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. Victoria Hume offers her perspective here.
Where does it hurt? is a collection of 40 short, manifesto-like essays – all packaged in a Baker-Miller(-ish) pink jacket and spiked with illustrations. It is a kind of introductory volume to the myriad meanings of ‘medical humanities’ – commissioned by one of its major funders in the UK and increasingly internationally; the Wellcome Trust.
The Wellcome have been canny about formatting; the book is easily reproducible, free, and readily available online as well as in hard copy. And they have put their money where their mouth is by commissioning Three Johns and Shelagh – an appropriately multi-disciplinary team – to bring this together. I like the fact that the design (by Project) seems to have been considered intrinsic to the book, and there are some nice ideas in there. But the balancing act between highbrow and light-hearted is not easy to pull off; and while illustrations could lighten this load of this surprisingly dense read, in fact the disrupted design – particularly the mix of styles – makes the brain judder a bit; I concede that this may in part be the price one pays for reading what is meant to be dipped in and out of in one go, but in some cases (‘Sonnet 118’ (p. 43), for example, or various slanting texts (pp. 38-39 and 46-47) the conceptualisation feels more cute than subversive. And – pedantically – it bothers me that there is a spelling mistake on the ‘Museum Pills’ (pp. 74-75). Maybe this would OK in a different book. But if it’s trying to challenge preconceptions about how one might express or make knowledge, perhaps it needs a bit more specificity.
Dan O’Connor’s introductory essay, in a similar mould of playing with format, feels more successful – with a kind of quick, self-deprecating humour that fits well with the cross-disciplinary nature of the general medical humanities project. And O’Connor makes it clear that the humanities ‘are not merely decorative add-ons’; hurrah for that. But the humour congeals slightly when it comes to getting across the Wellcome’s vision statement. The formatting belies the fact that this is actually the heart of the essay – the serious bit: ‘The Wellcome Trust’s vision is to achieve extraordinary improvements in human and animal health. We believe this can only be achieved if advances in biomedical research are accompanied by advances in our understanding of the cultural and historical contexts of medicine’.
One can glean a lot from this vision statement. First, an order of priority. The humanities might not be decorative add-ons, but they do seem to be instrumental to the biomedical task. And let’s look at ‘extraordinary improvements’, a phrase which speaks to a kind of scientific heroism that the medical humanities might well want to question.
O’Connor goes on to take a kind of medical anthropological stance – to attack the idea – as almost all of these essays do – that health sciences occur in a vacuum. True enough. But still, for me his essay describes the business of visiting a foreign country to discover yourself. What in this exchange is given back? And what is actually learnt about that country or how one might sit in relation to it?
My own feeling is that the medical humanities could and should present so fundamental a challenge to our conception of health (and certainly biomedicine) that the ‘medical’ part of its name becomes somewhat misleading. In this light, it is almost reassuring to read Claire Matterson, Wellcome’s Director of Culture & Society, suggest that ‘it could be time to contemplate dropping the potentially restricting term’ (p. 95). But in the meantime, as we hear repeatedly, ‘medical humanities’ is a term that means quite different things to different people. And the book offers in some ways appropriately confused messages about how established or not these ideas might be.
Victoria Bates, for example – a lecturer in modern history – takes the position that the medical humanities have now ‘come to hold an important place in academic studies’ (p. 8). Curator and writer Yasmin Khan displays a similar optimism: ‘Nowadays our national hospitals routinely exhibit art work in situ as part of a 360-degree therapeutic package for in-patients’ (p. 74). I salute the positivity but suspect we haven’t quite reached either of these stages. There are to be sure islands of astonishingly good and inventive practice (for many of which the books’ authors are responsible). But these islands exist thanks to individuals pushing the system to its extremes; they are not routine by any stretch of the imagination. Our hospitals are further from the 12th-century multidimensional spaces Khan refers to than she hints. And how many medical students (if we are to take what Jane McNaughton calls the ‘educational medical humanities’ model) have regular, sustained, university-sanctioned exposure to the humanities? How many practising biomedical scientists collaborate with anthropologists, or artists? How many government ministers have heard of the medical humanities, or arts in health, or – more importantly – formed policy with them in mind? Part of the selfish joy of working in these areas is how nascent and open they are; part of the frustration is the relatively small – though undoubtedly growing – number of people who care.
The concomitant sense of the need to convert the unconverted is what gives this book its slightly awkward mix of advocacy and critical analysis.
Bob & Roberta Smith’s 6-point system of valuing the arts, for example, has the definite whiff of a sales pitch to policy-makers. I don’t disagree with the points – but it’s a set designed to cover all the essentially capitalist power bases: national economic benefit, individual intellectual development, democratic freedom. Not so much speaking truth to power as power to power.
I think it’s a trap, but it’s one I and all of my colleagues constantly fall into. Having worked for years in hospitals and medical schools, I know how easy it is to sugar the pill of the humanities by tying them to outcomes. But this approach – that of the allowed fool, if you like – may not be enough. Andrews and Ballatt (pp. 68-69) talk about the danger of the solution becoming part of the problem, of compassion – in their example – being ‘framed in checklist, demanding ways’.
How instrumental should the medical humanities ultimately be? Could the pressure of creating change force this ‘bricolage collection’, in Dan O’Connor’s words, into a kind of false didacticism? But then where do the pragmatists fit in? I wanted to cheer when I read Matt Peacock’s direct and moving essay about Streetwise Opera. If ever something were tackling the nitty-gritty of smashing the humanities (in every sense of the word) into health, it is this brilliant charity. And there is a risk that academy’s control of this cross-disciplinary project may pull it (unintentionally) away from such charities, artists, from the myriad health workers who are not doctors, and (for want of a better word) patients – all groups with limited or no access to the international conference circuit and without institutional protection. This is where Where does it hurt? gets it absolutely right – bringing all these voices together in parity. There is a real generosity about the book in this way. As Callie Clapp says, ‘our writing […] brings us together’.
But Peacock also represents the tensions between theory and activity: after successfully demolishing Maslow’s hierarchy of needs, he says ‘I am not an academic – I am an activist and a passionate advocate’ (p.42). Now why does he feel the need say he’s not an academic? Perhaps I’m splitting hairs, but many of these essays point to the same jumpiness about where we sit, what right we have to particular languages, and how other disciplines might judge us from across the fence.
It pops up again – strangely enough – from that institutional powerhouse, the World Health Organisation (‘the mere fact that WHO is represented in this book could raise an eyebrow or two’). And from health economist Tessa Peasgood, in a slightly self-flagellating mock-interview set up to acknowledge the limitations of her own discipline.
And here, for example, is an interesting sentence from Mark Jackson: ‘I defected from medicine to the humanities’. What a loaded word ‘defected’ is. I’ve heard similar half-embarrassed sentiments many times from medics and assumed it might come from the cult-like, assertively hierarchal nature of medical training. But could this in fact be less about a hidebound clinical model than the amorphous, all-consuming nature of the humanities – which can absorb medicine, like any other subject, without the slightest threat to their own identity? This is something the humanities should perhaps consider. At a South African conference recently, I heard a delegate comment that we were asking doctors – after centuries of fetishisation and militaristic hierarchies set up to defend them from the real, painful, moral and emotional difficulties of medicine – to drop all that but continue, heroically, to medicate us. Perhaps the humanities – ever-disposable in a medical setting – are just as vulnerable; but I’m not sure.
Reviewed by Victoria Hume, who previously managed an award-winning arts programme at the Royal Brompton & Harefield NHS Foundation Trust, and also chaired the London Arts in Health Forum between 2010 and 2013. She also works as a musician and composer. Her most recent project – which focused on delirium in intensive care – was shortlisted for the inaugural Medicine Unboxed Creative Prize (UK) in 2014. She is studying for a Masters in Health Communication and Music at the University of the Witwatersrand (Johannesburg), and working with the medical humanities initiative at WiSER (Wits Institute for Social & Economic Research).
Correspondence to Victoria Hume.