They did it again… By which I mean that the many-nationed group of medical humanities free-spirits who have embraced the job of producing the Medical Humanities Companion series met up again this week (5th to 8th July 2011), and in a modest amount of style, to prepare and plan volume four in that series. The Companions, commissioned and published by Radcliffe Publishing, is a co-edited, co-authored and above all cross-disciplinary sequence of books of essays following the fortunes of fictional patients through the natural and personal histories of illness, from first symptom to final outcome (including death in one case). The project began in 2005 with a symposium in Oxford, and has resulted in Symptom (2008); Diagnosis (2010); Treatment (2011, forthcoming); and now, volume four – intriguingly and after much debate, to be called Prognosis – with a promise to ourselves that we will have the book out by the end of next year.
The loose rationale for the series is to tell a familiar story but in a new voice – or perhaps, a polyphony of voices expressing collective medical humanities enquiries. The voices include those of a psychiatrist, general practitioners, a psychotherapist, a cultural historian, an endocrinologist, a general internal physician, a dermatologist, a colposcopist, a poet, and several philosophers (the number varying between one and eleven depending on whether they be identified by inclination rather than by profession).
By name the team comprises Rolf Ahlzén, Martyn Evans, Jill Gordon, Iona Heath, Pekka Louhiala, Anne Macleod, Jane Macnaughton, Raimo Puustinen, Carl-Edvard Rudebeck and John Saunders. Together over the last six years we have met repeatedly to consider the tales of patients fictional and real (including, at times, ourselves) in the hope of better understanding the clinical encounter and the experiences of health and illness, in full acknowledgment of the perplexing relationship they all involve between the personal and the material, the existential and the biological, or – in Stephen Toulmin’s memorable terms – the natural and the historical.
Prognosis was a difficult choice of title for what is ostensibly to be our final volume. We resolved it in part by incorporating the idea of ‘outcome’ – ‘what happened next’ ‘what happened in the end’ – into the territory that actual prognosis prefigures or attempts to unveil. ‘Existential prognosis’ was a term that gained some temporary currency whilst the territory was scanned. But whether Prognosis will turn out to be the right title depends on how the nine envisaged chapters turn out. Still more difficult – though from the outset even more rewarding – was to discern the core material for the book, to pick out the substantive issues we wished to tackle that had not been tackled before in the particular polyphonic way that we’ve tried to make our hallmark. Whether we are correct in believing ourselves to have succeeded will not become clear until the book is written. But if the process was indeed as productive as we think it was, it will be because our way of working allows us all to be comfortable in the simultaneous activities of conjecture, criticism and (in the kindliest spirit) refutation.
This is in fact the sixth time we’ve gathered together for the substantive task of forging a book (not counting our original meeting in Oxford). The people and their mutual trust are a key ingredient in the process. Equally, we have tried to make it possible for people to be at their best by being in places that promote this. Each time we have sought venues and circumstances that would be distinctive, reasonably secluded, easy on the eye and above all conducive to scholarly conversation. Each time we have been fortunate – thanks to shrewd guesses and/or local knowledge by that member of our group who has in any particular case taken responsibility for securing the venue. In the past we have met in Hämeenlinna, Finland; Junglöfska Slottet, Stockholm; Villa Belpoggio, Tuscany (twice); and Trevelyan College, Durham. This time, thanks to the eagle-eye of poet, author and dermatologist Anne Macleod, we gathered at the promisingly-named Old Brewery in Cromarty, Scotland.
This is a wonderful pair of old red sandstone buildings cunningly joined together by a roofed courtyard and converted into a residential arts centre for the peaceful little shoreside town of Cromarty and for the surrounding countryside – the ‘Black Isle’ peninsula between the Beauly Firth (into which issues the River Ness, at Inverness) and the Firth of Cromarty, a large tidal basin with deepwater harbours supporting the maintenance of gigantic oil and gas platforms and – in days gone by – the Royal Navy at the famous (and briefly, mutinously, infamous) Invergordon naval base. Cromarty’s own miniature harbour nestles in front of a delicious collection of older sandstone and roughcast buildings both residential and municipal or sacramental, including the home of local hero Hugh Miller, writer, churchman, and geologist whose fossil-gathering led him to an acknowledgement of evolution that was at odds with his Christian fundamentalism; the conflict between the two is implicated in his suicide in middle age, ensuring his subsequent status as Cromarty’s most famous son (and additionally as a lamented reminder that the search for mutual accommodation between the sciences and the humanities has its tragedies).
Views up and down the Firth abound, and the promised wildlife includes harbour porpoises, bottlenose dolphins, red kites, seals, and even minke whales; but the cold wet weather prevented our enjoying the outdoor environs to the full or accessing the wide range of walking opportunities with attendant birdwatching, dolphin-spotting, and so forth. (The weather may even have been responsible for the local Cromarty-to-Nigg ferry’s refusal to allow three of us on board as speculative foot-passengers, although watching this rather dumpy and spartan little vessel plunge and roll extravagantly in really very moderate seas might suggest that the refusal was an act of prescient mercy on the part of the deckhand involved.)
So with a broad range of distractions denied us, what else to do but get on and work hard? And this we did, whilst scrupulously observing the normal constraints of coffee and tea and home-cooked meals as needed (often) and modest amounts of wine (in the evenings); and on the final night an exclusive recital by a quartet of traditional music-makers led by captivating violinist Alpha Munro, who regularly takes her music-making into therapeutic contexts. We did not easily have the space to attempt to get up and dance, but we really should have found a way to do so. Perhaps it was timidity that stopped us. A pity if so, because I think we could fairly resist the charge of timidity in our overall enterprise of the Medical Humanities Companion. The project could have stalled at the first volume; it didn’t, and as we said our farewells on the final morning in Cromarty we shared a quiet confidence that the series is indeed on track for completion. The critics will have their say on the product, but for the writers the process has been one to warm both the heart and the mind.