Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain philosophical approaches, on (...) the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (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)

There is a section in Samuel Delany’s magnificent autobiographical meditation, The Motion of Light in Water, that dramatically raises the problem of writing the history of difference, the history, that is, of the designation of “other,” of the attribution of characteristics that distinguish categories of people from some presumed norm.1 Delany recounts his reaction to his first visit to the St. Marks bathhouse in 1963. He remembers standing on the threshold of a “gym-sized room” dimly lit by blue bulbs. The (...) room was full of people, some standing, the rest an undulating mass of naked, male bodies, spread wall to wall. My first response was a kind of heart-thudding astonishment very close to fear. I have written of a space at certain libidinal saturation before. That was not what frightened me. It was rather that the saturation was not only kinesthetic but visible.2Watching the scene establishes for Delany a “fact that flew in the face” of the prevailing representation of homosexuals in the 1950s as “isolated perverts,” as subjects “gone awry.” The “apprehension of massed bodies” gave him a “sense of political power”:what this experience said was that there was a population—not of individual homosexuals … not of hundreds, not of thousands, but rather of millions of gay men, and that history had, actively and already, created for us whole galleries of institutions, good and bad, to accommodate our sex. [M, p. 174] 2. Samuel R. Delany, The Motion of Light in Water: Sex and Science Fiction Writing in the East Village, 1957-1965 , p. 173; hereafter abbreviated M. Joan W. Scott is professor of social science at the Institute for Advanced Study in Princeton, New Jersey. She is the author, most recently, of Gender and the Politics of History and is currently at work on a history of feminist claims for political rights in France during the period 1789-1945 as a way of exploring arguments about equality and difference. (shrink)

Medical humanities purchases its presence on the medical side of university campuses by adopting as its own the ends of medicine and medical ethics. It even justifies its presence by asserting promotion of those ends as an ethical imperative, most of all to improve the caring in medical care. As unobjectionable, even praiseworthy, as this imperative appears, it actually constrains the possibilities for interpersonal relationship in the context of medical practice. Development of those possibilities requires openness of self to the (...) existentially challenging ethical imperative to care also literally for nothing at all. (shrink)

This Thing of Darkness: A Sociology of the Enemy. By James A. Aho 224 pp. Identity/difference: Democratic Negotiations of Political Paradox. By William E. Connolly 244 pp. The Ethos of Pluralization. By William E. Connolly 244 pp.

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and (...) mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy. (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)