medicine and other health professions for educational purposes by opening up topics for exploration and discussion without providing unitary explanatory frameworks. The paper goes on to discuss the implications for medical education if this is the approach to the arts and humanities in healthcare education. It suggests that there needs to be a shift in the foundational assumptions of medicine if the arts and humanities are to contribute more fully.

The humanising power of medical history: responses to biomedicine in the 20th century United States

Warner, J. H. — 2011-11-23T07:39:25-08:00

Most American historians of medicine today would be very hesitant about any claim that medical history humanises doctors, medical students or the larger health care enterprise. Yet, the idea that history can and ought to serve modern medicine as a humanising force has been a persistent refrain in American medicine. This essay explores the emergence of this idea from the end of the 19th century, precisely the moment when modern biomedicine became ascendant. At the same institutions where the new version of scientific medicine was most energetically embraced, some professional leaders warned that the allegiance to science driving the profession's technical and cultural success was endangering humanistic values fundamental to professionalism and the art of medicine. They saw in history a means for rehumanising modern medicine and countering the risk of cultural crisis. While some iteration of this vision of history was remarkably durable, the meanings attached to ‘humanism’ were both multiple and changing, and the role envisioned for history in a humanistic intervention was transformed. Starting in the 1960s as part of a larger cultural critique of the putative ‘dehumanisation’ of the medical establishment, some advocates promoted medical history as a tool to help fashion a new kind of humanist physician and to confront social inequities in the health care system. What has persisted across time is the way that the idea of history as a humanising force has almost always functioned as a discourse of deficiency—a response to perceived shortcomings of biomedicine, medical institutions and medical professionalism.

Body-conscious Shakespeare: sensory disturbances in troubled characters

Heaton, K. W. — 2011-11-23T07:39:25-08:00

It is widely accepted that Shakespeare was unique in the range of his insights into the human mind, but the way his characters reveal their mental states through bodily sensations has not been systematically explored. The author has searched for these phenomena in the 42 major works of Shakespeare and in 46 genre-matched works by his contemporaries, and in this paper the author focuses on sensory changes other than those involving vision, taste, the heart and the alimentary tract (all considered in other papers). Vertigo is experienced by five distressed Shakespearean characters, all men, but not at all by the other writers' characters. Breathlessness, probably representing hyperventilation, occurs eleven times in Shakespeare's works but only twice in the other writers' works. Fatigue, expressing grief, is articulated by several Shakespearean characters including Hamlet. It features less often in the others' works. Deafness at a time of high emotion is mentioned by Shakespeare several times but usually by a character ‘turning a deaf ear’, consciously or unconsciously. To the other writers, ears show emotion only by burning or itching. Blunting of touch and pain and their opposites of hypersensitivity to touch and pain are all to be found in Shakespeare's works when a character is distressed or excited, but not so with his contemporaries' works. Faint feelings and cold feelings are also more common in the works of Shakespeare. Overall, therefore, Shakespeare was exceptional in his use of sensory disturbances to express emotional upset. This may be a conscious literary device or a sign of exceptional awareness of bodily sensations.

Plagued by kindness: contagious sympathy in Shakespearean drama

Langley, E. — 2011-11-23T07:39:25-08:00

This article considers Shakespeare's metaphors of transmission, contagion and infection in the light of period plague tracts, medical treatises and plague time literature. The author demonstrates how period conceptions of disease are predicated upon a notion of sympathetic transference and, consequently, how kindness, likeness and communication between characters in Shakespearean drama are complicated and fraught with period specific anxiety. This article situates Shakespearean literary texts within a precise historical and medical moment, considering how scientific conceptions contaminate dramatic text.

The glue ear 'epidemic': a historical perspective

Alderson, D. — 2011-11-23T07:39:25-08:00

This paper explores the historical context of the dramatic rise in surgery for glue ear in the mid-20th century, and questions the published assertion that this represented a manufactured ‘epidemic’. In examining historical sources, the reader's theoretical viewpoint greatly influences their conclusions: the sustained rise in treatment for glue ear may be seen as the advance of science in a golden age or the resistance of insular professionals to reason in the light of new scientific study methods. Current views on the practice of medicine, consumerism, science and standardisation, rationing and the nature of ‘truth’ all affect the way that we see this period. Technological advances clearly allowed better diagnosis and more effective treatment, but these did not appear to drive an ‘epidemic’, rather they were developed to meet the pre-existing challenges of otological practice. The proposition that an ‘epidemic’ was created does not appear to have any solid grounding. Society's perception of what constitutes disease and what needs treatment may have evolved, but the prevalence of other important diseases changed dramatically over this time period, and a real change in the epidemiology of glue ear cannot be dismissed. In defining the case for and against surgical treatment, a solely positivist, quantitative worldview cannot give us a complete picture of benefit and risk to individuals, families and society at large.

The 'I' of the beholder: studying the 'self' across the humanities and neuroscience

Pannese, A. — 2011-11-23T07:39:25-08:00

Long debated within the humanistic tradition, the concept of ‘self’ has recently been embraced as a subject of investigation by cognitive neuroscience. Tracing parallels between ancient philosophical ideas and current-day scientific research on the ‘self’, the author proposes that contemporary knowledge based on empirical neuroscientific evidence may inform novel perspectives on—and draw inspiration from—notions grounded in ancient intuitions and traditionally falling within humanistic fields of enquiry. Further, the author suggests that the ‘self’, as a major object of philosophical and psychological enquiry, as well as a central component of human motivation, cognition, affect and social identity, is an inherently cross-disciplinary research topic, which, by virtue of its pervasive and defining presence in human existence, lends itself—and demands—to be approached both from scientific (objective) and phenomenological (subjective) vantage points. On this premise, the author proposes that the study of the ‘self’ provides both neuroscientists and humanists with a fertile ground for cross-disciplinary research, and with the challenge and the opportunity to rethink the relationship of science to knowledge.

Eat more fatty fish

Possner, A. — 2011-11-23T07:39:25-08:00

and exercise more.

this is what I advise my patients

when their good cholesterol is low

triglycerides high.

I use a letter

a thin piece of paper light on words

which makes for quite a lean envelope

mostly bones really.

most patients swim past.

and yet a few always take the bait

ending up in front of crumbled ice

and prices per pound.

dressed in workout clothes

they ask the man in the plastic smock

for a pound of fatty fish—salmon

a piece freshly caught.

Competing interests

None.

Provenance and peer review

Not commissioned; not externally peer reviewed.

'Why, why did you have me treated?': the psychotic experience in a literary narrative

Kaptein, A. A., Koopman, J. J. E., Weinman, J. A., Gosselink, M. J. — 2011-11-23T07:39:25-08:00

In this paper, the authors suggest an approach that may be helpful in teaching medical humanities to medical students. In the context of an honours class on medicine and literature, students (1) read a novel on an illness, (2) interviewed a patient with the medical condition described in the novel and (3) wrote an essay on the biomedical, narrative and literary aspects of these sources of information. The authors compared the story of Chekhov's literary protagonist Kovrin in The Black Monk with the personal story of patient H., who was diagnosed with schizophrenia. The narratives of the two patients were compared, based on Chekhov's literary narrative and the narrative of the patient. Both patients appeared to somehow regret losing their symptoms, following various psychiatric treatments. Both narratives show the ambivalence between the gain and loss that adequate psychiatric treatment may bring. Studying novels and other literary sources may help in understanding the story of the patient better, with associated improvements in various aspects of medical outcome. Reading literary fiction may help to increase an understanding of patients' emotions, experiences, cognitions and perspectives. It may also reduce the emotional distance between the self and the patient. The educational approach that was explored in the authors' honours class may be helpful to others when developing methods for teaching medical humanities to (medical) students.

Confluence: understanding medical humanities through street theatre

Gupta, S., Singh, S. — 2011-11-23T07:39:25-08:00

The effectiveness of arts-based interventions in medical education is well documented1 but the development of medical humanities in Southeast Asia is a relatively recent phenomenon.2 3 The University College of Medical Sciences, Delhi, was the first Indian medical school to introduce medical humanities to its staff and students. A Medical Humanities Group was founded in 2009 and membership was open to all.4 Initial activities were directed towards sharing literature, with a bias towards Indian culture, including poetry in Hindi. In the inaugural year, student-led lunchtime meetings were attended by faculty. In the second year, there was a series of lectures by eminent guest speakers, in the form of a colloquium, called ‘Confluence’. The idea was to provide a forum to discuss art and medicine as a whole.5 As a result of these discussions, the group decided they wanted to...

She sees him still

Dhaliwal, U. — 2011-11-23T07:39:25-08:00

When she closes her eyes

He is still there.

She can sense the smile in his eyes.

She can smell his skin,

And hear his voice

She doesn't have to try; she can see him.

When she sleeps at night

She dreams sometimes;

It is always him that she sees.

He was right by her side

For years and years

But she needs him most now he's gone.

She sees him still

Though he is no longer here

Does he see her pain and anger?

For better or worse

Till death do they part

Wasn't supposed to happen till later.

Competing interests

None.

Provenance and peer reviewed

Not commissioned; internally peer reviewed.

Mental Health, Psychiatry and the Arts: A Teaching Handbook

Lovett, L. — 2011-11-23T07:39:25-08:00

Mental Health, Psychiatry and the Arts is a teaching handbook edited by Victoria Tischler, a chartered psychologist, who has taught behavioural sciences to medical students at the University of Nottingham since 2002.

The central intention of the book is to ‘inspire, guide and encourage’ other educators to establish courses that use the humanities to help students develop their humanity and empathy while encountering patients with psychiatric problems. Although this book appears to be targeted only at educators of medical students, it could be equally used by educators of other mental health disciplines, pharmacists and social workers. Coloured illustrations, resources and comprehensive references are included. Many of the chapters suggest how to plan and/or deliver teaching and what tasks and questions to set for students.

Anyone with an interest in the medical humanities will not need to rehearse the arguments that are presented in the foreword by Allan D Peterkin,...

Works of Illness: Narrative, Picturing and the Social Response to Serious Disease

Bolaki, S. — 2011-11-23T07:39:25-08:00

Alan Radley's previous work has focused on the relationships between sociology, aesthetics and ethics, with the overall aim of bringing these disciplines together. He has been at the forefront of the recent move within the social sciences towards a consideration of illness representations as anchoring social practices, arguing for the need to draw together the social and the representational, the discursive and the visual, and the aesthetic and the political. Works of Illness continues this interdisciplinary commitment by broadening the scope of the discussion about experiencing illness in contemporary society. Radley does this by ‘assembling a socio-cultural view of health and illness that underlines the semantic and aesthetic potential’ of the wide range of narratives and artworks of living with serious illness that he examines under the term ‘works of illness’.

The introductory chapter outlines a series of exchanges by art critics and social scientists debating whether illness representations...

Home Death

Borgstrom, E. — 2011-11-23T07:39:25-08:00

Gripping the audience, a staged reading of Home Death was well received at the National Council for Palliative Care's (NCPC) 20th Anniversary event in May 2011. Since 2008 and the release of the End of Life Care strategy, the activities of the council have been marked by more publicity and public concern about the way people are dying and should die within the UK. Being sponsored by Dying Matters, the NCPC and Napp Pharmaceuticals, the play is heralded as representing the issues at hand, the importance of ‘getting it right’ when it comes to dying and as a voice for change in a society set up as ‘death denying’.

One of these key issues is embodied in the quote attributed to Dame Cicely Saunders, the founder of the modern hospice movement: ‘How people die remains in the memory of those who live on’. It touches on our struggle for...

Old times

Iliffe, S. — 2011-11-23T07:39:26-08:00

In the year that this film was released in the USA, an anonymous 73-year-old woman wrote in the Reader's Digest: "...when declining health and declining finances left me no alternative but to live with my daughter, my first feeling was one of bitterness". She went on to list her rules of engagement in this new situation: "I must not be around when she was getting her work done, or when she had friends in. I must ask no questions and give no unasked advice. I resolved to spend the greater part of my day alone in my room".

This is almost a summary of Make Way for Tomorrow. An older couple are bankrupted in the wake of the Great Depression, when the husband loses his book-keeping job. Every American filmgoer knew this story. One in five banks had collapsed, and nine million families had lost their...