‘The Edinburgh Companion to the Critical Medical Humanities’ reviewed by Dr Stella Bolaki

The Edinburgh Companion to the Critical Medical Humanities, edited by Anne Whitehead and Angela Woods. Associate editors: Sarah Atkinson, Jane Macnaughton and Jennifer Richards (Edinburgh University Press, 2016).

ECCMH coverThe Edinburgh Companion to the Critical Medical Humanities is an epic, much-awaited collection of essays that brings together an impressive list of established and emerging scholars from around the world, and provides rich insights into the current shape of the medical humanities. As the editors describe the Companion’s field-defining intervention, it ‘is both a reinvigoration and a critical reorientation of the medical humanities: an identification of new challenges for research, which also expands the methodologies, perspectives and practices that might be called upon to meet them’ (p. 1). A rigorous but accessible volume, it consists of a compelling Introduction by Anne Whitehead and Angela Woods and thirty-six chapters distributed across four thematic sections that span periods and disciplines, including the arts and humanities and the social sciences: ‘Evidence and Experiment’; ‘The Body and The Senses’; ‘Mind, Imagination, Affect’; and ‘Health, Care, Citizens.’ Due to the size and diversity of the Companion, it is impossible to do each section or chapter justice, but this review will hopefully give a flavour of its wide-ranging scope, force and dynamism, which also befits the associations of the term ‘critical,’ as noted by the editors.

The Introduction opens with a ‘primal scene,’ the communication to the patient of a cancer diagnosis, which has retained a privileged place in the medical humanities ‘imaginary’ (p. 2). A critical medical humanities redirects the field’s focus beyond the clinical encounter between doctor and patient by interrogating what is ‘potentially occluded from view – both within the [primal] scene itself and in relation to other sites and modes of inquiry’ (p. 2), or ‘how and why some bodies, discourses and practices have come to matter more than others’ (p. 26). This is the driving force behind expanding the frame of enquiry to which every essay contributes in its own way. Adding new sites, topics and methodologies to the medical humanities is not ‘a colonising venture’ (p. 23) – this couldn’t be possible in a volume that is serious about placing the field in a global context and that is attentive to the political dimensions of biomedical research, the uneven circulation of knowledge and power, and Western medicine’s cultural imperialism, to list a small sample of the pressing issues addressed in it.

The editors show how specific concerns with ethics, education, experience and empathy (the four ‘Es’ of the medical humanities) have ‘shaped and influenced what has come to matter’ (p. 3) for the field in its ‘first wave.’ Moving beyond the binary of either servility or antagonism to medicine, they propose in the Introduction another ‘E,’ that of ‘entanglement’ (borrowed by feminist philosopher Karen Barad) as a way of illuminating the critical work of what they refer to as the ‘second-wave’ medical humanities. Entanglement is elaborated by Des Fitzgerald and Felicity Callard in their essay that encourages us to go beyond a rigid model of interdisciplinarity (where the boundaries of each discipline are retained) and embrace instead ‘a more ambiguous and risky intellectual space’ (p. 38) in our collaborative relationships. The concept is taken on by many other contributors in relation to a range of topics, including the research laboratory, Chinese medicine, visual arts practices and the human and animal categories. Alongside critical theory, and its alliances with social/political activism, phenomenology and history have a central role to play in the project for a more critical medical humanities. So do perspectives from arts practitioners, as they can open up the category of the ‘critical thinker’ and redress the dominance of narrative/verbal language in the field. It is notable that the Companion includes several essays focusing on the medieval, early modern and nineteenth century periods that examine how the past has shaped the present and what critical value may be recovered from other ways of thinking about the body, medical records, the literary text, the experience of voice-hearing and patient adherence, among other topics.

At the same time, the Introduction situates the critical turn in the medical humanities in relation to other relevant critical turns, including in disability and animal studies and in relation to the digital, visual and material turns – all of these entanglements are captured in the essays revealing the creative, border-crossing and capacious nature of the field in the current moment. It would have been useful perhaps to position the call for a critical medical humanities in relation to other arguments in favour of expanding the field’s existing scope, coming from scholars who ally themselves with ‘the health humanities’, as in the previously published essay ‘“The Medical” and “Health” in a Critical Medical Humanities,’ partly written by Woods and one of the Companion’s associate editors, Sarah Atkinson (see Atkinson et al. 2015).

The Introduction also offers alternative pathways – disciplinary, historical and spatial/geographical – to the volume’s four thematic sections as well as some reflections on key (sometimes unpredictable, as the editors admit) concerns emerging from the essays: related to ‘violence,’ most evident in the essays on the quasi-medical executions staged by the US penal system (Lisa Guenther) and the link between care and abuse in Alzheimer’s literature that is symptomatic of the systemic breakdown of care provision (Lucy Burke), as well as in the numerous essays that explore artistic representations of pain and embodiment; and to questions of ‘authority and expertise’ that move away from the first wave’s emphasis on the individual patient experience to address broader structural problems such as access to healthcare and the unequal distribution of resources. In carefully and generously mapping these trajectories, the editors show their commitment to helping readers engage with this multivalent field without ‘domesticating’ but rather ‘actively embracing the diversity’ of the volume (p. 15).

Whitehead and Woods’ meticulous consideration of the collection’s shape is evident in the dialogue between – or entanglement of – the essays themselves: contributors draw helpful links with other essays across the four sections, and each chapter offers suggestions for further reading. The Afterword that concludes each section is written by a leading critic and, by reflecting on the essays, points to new directions for future research. It is here where the Companion importantly reflects on its potential omissions or limits; an example is Patricia Waugh’s concluding point that the concepts of complexity and entanglement are often ‘double-edged tools’ when we consider, for instance, their connection to the creation of ‘a new risk culture.’ As she notes, the critical medical humanities will need to be ‘watchfully entangled’ (p. 159). It is also clear that a variety of writing styles and experiments have been included reinforcing the idea that ‘the critical’ produces neither a single message nor a single voice: for example Jill Magi, Nev Jones and Timothy Kelly perform a ‘poetics of care’ (p. 151) in an essay that interrogates the link between writing/reading and forms of authority in the context of psychiatry. As Callard writes in her Afterword, noting the strikingly different rhetorical styles and argumentation of the section ‘Mind, Imagination, Affect’, each essay has ‘its own affective tone’ (p. 481). This certainly enhances their distinct intellectual, ethical and political work.

All four sections critically widen the frame of enquiry to explore new scenes and sites of health and illness across different periods. In essays on systems biomedicine, holism, ‘the lived genome,’ research on twins and paper technologies, the contributors of ‘Evidence and Experiment’ challenge positivist assumptions surrounding the idea of the experiment and show the need for the medical humanities to move beyond a model of integration towards entanglement. For humanities scholars, as Annamaria Carusi powerfully argues, ‘taking on board the ontology of intertwinement, implies accepting to participate in [the] responsibility’, recognising that such responsibility ‘does not come after science “captures” reality’ (p. 62).

‘The Body and The Senses’ section provides the conceptual and historical tools for ‘the future of a more sensate biomedicine’ (p. 333) through its attention to touch, voice, flesh, as well as distinct ways of looking as in Lindsey Andrews and Jonathan Metzl’s fascinating analysis of the racial assumptions embedded in supposedly neutral machine-mediated medical images. Topics range from the aesthetics of pain in visual arts, alternative understandings of fatness beyond pathology that promote ‘research justice,’ to breathlessness and the anatomised and posthuman body. All the essays demonstrate the ways in which the coming together of critical theory and clinical practice can enrich each other’s perspectives on the human body.

Many of the essays in ‘Mind, Imagination, Affect’ shed new light on key debates of the first wave surrounding narrative and the language and experience of illness. In her essay on aphasic modernism, Laura Salisbury cautions against mistaking narrative for language as she traces modes of embodied expressivity that ‘sheer away from linear coherence’ (p. 458). David Herman shows the relevance of a ‘narratology beyond the human’ (p. 475) to the critical medical humanities in his exploration of animal-assisted interventions in autism, while Martyn Evans calls for the field to embrace wonder and adopt ‘a view of patients that does justice to their personhood and objecthood alike’ (p. 350). For readers familiar with an alternative tradition of affect and emotion coming from literary/cultural studies and queer theory (the work of Eve Kosofky Sedgwick, Lauren Berlant, and Ann Cvetkovich, for example), there is arguably a missed opportunity to engage with such scholarship in this section – including work that has re-envisaged the ‘primal scene’ in exploring a range of critical responses to the language, politics and cultural contexts of illness narratives (see Lisa Diedrich and Ann Jurecic).

‘Health, Care, Citizens’ mobilises the key terms of the final section in different ways by examining various modalities of caring (for example caring for or about, or caring in the context of the asylum or the Alzheimer’s epidemic) and how practices of uncare produce non-citizens. Stressing the importance of engaging with a global context, essays cover medical migration, the availability of organ transplant technology and the South African AIDS epidemic. Contributors illustrate the role of fiction and life writing in developing a critical engagement with care, as well as the ways in which narrative, broadly defined, is often, though not unproblematically as Stuart Murray outlines in his Afterword, ‘at the heart of the expression of health citizenship’ (p. 628). In one of the most provocative essays, Rebecca Hester puts forward an ‘argument against competence’ and exposes how ‘the dehistoricised and uncritical version of cultural competence’ ‘obscures the ways in which medical dominance has historically depended on gathering and deploying cultural knowledge or “competence” to establish and maintain its hegemony’ (p. 548).

The Edinburgh Companion to the Critical Medical Humanities will no doubt be an invaluable resource for scholars and teachers: I expect it to be on every medical humanities reading list and set the agenda for debates in the field for years to come. While the critical medical humanities is not presented as ‘the final word’ (p.1) and the editors look forward to more waves in the future, this publication is the first of its kind, a landmark collection in its comprehensive encapsulation of the medical humanities’ current momentum, demonstrated through the ‘critical mass’ it gathers and the force with which it communicates ‘a sense of urgency and imperative’ (p. 14) about a field that is at a crucial and exciting point of change and growth.

Reviewed by Dr Stella Bolaki, Senior Lecturer in the School of English, University of Kent and author of Illness as Many Narratives: Arts, Medicine and Culture (Edinburgh University Press, 2016). She is also the Director of the University of Kent’s MA in Medical Humanities.

Works cited:

Atkinson, Sarah, Bethan Evans, Angela Woods and Robin Kearns. 2015. ‘“The Medical” and “Health” in a Critical Medical Humanities.’ Journal of Medical Humanities, 36(1): 71-81.

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *