Medical Humanities as an Intersection: Fostering Cross-Disciplinary Intellectual Spaces, A Commentary

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This Wednesday we’re pleased to have a post from Julia Knopes. Julia is a PhD candidate in anthropology at Case Western Reserve University, and serves as the administrative coordinator for the newly-launched MA Track in Medicine, Society & Culture in the CWRU Department of Bioethics. Julia’s research examines the socio-material basis of professional role development amongst American medical students. She holds an MA in Humanities from the University of Chicago and a BA in English from Washington & Jefferson College. You can learn more about Julia’s work and current research here.

When I set out to write this commentary, I first intended on penning a blog piece about my own definition of the medical humanities as someone trained in both the humanities and the social sciences. Having come to medical anthropology from a past life in literary studies, my work has straddled the fissure between humanities and qualitative social sciences. I have presented work both on the history and theatrical presence of anatomical learning in the English Renaissance, and on my ethnographic research with medical students in the gross anatomy lab today. Sometimes, my work is focused solely on the present; in other instances, I turn to the historical past to inform my work as a scholar of contemporary medical training. My vision of the medical humanities is one that arrives from both within and beyond traditional disciplinary boundaries.

My approach, however, is but one. I recognize that the medical humanities do not offer a single or unified outlook on human health, illness, and medical practice. In fact, the medical humanities are populated by historians and artists, poets and literary scholars, philosophers and social scientists. Our individual professional identities may be firm—I identify now as an ethnographer and anthropologist, not a literary scholar—but the social, cultural, historical, experiential, and existential study of medicine is simply too complex to be dominated by a single field. The medical humanities (and its ally, social medicine), welcomes perspectives on the humanistic study of medicine informed by our varied native disciplines. More than a single field, the medical humanities often serve as a crossroads: an intellectual intersection (physical, virtual, or social) at which scholars across fields gather in dialogue, whether they identify with a single specialty or as interdisciplinary scholars. For this reason, and regardless of disciplinary allegiances, we can all benefit from the medical humanities as a site of discussion that welcomes myriad voices. Diverse perspectives encourage us to analyze human health and medical problems from numerous angles. As we all carry with us our own analytical methods and theories to this junction, so too do we leave these dialogues having ourselves learned and gained the critical perspectives of our peers. This sharpens our focus anew on social, cultural, and medical problems for which one discipline lacks all answers.

The value of the medical humanities is that they enable all of us to see medical and social problems through multiple lenses. If we cannot fully grasp a complex medical problem through ethnography alone, we turn to historical approaches to complete our understanding of the issue at hand. If individual illness narratives beg to be woven together through other data, we look to sociology and economics to conceptualize the underlying health inequities faced by diverse populations, amongst other socio-medical problems. And, further, when we strive to understand how medical science is confronting illness and suffering today, we turn to nurses, social workers, therapists, physicians, and other health professionals whose day-to-day interaction with patients is deeply informative for our own research. Indeed, clinicians also benefit from our work: the humanities have been widely integrated into coursework for physicians in the United Kingdom[1] and the United States[2]. While obstacles remain in the creation and implementation of medical humanities curricula for future medical practitioners[3], this coursework has widened the intellectual space in which medical humanists exchange ideas with multiple audiences.

Whether medical humanities programs are physically housed within humanities departments, or whether they are exported into numerous health education venues, they remain a space for invaluable cross-disciplinary conversation. I have been fortunate to serve as the administrative coordinator of a medical humanities and social medicine collaborative that has overcome departmental boundaries in creating a new space for scholarly dialogue. This new university-wide initiative in medical humanities and social medicine (MHSM) is anchored by a Bioethics MA degree track entitled Medicine, Society and Culture at Case Western Reserve University. Though the degree program is housed in the School of Medicine, our MHSM (Medical Humanities and Social Medicine) advisory committee (which oversees university-wide activities in medical humanities[4]) includes historians, philosophers, literary scholars, social scientists, rhetoricians, and many others. Across the university, we facilitate lectures, administer competitive conference and research grants for students, and support faculty scholarship and teaching innovation. In the region, we collaborate with neighboring institutions to spearhead events that bring together scholars in all disciplines to discuss common themes in the social and contextual study of medicine, illness, and human health. In addition, we look forward to welcoming our first entering class of graduate students in the Medicine, Society, and Culture track in the Bioethics graduate program this Fall 2016. These students will complete clinical rotations, bioethics coursework, and multidisciplinary training in medical humanities and social medicine.

In sum, the Medicine, Society and Culture initiative has become another significant intersection at which scholars—both practicing academics and new graduate students alike—are able to trade theories, exchange methods, and discuss contemporary intellectual issues with fellow medical humanists and social scientists. Thus, our program seeks to both produce new scholars who approach illness and medicine as inherently multi-faceted human experiences, and to facilitate dialogues with current scholars within various departments who strive to complicate their own understandings of health and the human condition.

Beyond university programming, however, there are many ways that all medical humanities scholars strive—and should continue—to reach across departments and disciplines to share our methods, theories, approaches, and reflections on medicine with one another. This blog is one such space that beautifully forges virtual connections across academic audiences with a shared interest in health, illness, and medical practice. My own field, medical anthropology, by its nature requires researchers to inform their claims through many kinds of data that necessitate several forms of analysis: all which dovetail approaches in other fields. So too did my previous training in literary studies require me to be conversant in historical methods, in close reading techniques, and in the same inductive reasoning skills that I now apply to my ethnographic work. No discipline is an intellectual island: and if there is a universal value of the medical humanities, it is that it has made junctures out of disparate disciplines. It is at once clinical, scientific, and humanistic.

~~~References~~~

[1] Macnaughton, Jane. (2000). “The humanities in medical education: context, outcomes and structures.” Journal of Medical Ethics: Medical Humanities 26: 23-30.

[2] Hunter, KM; Charon, Rita; Coulehan, Jack. (1995). “The study of literature in medical education.” Academic Medicine 70(9): 787-794.

[3] Shapiro, Johanna; Coulehan, Jack; Wear, Delese; Montello, Martha. (2009). “Medical Humanities and Their Discontents: Definitions, Critiques, and Implications.” Academic Medicine 84(2): 192-198.

[4] Information on members of the CWRU MHSM advisory committee can be found here: http://case.edu/medicine/msc/about/advisory-committee/

Friday Fiction Feature: MedHum T.V. for the Holidays

On this Friday after the last night of Hanukkah, exactly a week before Christmas Eve, I hope many of you are enjoying or about to enjoy a few weeks of relative rest and relaxation as we close out the old year and look forward to the new. If your find yourself looking for some binge-watching fare to balance out — or perhaps become the featured entertainment of — holiday gatherings, here are a few television shows I’ve viewed in part or in whole over the past year with medical humanities themes. Here’s hoping you find something on this list to round out your year in viewing — or get you started on 2016!

ANZAC Girls (2014). From Australia comes a six part miniseries dramatizing the experience of women who served in Egypt and at the Dardanelles during World War One as part of the Australia and New Zealand Army Corp. Trained as nurses, Alice, Hilda, Elsie, Olive, and Grace arrive in Cairo ready to do their part for the war effort. Starry-eyed patriotic idealism soon gives way to gritty, even horrific, realities of battlefield medicine on and near the front lines of the Gallipoli Campaign, April 1915-January 1916.

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Murdoch Mysteries

Murdoch Mysteries (2008-). In 1890s Toronto, science geek detective William Murdoch and forensic pathologist Dr. Julia Ogden solve crimes using the latest scientific methods, adorably falling in love on the way by. Murdoch remains grounded in historical realism while playing with both paranormal and steampunk elements. Halfway into the second of nine seasons, I can say I’ve also been impressed by the way the show has handled race and gender as both particular plot elements and a consistant part of the background narrative.

Penny Dreadful (2014-). Headlined by the commanding Eva Green, Penny Dreadful offers us a thoroughly steampunked, paranormal Victorian world in which the likes of Dr. Frankenstein and Dorian Gray stalk the streets of London and demonic possession, vampires, werewolves, and other supernatural beings flicker at the edge of the everyday. Watch Penny Dreadful for the rich literary allusions and superb acting by Green and her talented supporting cast including Timothy Dalton, Josh Hartnett, and Billie Piper.

Penny-Dreadful
Penny Dreadful

Outlander (2014-). Based on Diana Gabaldon’s series by the same name, Outlander is part costume drama, part romance, part science fiction as WWII battlefield nurse Claire Randall time-travels from late 1940s Scotland to 1740s Scotland on the eve of the Jacobite rising of 1745. Forced into a marriage of political necessity to a highland outlaw (it’s complicated), Claire struggles to decide whether to continue to search for a way back home, or whether to choose a life in the time and place she has found herself. In season one, Claire’s futuristic medical expertise both gives her value to the 18th century Scots and also puts her life in danger as her unconventional healing techniques cast suspicion on her intentions, at one point even leading to a trial for witchcraft.

Sense8 (2015-). Like its older sister Orphan Black (2013-), Sense8 explores the nature of humanity by positing the existence of human-like beings (clones or sensates) whose existence both fascinates and threatens powerful human political and scientific interests. In season one of Sense8 we meet a global cast of characters centered around eight individual sensates who discover they are able to tap into one anothers’ sensory experiences. In this show, the world of science both illuminates and threatens as the sensates struggle to learn more about themselves while hiding from those who seek to forcibly hospitalize them and destroy their psychic potential.

Strange Empire
Strange Empire

Strange Empire (2014-). Set on the isolated Canadian borderlands north of Montana, Strange Empire echoes Deadwood (2004-2006) in setting and plot — yet with a female-centric cast of characters that include gunslinger Kat Loving, brothel madame Isabelle Slotter, and surgeon Dr. Rebecca Blithely. Each of these three characters brings with her a complex history of interaction with a world that racializes and sexualizes her in specific ways. Of particular interest to the medical humanities crowd may be Dr. Blithely’s history being treated for neuro-atypical behavior (autism?), her medical training, and work as a surgeon in the remote Canadian frontier.

All of these shows, of course, have their strengths and weaknesses — yet I hope you find at least one on the list which piques your interest enough to try and episode or two. Have fun, and happy holidays!

Public Access, Outreach, and Health

DailyDose_PosterMedicine is not practiced in a vacuum; cultural and geographical context matter, and the community shapes both innovation and practice. Cleveland’s history reveals the remarkable collaboration of medical institutions and the public—it does not rest only in the hands of physicians or with distant hospital systems. Now, as then, health is everyone’s concern. But how do we engage the public? And how can we make it plain that the public has rights–and power–to shape medicine? Historically, individuals had a greater share in shaping their care out of necessity. The Dittrick Museum’s collection of herbals and medical remedies is a testament to just how much people took health into their own hands. Dr. Culpepper’s Last Legacy (1655) contains prescriptions for do-it-yourself potions [from our instagram]: Untitled-1Obviously, we are not mixing witches’ brew these days, and certainly no doctor or pharmaceutical company is going to publish recipes for homemade medicine. Then again, a resurgence in homeopathy and plenty of websites that promote home-remedies suggest that there is an audience…And a quick scan reveals plenty of misinformation, too. How can an interested public find good information about their health and health choices? Whose responsibility is it to make access to care, and even information about care, easier and more intuitive? The patient often does not feel like an empowered part of the medical process. A few years ago, The Atlantic published a piece called “Power to the Patients” that took issue with the traditional doctor knows best mantra: “it is only by empowering patients – entrusting them with greater responsibility and putting opportunities for self-directed care into their hands – that health care can be made significantly more efficient and effective.” [1] But, the article goes on to admit, sorting out how you can be empowered in the midst of a health crisis is probably too late. Let’s take it a step further: do healthy people feel empowered about their health? Do they understand that they are stake-holders? Possibly not. The New York Academy of Medicine is taking a community approach to this problem. They have a renewed dedication to “urban health,” and seek to address the broader determinants of health, and “the importance of interdisciplinary approaches to care.” Their new logo sports the phrase: Healthy Cities. Better Lives. It’s not a new idea. It’s a return to an old idea–one that thrived in cities of the 19th and early 20th centuries. Cleveland, Ohio, is one brilliant example. Polio hit urban centers hard,  leaving debilitated children in its wake. The iron lung could keep people alive, but the world needed a vaccine, and then a systematic way of implementing vaccination protocols. A combined effort of doctors, philanthropists, the media, and everyday people led to record-breaking changes. Salk’s vaccine dropped cases by 90% by 1962 in Cleveland, and led to the eradication of the disease in the rest of the US. Public awareness and empowerment did what laboratory medicine could never hope to achieve on  its own. Community engagement, public empowerment, and (key in the polio crisis) access to care and information wins the day. And that returns us to the first question. How do we engage and educate the public? Whose job is it?

The short answer: it’s everyone’s job. But I want to take a moment and focus on the power of history.  Museums and libraries–and institutions generally–have an important role to play. To address misunderstandings about medicine, and crucially about who controls or drives innovation, the Dittrick has developed an interactive, digital exhibit and attendant programming called How Medicine Became Modern. The exhibit will be a free-standing digital touch-screen wall, 10ft x 4ft, in the main gallery, providing the story of our shared medical past and cultivating means of seeing the relationships among culture, society, and health. But we have also begun two types of public outreach as well–“conversations” that begin with the history, then allow panels and round tables to discuss medicine today. The story of polio and others like it remind us: we are part of this story. History records more than the names of famous doctors. It demonstrates the innovation, the boldness, the concern, and the action of every day citizens. Medical humanities, or health and humanities, is all about the human story at the core. Let’s work together to bring that story out, and to be part of it. [1] Clayton M. Christensen and Jason Hwang. “Power to the Patients” The Atlantic 2009