After a long winter break, we are back and excited to present new projects from medical humanists, historians, and other interested in the interconnections of medicine, literary and culture. Today I am pleased to host Daniel Goldberg, who will be speaking a little bit about what he does, and how it fits under the rubric of the health humanities (a term he increasingly prefer to the medical humanities). Like many of my contributors, he has broad interests and a unique way of pursuing health, humanities and culture–and I would like to take this opportunity to reiterate the mission of the Dose: to honor, support and share perspectives about medicine and humanities across cultures and disciplines. It is an increasingly inter-disciplinary world, and we are happy to promote those who–as academics, physicians, alt-acs, independent scholars, authors, and just plain curious and intrepid souls–add to our shared knowledge of medicine, literature, and the search for what it means to be human. Thank you for joining us, Daniel!
It’s an honor to write for The Daily Dose, especially on what seems to be most academics’ all-time favorite subject to discuss: myself!
I’m a peculiar academic creature. I am a bioethicist, but I am not a philosopher, and I focus on very different subjects and tend to use different lenses than do many Western bioethicists. I am an attorney with both private practice and public policy experience. I am an intellectual historian. And I try my darndest to be competent at all three of those while at the same time quietly and perhaps even surreptitiously attempting to practice as a junior interdisciplinarian. Hic Sunt Dracones!I have two principal lines of research; one as a public health ethicist/population-level bioethicist, and one as an intellectual historian of medicine & public health. In the former, I am obsessed with the social determinants of health, and explore the topic with emphasis on health inequities, health and disease stigma, and the historical pathways of oppression and structural violence that so strongly shape each. In the latter, I work primarily on two topics: the history of pain without lesion, and the early history of X-rays, both in mid-to-late 19th-early 20th c. Anglophone culture. I have also recently launched a project attempting to trace the disappearance of the social determinants of health from American public health policy c. 1870-1935, and have published on the history of yellow fever in the southern U.S. as well (although I am very unlikely to do much more with this topic).
I know, I know, it seems a bit all over the place. That’s one of the major perils and difficulties faced by those attempting to do rigorous, responsible interdisciplinary work. Dilettantism is a if not the primary demon for most interdisciplinarians, and I work every day to avoid it. I’m rigorous and responsible, right?
Actually, there are some significant crossovers that I am developing, two of which I’ll discuss here, as they relate to my substantive research projects. The first is pain. I’ve been studying pain, and more specifically, the undertreatment of pain, for the past seven years, which does not sound like much until one realizes that such a period is actually 20 percent of my life, and a much higher percentage of my academic life. I study pain as both a population and public health problem, and as an historical phenomenon, and believe the two are deeply intertwined. That is, I argue that we cannot understand the root causes of the devastating and inequitable undertreatment of pain in both global North and global South without understanding historical attitudes towards pain without lesion (we’d call it chronic pain today, but that term did not arise until the 1960s) in the West.
Attitudes, practices, and ideas about objectivity, the brain, the body, health and disease changed dramatically over the long 19th c., and, I want to say, it is not coincidental that concerns over so-called malingering explode in the mid-to-late 19th c. and the early 20th c. in both the U.S. and in Great Britain. Why? How did so-called ‘invisible’ pain become stigmatized? And what is the significance and determinants of the distribution of that stigma along social strata of race, class, and gender?
Accordingly, the modern history of pain without lesion dovetails with studies in the history of stigma, and in the history of increasing concerns over malingering. All three are of course highly gendered (‘hysteria’ was, in the dynamic nosologies of the 19th c. West, frequently deployed as a term for pain complaints). Unsurprisingly, then, pain stigma and concerns of malingering appear most commonly in military, pension, and railway contexts, and is therein saturated with ideas about manhood and femininity.
The connection to X-rays comes from the significance of the fact that the pain complaints that most interest me are those without lesion. What Foucault terms the anatomoclinical method is in some important sense born during the 19th c., and my contention is that illness complaints that could not be clinically correlated with a discrete, material pathology (read: lesion) were increasingly problematic over the long 19th c. (And as a meta-point, one item I have great difficulty understanding is why the vast majority of work in health humanities & Foucault studies pays unjustifiably short shrift to what I consider to be one of his most important books – The Birth of the Clinic.)
So the history of pathological anatomy becomes significant here, which dovetails with the explosion of novel scientific and medical imaging techniques over the same time period (daguerreotype, lithograph, microscope [not new, but renewed focus and interest], and, of course, the X-ray). The X-ray bestows upon the user the capacity to anatomize remotely the living body, and the social, cultural, and intellectual importance of this power across a wide variety of domains can hardly be overstated. Finally, the latter cannot properly be analyzed with attention to the history of objectivity, so I spend some time working with that as well.
Thems a lot of words. My hope is to connect these historical studies to our present difficulties in treating pain and in regarding those who suffer pain equally. There’s a risk of instrumentalism there, which I work hard to avoid. One of the wonderful things about history, especially the history of medicine &/or public health, is how much it helps inform us about what we are doing and what we could be doing. But even if it did no such thing, history would be worth studying for its own sake; has intrinsic value. So I tack between trying to harness the amazing power of history and historical approaches for making sense of the world we live in and our understandings of mind, body, illness, and health across populations, and studying and learning about history just because it is intrinsically valuable. I hope Clio is not too angry with me.
Finally – I promise – what does all of this have to do with the health humanities? I believe, and say as much in a contribution to the forthcoming Health & Humanities Reader (Rutgers, 2013), that we need to harken back to the studia humanitatis as shaped by the medieval and Renaissance humanists (and in the essay I trace the influence of law and rhetoric in thinking about the historical and contemporary humanities). The humanists eschewed the Scholastic search for grand, metaphysical truths, and were much more interested in using erudition and learning in the service of virtue and practical wisdom. This underpins how I try to practice the health humanities. As Montaigne, my personal and professional hero notes, it is myself that I paint.