Foucault's work has had a profound impact on the medical humanities over the last decade or so. However, most work to date has focused on Foucault's earlier writings rather than his later contributions on the self and governmentality. This article assesses the significance of the concept of governmentality for critical scholarship in the medical humanities, particularly in creating ethical awareness in the field of health care. It examines the context for Foucault's later work, and contributions arising from scholarship (...) building on this work. The governmentality literature, it is argued, raises novel questions about the ways we have come to think about health care in late modern societies. However, there are some limitations with this body of work which have not been fully acknowledged by scholars. The article discusses some of these limitations and offers some suggestions for a fruitful way forward. (shrink)
The advent of integration as a feature of contemporary medical curricula can be seen as an advantage for the medical humanities in that it provides a clear implementation strategy for the inclusion of medical humanities content and/or perspectives, while also making its relevance to medical education more apparent. This paper discusses an example of integration of humanities content into a graduate medical course, raises questions about the desirability of an exclusively integrated approach, and argues for the value (...) of retaining a discrete and coherent disciplinary presence for the medical humanities in medical curricula. (shrink)
The medical humanities have been presented as a panacea for medical reductionism; a means for ‘humanizing’ medicine. However, there is a lack of consensus about the appropriate contributing disciplines and how curricula should be taught and assessed. This special issue critically examines the role of the medical humanities in medical education and their potential to serve, inadvertently or otherwise, as a tool of governance. The contributors, who include medical educators and medical practitioners, employ a range of perspectives for (...) analysing the pertinent issues. (shrink)
This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as “arts-in-health”): first, an intellectual enquiry into the nature of clinical medicine; second, (...) an important dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting “humane health care” as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny. (shrink)
The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates (...) a dualism of humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)
The medical humanities are often implemented in the undergraduate medicine curriculum through injection of discrete option courses as compensation for an overdose of science. The medical humanities may be reformulated as process and perspective, rather than content, where the curriculum is viewed as an aesthetic text and learning as aesthetic and ethical identity formation. This article suggests that a “humanities” perspective may be inherent to the life sciences required for study of medicine. The medical humanities emerge (...) as a revelation of value inherent to an aesthetic medicine taught and learned imaginatively. (shrink)
The definition of ‘medical humanities’ may be approached via three conceptions—the humanities as a list of disciplines, as a program of moral development, and as a supportive friend. The conceptions are grounded by linking them to three narratives—respectively, the history of the modern liberal arts college; the history of Petrarch and the studia humanitatis of the early Renaissance; and the life of Sir William Osler. The three conceptions are complementary, each filling gaps in one or more of the (...) others. Getting clearer on a definition of ‘medical humanities’ is practically important if this field is to take its rightful place within health professions education and practice. (shrink)
Accepting as a given that the humanities disciplines are not product or “results” driven, this paper argues that the core of an interdisciplinary field of medicine and humanities, or medical humanities, is an interpretive enterprise that is not readily open to quantitative assessment. A more humanistically oriented medical practice can derive, however, from the process that produces new insights and works toward the development of a new, mutually shared, and humanizing language.
We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada’s seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted – or is even desirable – given that (...) Canadian medical humanities programs are largely shaped by individual educators’ interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities – which defy easy metrical appraisal – are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches. (shrink)
Visuality is a concept used to study vision as an historically and culturally specific activity. Curriculum in the medical humanities could address visuality by stressing how different kinds of practitioners and peoples learn how to see. This paper introduces the visual training promoted by the discipline of art history, analysing early modern French medical images of the unborn as a case study. The goal is to encourage medical practitioners to reflect on their own visual skills, comparing and contrasting them (...) with the visual methodologies of art history. (shrink)
Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American (...) Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP). (shrink)
In this essay, the directors of an NEH Institute on “Medicine, Literature, and Culture” consider the lessons they learned by bringing humanities scholars to a teaching hospital for a month-long institute that mingled seminar discussions, outside speakers and clinical observations. In an exchange of letters, they discuss the productive tensions inherent in approaching medicine from multiple perspectives, and they argue the case for a broader conception of medical humanities that incorporates the methodologies of cultural studies.
Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of (...) what patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients’ problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences. (shrink)
In this essay, I explore medical humanities practice in the United States with descriptions offered by fifteen faculty members who participated in an electronic survey. The questions posed focused on the desirability of a core humanities curriculum in medical education; on the knowledge, skills, and values that are found in such a curriculum; and on who should teach medical humanities and make curriculum decisions regarding content and placement. I conclude with a call for a renewed interdisciplinarity in (...) the medical humanities and a move away from the territorial aspects of disciplinary knowledge and methods sometimes found in medical humanities practice. (shrink)
Whenever we try to make an inventory of humankind’s store of knowledge, we stumble into an ongoing battle between what CP Snow called ‘the two cultures’. On one side are the humanities, on the other are the sciences (natural and physical), with social science and philosophy caught somewhere in the middle. This is more than a turf dispute among academics. It strikes at the core of what we mean by human knowledge.
What Science Offers the Humanities examines some of the deep problems facing current approaches to the study of culture. It focuses especially on the excesses of postmodernism, but also acknowledges serious problems with postmodernism's harshest critics. In short, Edward Slingerland argues that in order for the humanities to progress, its scholars need to take seriously contributions from the natural sciences—and particular research on human cognition—which demonstrate that any separation of the mind and the body is entirely untenable. The (...) author provides suggestions for how humanists might begin to utilize these scientific discoveries without conceding that science has the last word on morality, religion, art, and literature. Calling into question such deeply entrenched dogmas as the "blank slate" theory of nature, strong social constructivism, and the ideal of disembodied reason, What Science Offers the Humanities replaces the human-sciences divide with a more integrated approach to the study of culture. (shrink)
The experience with genetically modified foods has been prominent in motivating science, industry and regulatory bodies to address the social and ethical dimensions of nanotechnology. The overall objective is to gain the general public’s acceptance of nanotechnology in order not to provoke a consumer boycott as it happened with genetically modified foods. It is stated implicitly in reports on nanotechnology research and development that this acceptance depends on the public’s confidence in the technology and that the confidence is created on (...) the basis of information, education, openness and debate about scientific and technological developments. Hence, it is assumed that informing and educating the public will create trust, which will consequently lead to an acceptance of nanotechnology. Thus, the humanities and social sciences are seen as tools to achieve public acceptance. In this paper, the author argues that this is a narrow apprehension of the role of the humanities and social sciences. The humanities and social sciences have a critical function asking fundamental questions and informing the public about these reflections. This may lead to scepticism, however, the motivation for addressing the social and ethical dimensions of nanotechnology should not be public acceptance but informed judgement. The author illustrates this critical function by discussing the role, motivation and contribution of ethics as an example. Lastly, the author shows that a possible strategy for incorporating the humanities and the social sciences into nanotechnology research and development is Real-Time Technology Assessment, where the purpose is to integrate natural science and engineering investigations with ethical, legal and social science from the outset. (shrink)
The work of Jacques Derrida has transformed our understanding of a range of disciplines in the humanities through its questioning of some of the basic tenets of western metaphysics. This volume is a trans-disciplinary collection dedicated to his work; the assembled contributions - on law, literature, ethics, history, gender, politics and psychoanalysis, among others - constitute an investigation of the role of Derrida's work within the field of humanities, present and future. The volume is distinguished by work on (...) some of his most recent writings, and contains Derrida's own address on 'the future of the humanities'. In addition to its pedagogic interest, this collection of essays attempts to respond to the question: what might be the relation of Derrida, or 'deconstruction' to the future of the humanities? The volume presents the most sustained examples yet of what deconstruction is in its current phase - as well as what its possible future may be. (shrink)
Research Ethics Committees (RECs) or Institutional Review Boards (IRBs) are rapidly becoming indispensable mechanisms in the overall workings of university institutions. In fact, the ethical dimension is an important aspect of research governance processes present in institutions of higher learning. However, it is often deemed that research in the social sciences do not require ethical appraisal or clearance, because of the alleged absence of harm in conducting such research. This is an erroneous and dangerous assumption given that research in social (...) sciences poses various and complex dilemmas related to ethics. The article aims to gauge the importance of ethical appraisal at a particular institution of higher learning’s Faculty of Humanities. This is done by scrutinising its defunct REC, and the views that Heads of Departments of the Faculty have of ethics in research and the need for ethical appraisal by this REC. Finally, some suggestions are made to proceed to review and restructure the current REC with the ultimate objective to make it functional again. It was found that the development and discussion around ethics in research and ethical appraisal are part of a much needed thrust to sensitise the entire Faculty and the institution on the widespread beneficial repercussions of ethical awareness in research and beyond. (shrink)
Jean Hamburger (1909--1992) is considered the founder of the concept of medical intensive care (reanimation medicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix (...) Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a "golden" book, "Conseils aux etudiants en medicine de mon service" ("Advice to the Medical Students in my Service"), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)
“Medical humanities” is a phrase whose currency is wider than its agreed meaning or denotation. What sort of study is it, and what is its relation to the study of philosophy of medicine? This paper briefly reviews the origins of the current flowering of interest and activity in studies that are collectively called “medical humanities” and presents an account of its nature and central enquiries in which philosophical questions are unashamedly central. In the process this paper argues that (...) the field of enquiry is well-conceived as being philosophical in character, and as having philosophy — albeit pursued over a larger canvas — at the core of its contributing humanities disciplines. The paper characterises humanities disciplines as having an important focus on human experience and subjectivity, of which the experiences and subjectivities at stake in health, medicine and illness form an important sub-set, the preoccupation of the medical humanities as a whole. Claims of interdisciplinarity (as distinct from multidisciplinarity) are noted, but such claims need to be recognised for the high and stern ambition that they embody, and should not be made lightly. (shrink)
The contemporary humanities--from "intertextuality" to "queer theory"--are a minefield of new theories and controversies. This book explores some of the new ways of thinking about the traditional arts and human sciences, providing historical background, defining key terms, and introducing the ideas of the important personalities.
This book combines contemporary ethical theory, literary interpretation, and historical narrative to defend a view of the humanities as a source of moral guidance. Peter Levine argues that moral philosophers should interpret narratives and literary critics should adopt moral positions. His new analysis of Dante’s story of Paolo and Francesca sheds new light on the moral advantages and pitfalls of narratives versus ethical theories and principles.
The question of whether the universe is expanding or contracting serves as a model for current questions facing the medical humanities. The medical humanities might aptly be described as a metamedical multiverse encompassing many separate universes of discourse, the most prominent of which is probably bioethics. Bioethics, however, is increasingly developing into a new interdisciplinary discipline, and threatens to engulf the other medical humanities, robbing them of their own distinctive contributions to metamedicine. The philosophy of medicine considered (...) as a distinct field of study has suffered as a result. Indeed, consensus on whether the philosophy of medicine even constitutes a legitimate field of study is lacking. This paper presents an argument for the importance of a broad conception of the philosophy of medicine and the central role it should play in organizing and interpreting the various fields of study that make up the metamedical multiverse. (shrink)
The Twentieth European Conference on Philosophy of Medicine and Health Care was held in Helsinki, Finland, in August 2006 and highlighted the theme “Medicine, Philosophy and the Humanities.” The four papers in this thematic section are developed from presentations made at that conference.They are the work of physicians and philosophers and present fundamentally philosophical reflections on the medical humanities. The authors show that philosophy offers both a substantial way of humanizing the theory and practice of medicine and a (...) way to orchestrate the contributions of all the medical humanities. (shrink)
Responding to Jacques Derrida's vision for what a "new" humanities should strive toward, Peter Trifonas and Michael Peters gather together in a single volume original essays by major scholars in the humanities today. Using Derrida's seven programmatic theses as a springboard, the contributors aim to reimagine, as Derrida did, the tasks for the new humanities in such areas as history of literature, history of democracy, history of profession, idea of sovereignty, and history of man.
Patients increasingly see physicians not as humane caregivers but as unfeeling technicians. The study of philosophy in medical school has been proposed to foster critical thinking about one's assumptions, perspectives and biases, encourage greater tolerance toward the ideas of others, and cultivate empathy. I suggest that the study of ethics and philosophy by medical students has failed to produce the humane physicians we seek because of the way the subject matter is quarantined in American medical education. First, the liberal arts (...) are seen as the province of undergraduate education, and not medical school. Second, philosophy, when taught in medical school, is seen by students as just one subject to be mastered along with many other more important ones, and not as a way to foster critical thinking and empathy. What is needed is a new pedagogy that combines both cognitive and affective elements to implant and nourish the liberal arts in students. Removing the quarantine of philosophy from other facets of medical education is an important first step. (shrink)
This paper aims to (re)ignite debate about the role of narrative in the medical humanities. It begins with a critical review of the ways in which narrative has been mobilised by humanities and social science scholars to understand the experience of health and illness. I highlight seven dangers or blind spots in the dominant medical humanities approach to narrative, including the frequently unexamined assumption that all human beings are ‘naturally narrative’. I then explore this assumption further through (...) an analysis of philosopher Galen Strawson's influential article ‘Against Narrativity’. Strawson rejects the descriptive claim that “human beings typically see or live or experience their lives as a narrative” and the normative claim that “a richly Narrative outlook is essential to a well-lived life, to true or full personhood”. His work has been taken up across a range of disciplines, but its implications in the context of health and illness have not yet been sufficiently discussed. This article argues that ‘Against Narrativity’ can and should stimulate robust debate within the medical humanities regarding the limits of narrative, and concludes by discussing a range of possibilities for venturing ‘beyond narrative’. (shrink)
This paper explores narrative literature as a means of inquiry into the sense of self in depression. Described as a disease, an identity and a way of life, depression is influenced by both internal and external factors. Although brain research has provided new insight into the relationship between neurotransmitter function and depression, the symptoms are experienced by individuals whose lives are intertwined with historical and sociocultural interpretations of illness and its manifestations. At the intersection of science and the humanities, (...) narratives aid in the interpretation of lived experiences, provide a window to that experience, and a public medium that engages writers and readers as they interpret the world. Engaging narratives to interpret both experience and medical jargon may reveal for both those experiencing depression and those engaged in their care, a way of mediating that experience. Narratives can help dissect and thus illuminate the official language of medicine and psychiatry and the personal language of depression. Such a window can enhance the opportunities for empathy and care. (shrink)
There is now a context for teaching humanities in undergraduate medical education via special study modules (SSMs). This paper discusses the instrumental and non-instrumental role of the humanities in the education of doctors. Three courses are then described and compared. The most successful of the three is a SSM which had the following characteristics: it was voluntary, it was an integral part of the curriculum, and it was examinable.
In this paper we articulate a growing awareness within the field of the ways in which medical humanities could be deemed expressive of Western cultural values. The authors suggest that medical humanities is culturally limited by a pedagogical and scholarly emphasis on Western cultural artefacts, as well as a tendency to enact an uncritical reliance upon foundational concepts (such as ‘patient’ and ‘experience’) within Western medicine. Both these tendencies within the field, we suggest, are underpinned by a humanistic (...) emphasis on appreciative or receptive encounters with ‘difference’ among patients that may unwittingly contribute to the marginalisation of some patients and healthcare workers. While cultural difference should be acknowledged as a central preoccupation of medical humanities, we argue that the discipline must continue to expand its scholarly and critical engagements with processes of Othering in biomedicine. We suggest that such improvements are necessary in order to reflect the cultural diversification of medical humanities students, and the geographical expansion of the discipline within non-Western and/or non-Anglophone locations. (shrink)
Next SectionPeople with disabilities are a large minority that disproportionately seeks medical care. However, disability is relatively neglected in medical education and practice, and disabled people experience troubling differences and even disparities in healthcare. Practitioners can help improve healthcare for disabled people through disability studies, a multi-disciplinary field of enquiry that draws on the experiences and perspectives of people with disabilities to address discrimination. This article outlines a disability studies perspective on healthcare, specifically the rejection of the medicalisation of disability (...) and difference in favour of an understanding of disability that focuses on social factors that disable, such as stigmatisation and a lack of accommodation. The ‘social model’ of disability can be expanded to chronic illness and to the broader work of the medial humanities. The author argues that narrative, particularly first-person accounts, provide a critical resource by representing the point of view of people with disabilities and by offering a means of examining the social context and social determinants of disability. The author examines specific conventions of narrative, the dominant plotlines such as the triumph over adversity, that predetermine experiences of disability and illness. Through disability studies and critical examinations of narrative informed by disability studies, practitioners can provide better care for patients with disabilities and work as allies towards more equitable relations in the clinic. (shrink)
Researchers in medical education have extensively studied negative reactions to gross anatomy, sometimes grouped under the term “the cadaver experience.” Although there has been disagreement about the extent and importance of such phenomena, several attempts at curricular reform have been designed to “humanize” the student-cadaver encounter. However, some obvious sources linking gross anatomy and the humanities have been consistently overlooked. Such sources—from the history of art, the history of anatomy, and autobiographical and imaginative literature—not only bear witness to the (...) “cadaver experience” for anatomists of the past, but also offer forgotten alternatives for placing present-day reactions in perspective. Former methods of teaching which used such material might serve as models for reintegrating the humanities into the study of gross anatomy as a possible humanizing force. (shrink)
Medical humanities—history, literature, anthropology, ethics and fine arts applied to medicine—play an important role in medical education. For more than 20 years an effort has been made to obtain an academic identity for such a multidisciplinary approach. A distinction between humanitarianism and humanism is attempted here, the former being associated with medical care and the latter with medical education. In order more precisely to define the relationship between the arts and medicine, an alternative term “medical kalology”, as-yet-unsanctioned, coined after (...) the rules of medical terminology, is proposed. The Department of Medical Humanities in the School of Medicine, National University of La Plata, submits the following apologia: Don't cry for us Argentinians, since the teaching of medical humanities has helped our doctors to function more truly humanistically during the past two decades, and we intend to continue with this calling in the future. (shrink)
Next SectionIn this paper the authors discuss the benefits of history and literature in the teaching of medical humanities. They suggest that human sciences produce a common effect, which they call distancing. Distancing is the awareness that one natural way to describe a given situation does not exist and that any point of view—scientific or not—is context dependant and culturally shaped. Distancing is important to medical students, by allowing them to become aware of the specificity of their own professional (...) point of view. The authors offer a reflection on the specificities of both historical and literary approaches and on the tools they provide for medical students. This paper assumes there is a close link between the theoretical debate on the benefits provided by human sciences and the concrete framework of a given programme. The authors describe team teaching, which has been the solution adopted in the School of Medicine at the University of Geneva to obtain the most from history and literature. (shrink)
The AIDS epidemic touches upon basic humanities themes: sex, death and social worth, to name just three. AIDS policy in general builds upon society's discourse on these topics. The growing Latino population (25% of California and Texas) needs an AIDS policy that builds upon the Latino humanities tradition. The contours of the Latino intellectual tradition, as focused on issues attendant to health, are presented, with examples from Aztec, colonial and modern times.
Although the humanities' place in the medical school curriculum has been established, how we can best approach our teaching remains unanswered. A curricular framework which addresses process, as well as subject matter and structure is needed. A process-oriented framework demands that we enhance our student's ability to contextualize experience through multiple realms of meaning; encourage our students in the struggle to find a voice; and once a voice is found, to endow our students with the courage to let it (...) be heard. (shrink)