Medical Humanities and Literary Medicine: Guest Post by Brandy Schillace

Medical Humanities and Literary Medicine
Brandy Schillace, PhD
Managing Editor, Culture, Medicine and Psychiatry

The designation “medical humanities” is a relatively new one. The British Medical Journal began its run 38 volumes ago, followed closely by The Journal of Medical Humanities (published by Springer) 34 volumes ago. But though these publications began in the late seventies, medical humanities did not really enter the popular lexicon until the internet age. It might be argued that the field is still not widely understood, though it has been gaining popularity (and programs and press) since the late nineties, branching into health and humanities, appearing as part of bio-ethics programs, and required as coursework at medical schools. Most choose to define the term broadly. The New York University School of Medicine considers it “an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice” (Aull). Baylor University uses this definition verbatim, while the University of California SF’s departs only slightly, suggesting that medical humanities provide an “interprofessional approach to investigating and understanding the profound effects of illness and disease on patients, health professionals, and the social worlds in which they live and work” (UCSF School of Medicine). The medical humanities, in this and other definitions, are thus more interested in the “meaning making” than the “measurement” (UCSF School of Medicine).

One thing that many of the above (largely United States) perspectives have in common is the perception that the medical humanist is anchored in medicine and looking outward, using the lens of the humanities to reconsider medical practice itself. While there is an emphasis on interdisciplinarily and interprofessionalism, it is still largely the patient and the health professional who remain at the center of the discourse. The fact that these programs are rooted in medical schools further solidifies the notion that this is an aspect of medicine, that medical humanists are medical doctors, researchers, and sometimes anthropologists who have taken on the mantle of humanities in service of their profession. They are specialists of medicine first and of the humanities second—a privilege reflected also in the order of the name: medical humanities.

What I would like to discuss today, however, is an alternative perspective—and one that I find has greater presence in the UK than in the US. The Centre for Medical Humanities (home of this blog and supported by the Wellcome Trust) considers the medical humanities  as a field of enquiry in which “humanities and social sciences perspectives are brought to bear upon an exploration of the human side of medicine” (Durham University). While this is a subtle distinction, it is significant. The focus here is not upon the practice of medicine, but on the human—and so the privileged perspective is the humanist’s perspective rather that the medical one. What difference does that make? Well, to begin, it means that someone like myself—with a PhD in literature and a string of medical history publications—may also be a medical humanist. Rather than grounded in medicine and peering out, we are grounded in humanities (the literature, philosophy, ethics, history and religion mentioned above) and looking in. Recognizing not only the power of narrative for today’s healing practices, this perspective engages with history (also a narrative) and fiction, revealing the reciprocal relationship between them and, more importantly, the way “meaning-making” influences and even inspires “measurement.” William Benjamin Carpenter, author of Principles of Mental Physiology (1876) cites Charles Dickens’ concept of imagination in his own construction of “latency and memory” (Matus 12). British neurologist Russel Brain went so far as to call Dickens a “neuro-psychiatrist” (Qtd. in Tytler 424), and the evidence of psychological disturbance (and terminology) appears in works by Bronte, Balzac, and Walter Scott (423).

We owe a great debt not only to early medical pioneers, but to their popularizers, those who examined and questioned (and spread) emerging medical concepts through fiction. Historically, there has always been a tacit recognition that divisions between fields were permeable or even illusory; medical humanities, if we consider it from this vantage point, is not new but old. What is “new” is the categorization that so strictly separates them, something we also borrowed from the Victorians, incidentally. As the managing editor for a medical anthropology journal, Culture, Medicine, and Psychiatry, I have come to understand that this divisiveness is not only recent, but also largely Western. From Cambodia to China to India to the African subcontinent, healers, patients and people in general much more readily see the ways in which story and science are linked, symbiotically and dependently, to one another.

The literary perspective on medicine is therefore a necessary one, though it has not—or not often—been part of the medical humanities, but rather subsumed under aspects of “English Studies” or “Literature.” One purpose of my blog, Literary Medicine’s Daily Dose, is to bring this perspective more to the center. It is a project beginning to take shape elsewhere, as well. Dr. Jonathan Metzl, director of Vanderbilt’s Center for Medicine, Health and Society, is also exploring (and forging) new connections between the humanities and medicine. A psychiatrist with a dual B.A. in biology and humanities, a Masters in poetry and a PhD in American Studies, Dr. Metzl represent the kind of bridge figure that the field needs—not a medical maven using the humanities only as a lens or addendum, but someone for whom the integration is seamless and organic. I am—with other “literary medicine” colleagues—building that bridge from the other side.

It is an increasingly inter-disciplinary world, and the medical humanities offers a place where academics, physicians, anthropologists, sociologists, literature professors, fiction authors, and just plain curious and intrepid souls might add to our shared knowledge of what it means to be human. I hope that the field will continue to broaden, and that we—medical humanists and scholars of literary medicine—will shake hands at the interstices. Fiction and literature, medicine and history, anthropology and religion: the world is more interesting at the intersection.

Tytler, Graeme. “Charles Dickens’s ‘The Signalman’: a case of partial insanity?” History of Psychiatry, 8 (1997) 421-432.

Matus, Jill. Shock, Memory and the Unconscious in Victorian Fiction. Cambridge: Cambridge University Press, 2009.

Aull, Felice. “Mission Statement.” Medical Humanities. New York University School of Medicine. 4, Jan 2011. Web. 4, April 2013. < http://medhum.med.nyu.edu/>

“Medical Humanities.” UCSF School of Medicine. 14, March 2013. Web. 4, April 2013. < http://medicalhumanities.ucsf.edu/>

9 thoughts on “Medical Humanities and Literary Medicine: Guest Post by Brandy Schillace

  1. Wonderful post!

    One question: I love the idea of expanding the medical humanities from practitioners looking out to expand the “humanism in medicine” (an idea for which I have to admit having more than a bit of skepticism, although I am not opposed to the objectives per se). But I have also come to believe that part of what is required to look in from the outside is an expansion of the concepts, frameworks, and priorities beyond the practice of medicine itself. After all, so much that matters to health, illness, and suffering goes on outside the walls of any clinic, outside the practices of any provider.

    If so, this is partly why I (and many others, I know!) tend to prefer the term “health humanities” — it represents an expansion of lenses and possibilities for examining some of these problems.

    Thoughts?

  2. Hi there, Thanks for such an interesting post. I find the subject of medical humanities fascinating! I am the author of an autobiographical novel ‘The State of Me’ (HarperCollins 2008), which explores the neuroimmune illness myalgic encephalomyelitis (ME) through fiction. (I myself have suffered from the illness since 1983, triggered by Coxsackie B4 virus when I was an undergraduate studying English Lit and French.) I attended a medical humanities event last week (‘DIssecting Edinburgh’, a collaboration between the University English Department and Surgeon’s Hall museum), and the question was posed if reading fiction and/or patient narratives could help doctors to empathise more? I wrote a short post about it here: http://www.velo-gubbed-legs.blogspot.co.uk/2013/04/why-do-we-read-fiction.html I am taking part myself in a Dissecting Edinburgh event next month, discussing medicine and literature alongside another two writers. My own thoughts are that fictional narrative can often get us more easily to the truth (of any situation, not just medicine).

  3. Many thanks Brandy for this post, and everyone for their comments!

    Daniel, you must be aware of the article by Crawford et al, “Health humanities: the future of medical humanities?” http://www.emeraldinsight.com/journals.htm?articleid=1935372 While it makes some important points which resonate with your concerns, I’ve argued with colleagues from geography that there are good reasons for keeping the ‘medical’ in focus, especially when it comes to chllenging the pervasive forces of medicalisation. (Our paper – “‘The medical’ and ‘health’ in a critical medical humanities” – is forthcoming in a special issue of the Journal of Medical Humanities about the field’s links with medical and health geographies).

    velogubbed – Many thanks for your thoughts and links – I’ll look forward to following up! I’ve just returned from a conference on the cognitive futures of the humanities where Marco Caracciolo gave a great talk on “Patterns of Cognitive Dissonance in Readers’ Engagement with Characters” with huge potential both to advance and to challenge the still-undertheorised-but-undyingly-popular claim that “reading makes doctors empathise more”. Full programme is here tiny.cc/7brwuw

    • Thanks for the response, Angela!

      I very much look forward to reading your paper, as I must say I find the arguments in favor of accommodating a shift from “medical” to “health” humanities quite compelling. (This is self-serving, of course: most of my ethics and policy work has much to do with public and population health and much less to do with the provision of medical care).

      There is room for both, of course, but so much of what determines health, illness, and human suffering has very little to do with the provision of health care services. This does not imply the unimportance of said services, b/c, as I have argued, no matter how we structure society people will still fall ill and we should care for them.

      But I worry that if we focus so concretely on medicine or even on the provision of such services, we leave out so much that shapes experiences of health and illness.

      In any event, thanks for the great discussion!

  4. Your article helps convey how the medical profession benefits from its own self-regulation, but on a greater level, the humanities as a whole. No area of academia, nor any individual, shall be excluded from the medical humanities and literature on the basis of specific training. We must accept that our knowledge of health and medicine is primitive, and welcome collaboration from the entire spectrum of the academic universe.

  5. Great piece! The world is, as you say, definitely more interesting at the intersections. I’ve been interested recently in the pervasiveness of narrative in medicine (I’m a historian, so I come at it from that perspective primarily). It seems valuable to look at how case histories written by doctors often took a narrative approach, but also at how the stories patients told to describe what they observed in their bodies (describing symptoms, life histories, etc.) and how sometimes these narratives seemed to take on a world of their own and find their way into popular discourse. One can seen, for example, a lot of the language from early sexologists’ case studies in Radclyffe Hall’s The Well of Loneliness.

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