‘Where does it hurt?’ Reviewed by Kyle W. West

Following our call for review, we have brought together multiple takes on a curious collection entitled ‘Where does it hurt?’. Commissioned by the Wellcome Trust (2014) and edited by John Holden, John Kieffer, John Newbigin, and Shelagh Wright, the collection explores the meanings and uses of the medical humanities. Kyle W. West offers his perspective here.

where-does-it-hurtAmong the earliest lessons taught to students of medical anthropology is the difference between the terms ‘disease’ and ‘illness.’ A disease is a biological dysfunction that produces a malady. An illness is how the individual experiences the disease. By recognising this key difference, we acknowledge that more than just biomedical expertise is needed to properly treat illnesses. This multi-disciplinary approach has been referred to as ‘medical humanities.’

But the term is often greeted with some degree of confusion. People are not always clear as to what exactly falls under the rubric of the medical humanities. To address this confusion and perhaps give readers an idea of the breadth of the medical humanities, the Wellcome Trust has commissioned Where Does It Hurt? The New World of the Medical Humanities.

The book is a collection of essays from a wide variety of scholars, artist, and medical professionals. In each essay, the authors explain in their own ways how the humanities and medical sciences are linked. There are some 40 different essays in the book, so the breadth is quite wide the essays are relatively condensed as a result. There are two essays that immediately caught my fancy, ‘So, why is reading good for you?’ by Rick Rylance and Adam Zeman (pp. 56-57), and ‘Museums: tonic for the soul’ by Yasmin Kahn (pp. 74-75).

Rylance and Zeman outline their collaborative research which consisted of asking ‘volunteers with an expert background in literature (university staff or postgraduates) to read chosen texts in an fMRI scanner’ (p. 56). The poetry and prose chosen were rated for literary merit (the exact criteria for determining this is not discussed in the essay). Volunteers would then read the text from a computer screen suspended over the reader’s face.

For those who aren’t familiar, fMRI (functional magnetic resonance imaging) is to traditional MRI what video cameras are to still cameras. They display real-time activity in the brain. It does this ‘by detecting small changes in oxygen levels related to chances in neuronal activation’ (p. 57). This research is unique because most of the research into neuronal activity, as it relates to language, has been concerned with single words or short phrases instead of longer works of poetry or fiction. The length of literary works is ‘a reason why it carries greater emotional depth and sense of meaningfulness than more functional writing’ (p. 57). When smaller bits of language are used with a person in an fMRI machine, the language centres of the brain (Broca’s and Wernicke’s areas) are engaged, but little else. However, ‘complex, literary writing evokes responses across a greater variety of those parts of the brain associated with, for example, visual as well as semantic functions, and personal memory’ (p. 57).

Based on the data collected, Ryland, et al have concluded that ‘emotional passages activated a set of regions associated with the brain’s response to emotionally-resonant music, reinforcing the thought that poetry’s effects require the musical use of language; favourite poems, selected by our participants, strongly excited areas linked to memory, as if they were being recollected rather than read’ (p. 57). They also found the surprising link between reading poetry and neural activity that is seen when external demands are removed. This ‘default network’ in the brain is considered the ‘locus for autobiographical memory and daydreaming’ (p.57), and may hold the key to understanding our sense of identity.

But to answer why reading is good for you, the authors state that ‘reading may help us recover a valuable sense of connection with our past selves when identity is threatened by, for example, trauma or dementia’ (p. 57). This is because reading forces the brain to conceptualize what the words illustrate. Reading an author’s description of a sunny meadow or a filthy industrial city causes the brain to create a mental image taken from the reader’s own past experiences.

In her article ‘Museums: tonic for the soul,’ Yasmin Khan discusses how museums are no longer ‘repositories for showcasing objects,’ and have become ‘cerebral gyms that can stir our moods and exercise our emotions’ (p. 74). In light of this, researchers have begun investigating museums and their objects as ways to treating cognitive dysfunction, such as dementia.

However, not all is salubrious in the museum world. Khan goes onto to discuss how museums (science museums in particular) may have ‘contributed to the fracturing of our mind-sets’ (p. 75) by compartmentalising areas of knowledge. She quotes Seyyid Hossein Nasr, a historian of Islamic sciences, as saying that by separating areas of knowledge (palaeontology and engineering, for example) creates ‘a segmented view of knowledge which is going to have a deep effect upon the young person who goes there’ (p.74). If this is in fact the case, Khan also sees museums as a potential source of repair to correct this fragmentation through initiatives like the Happy Museum project.

Khan illustrates the early recognition of the connection between physical and mental health by discussing early Islamic hospitals in Baghdad and Cairo. ‘By the 12th Century these sophisticated hospitals were multidimensional in outlook – not just dispensing medicines and treatments, but also considering the aesthetics in all its aspects’ (p.75). This holistic approach is making somewhat of a comeback as modern hospitals slowly abandon the strictly utilitarian stance that has been commonplace and now include permanent works of art as a part of the therapeutic regimen.

Khan states that, while ‘museums cannot be the panacea to all our mental ailments – perhaps they are at best, a much-needed pressure valve for our society’ (p. 75). This echoes the thoughts of philosopher Alain de Botton who, in a video for The Guardian titled ‘What is art for?,’ says that one of the functions of art is to act as a counterweight to all the pressures of everyday life. He also states that art can help remind us of that our emotional states are normal, even if they’re not always publically acceptable. Art can also fill gaps in a person’s psyche. For example, an individual who has a muted emotional response to the world around him may be attracted to works that evoke a strong emotional response. This happens to entire societies as well. Botton gives the example of the Pre-Raphaelite craze in Britain as a reaction against the rapid industrialisation of the 19th century.

In my view, this is what the medical humanities are all about – understanding that our bodies are only a part of what constitutes good health. If we ignore the mental aspects of health, we make proper well-being an impossibility. But, like any emerging field of inquiry, the medical humanities face confusion and scepticism. Where Does It Hurt? does an excellent job of giving the reader an idea of the wide breadth of the medical humanities. And the book performs a great service by helping to illuminate the value of this field.

This guest contribution was written by Kyle W. West, a medical anthropologist and research assistant at UT Southwestern Medical Center in Dallas, TX. He is currently working on a study investigating clinical depression in patients with chronic kidney disease. He holds two degrees in anthropology (BA, MS) from the University of North Texas.

Correspondence to Kyle W. West.


Works Cited:

De Botton, Alain. What Is Art For? The Guardian. 10 September, 2014.

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