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Absent friends in medical humanities
  1. Stephen Pattison
  1. Rev Prof S Pattison, Dept of Theology and Religion, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; s.pattison.1{at}

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Several humanities disciplines, including the study of modern languages and of religion and theology, can greatly enhance discussions of humane healthcare and should be encouraged to contribute more.

Medical humanities have benefited from many of the disciplines that have chosen to offer their knowledge, techniques and insights to this field. Philosophy, literary analysis, media studies and social history, as well as art and creative writing at the more practical end of things, have all contributed generously to the feast of increasing understanding of healthcare through humanities. For this we should all be grateful.

But there are many humanities disciplines and subdisciplines that have so far not really contributed at all, or have contributed only sporadically. For example, healthcare is conducted significantly through the medium of language. In many multicultural Western societies, this is not so much one language as many. Linguists maintain that every language contains world views and concepts and meanings that are modified, even completely lost, in translation. This means that to learn a language is to encounter the otherness of different worlds and cultures and to change as a person. So where is the interest in learning languages and thinking about what linguistic study might offer in healthcare? Thus far, it seems, modern languages do not form a significant part of medical humanities. Nor, for that matter, is there much expressed interest in the classical languages and literatures of non-modern cultures such as ancient Rome and Greece, where much of our intellectual and assumptive world is still rooted.

My own discipline, religious studies and theology, has not been particularly fully represented in these pages. This is, I believe, unfortunate.

Since the Enlightenment, the educated, professional classes have been somewhat dismissive of religion and all that goes with it. Religion has often been seen irrational, incredible, oppressive, immoral and infantile. At best, it is a matter of private conviction to be tolerated and (perhaps grudgingly) respected in those who, for reasons of their own, “like that sort of thing” and fail to grow out of it. Yet it should not have taken 9/11 to remind us that the vast majority of the world’s adult population is still engaged in some kind of active commitment to religion; official agnosticism or atheism is still a minority belief system in the contemporary world. Many healthcare users in Western countries are religious adherents and see the world through the primary lens of faith. So are quite a lot of the people who provide care for them. For some patients, religious attachment and conviction is the most basic thing in their lives, enabling them to cope and to make life-sustaining meaning in time of travail. It is the same for large numbers of healthcare professionals and managers, part of whose motivation for going to work may spring from a religious or religiously informed world view of what is ultimately valuable and imminently achievable.

So much of the history and present shape of Western society and healthcare has been and continues to be shaped by monotheistic traditions such as Christianity and Islam that it is astonishing that they receive so little attention in medical humanistic discourse. Christianity was shaped from its earliest days by a concern for healing the sick and exorcising evil. This helped to bring the hospital into existence and also influenced and legitimated dualistic, allopathic medicine, with its emphasis on the elimination rather than accommodation of disease. Christian traditions of valuing reason and the individual who bears the image of God helped to create modern psychological individualism and the Enlightenment tradition of equality and respect. More recently, religiously influenced thinkers such as RH Tawney and William Temple were key players in establishing the welfare state, with its effective sacralisation of equality of access to healthcare for all citizens. Christian pastors Herbert Gray and Chad Varah founded The National Marriage Guidance Council and The Samaritans, respectively, and it was a religious laywoman, Cicely Saunders, who laid the foundations for modern palliative care, with the hospice movement. Classic religious texts such as the Bible continue to form part of the way in which we think about values in Western society, as well as forming a record of how a community of people wrestles with trying to see what life is all about and where it is all going. At least until 1900, such texts underlay most other kinds of writing in Western society, often created in tribute or reaction to the monotheistic tradition.

Religion is not the only factor that shapes healthcare and healthcare encounters. And, like many other factors and institutions in life, including medicine and healthcare, its effects and influence are ambiguous; if the Judaic and Christian traditions bear witness to creative struggle, human solidarity and hard-won wisdom, they are also reminders of inhumanity, folly and otiose stupidity. However, religion has not gone away, even if in the West it may now often express itself more in terms of individualistic spirituality than in formal institutional membership.1 And many sociologists, abandoning formerly popular theories of total secularisation in the West, are now of the opinion that it will not be disappearing any time soon. Indeed, religions may soon be assuming much greater public as well as personal significance.2 For the sake of knowing where healthcare and other humanitarian (and antihumanitarian) endeavours and ideas have come from, as well as for the sake of better understanding ourselves, our world, our colleagues and our clients, we therefore need to understand it more fully and critically.

It is here that theology and religious studies should come more prominently and frequently to the medical humanities table. To inhabit a non-theistic world view is not to have no world view at all.3 To privilege rationality does not prevent all of us from having operant non-rational convictions and assumptions that partly but significantly determine who and what we are as professionals and as “private” individuals, both for good and ill. Theologians and religious studies scholars, along with other humanities specialists, should be able to help healthcare theorists and practitioners better to understand their inherited and active world views, myths, deep assumptions and metaphors about reality. In doing this, they might help people to inhabit their own faith worlds more critically and appreciatively, as well as to better understand those of others. This should be a significant aspect of the humane study of humans, particularly in the healthcare context of suffering, where world views are contested and may break down in important, even painful, ways.

A number of important humanities disciplines appear not to contribute as fully as they might to medical humanities. This is regrettable, for only if all the humanities contribute to this field can a full, rich picture of the human in the context of healthcare emerge. Specialist humanities scholars are shy creatures, often ploughing deep furrows in obscure parts of the literary and cultural heritage and frequently more concerned with the past than the present.4 However, if they can be more generously encouraged to think laterally by those whose feet are already firmly under the medical humanities table, this should make the conversation deeper and more interesting for all the diners. Perhaps, then, an important next stage in the development of this discipline might be to identify ways of including those scholars and practitioners who do not yet realise that they might have important insights, resources and methods to offer to the theory and practice of humane healthcare.