“The Routledge Companion to Health Humanities”: Book Review by Shayna Watson

Shayna Watson reviews The Routledge Companion to Health Humanities, edited by Paul Crawford, Brian Brown, and Andrea Charise (Abingdon and New York: Routledge, 2000).

I approached this book from the perspective of a physician and clinician-educator, in search of material to inform my practice and teaching. As a generalist I am interested in person-centred care, interprofessional care and education, addressing inequity in healthcare, and bringing humanity to my clinical work.

At the School of Medicine at Queen’s University, Canada, we have a Chair in the History of Medicine and once had a course called “Images of Doctors and Lawyers in Literature” which lasted as long as the careers of the gifted educators who designed and taught it for many years. It had a short incarnation after their retirements but eventually became an interest group run by students; gifted, talented, thoughtful and educated students, but students all the same. I suspect I am not alone as a clinician with this kind of aspirational interest in incorporating humanities perspectives into the medical curriculum, but lacking sufficient institutional support to do so.

I approached this book hoping for answers to the following questions:

  • How does the reframing ‘medical’ to ‘health’ humanities help my patients? our learners? me as a clinician? our efforts to embed this perspective in the curriculum?
  • Might this book chart a way forward as we come to terms with what has happened to each – all – of us over the course of the COVID-19 pandemic?
  • How can a health humanities perspective inform my participation as my university and faculty address issues of equity, diversity, inclusion, Indigeneity, and accessibility (EDIIA)?

This volume of 65 chapters presents the work of more than 80 clinicians, academics, artists, those who defy categorization, and thinkers who cross borders in their work. Their collective presence invites us to think more widely, to push boundaries and engage with diverse colleagues – not as guests and informants from other disciplines, or as a resource to be mined for our own purposes, but as colleagues and mentors for our own change and development. This compendium both informs and represents the goals of health humanities, it opens with an assertion that health humanities represents “a more inclusive, democratizing, and applied approach to arts and humanities in health care, health and well-being” (p.1). We are invited in to a large (and slightly uncomfortable) space and are met with a transformative agenda and a demand for change.

This book is structured in two parts. The first collection of chapters is described as “reflections and critical perspectives”, and includes essays on the state of the discipline and exemplars of the application of a health humanities approach.

The second section is a demonstration of health humanities in action and makes the case for these approaches as non-pharmacologic interventions. Here we find the familiar: literature, theatre, classics and ancient texts, history (including oral histories), reflective writing and graphic medicine – some of our old friends from the medical humanities. I was introduced to some less expected but equally inspiring examples from dance, fashion and textiles, puppetry, photography, drawing, paper making, music (making, shared listening, heavy metal, choirs and singing), clay modelling, storytelling, horticultural, philosophy, yoga, applied theatre, knitting, therapeutic filmmaking, cooking, quilting, design and architecture. In the hierarchical landscape of healthcare, it is wonderful to see the inclusion of craft alongside fine art and academic disciplines. Lydia Lewis’s chapter on creative arts adult community learning presents craft as psycho-social medicine – not in the service of a health discipline but as its own powerful intervention.

These chapters are not presented as experiences to be offered to students in health profession programmes to make them ‘better people’, but as disciplines and health interventions in their own right. The authors are making the case for their disciplines and creative work as content and method, and as therapeutic modality.  Health humanities is not arts in the service of medicine (for example, to make more empathic physicians); rather, it “values co-design, co-creativity, and co-learning over privileged direction and control” (p.3).

The volume presents a persuasive argument for reclassifying ‘medical’ humanities as ‘health’ humanities. In his chapter “Representations of Medical and Health Delivery Paradigms” Phillip Barrish suggests that within medical schools “the humanities tend to be valued for the lessons they can teach, and the skills and sensibilities they can help develop, regarding one-to-one human relationships, and above all the relationship between patient and health-care provider.” Reconceptualizing our work as health humanities invites us to consider the possibility of inequity when one or more disciplines (arts and humanities) are used in the service of another (medicine), especially when there is a divergence of economic viability within the academy. And as a physician I worry that we, in medicine, were sometimes at risk of using the arts and humanities to reflect and indulge our fascination with our medical selves.  In her chapter, “Medicine within Health Humanities”, Gail Allsopp argues that “medical humanities remain a strong and worthwhile discipline, but as a subheading under the bright, inclusive, and multidisciplinary umbrella of health humanities itself” (p.71). The inclusivity of health humanities recognizes our work as inherently collaborative without sacrificing or excluding the identity of any professional discipline.

Considering the future of health humanities in Japan, Huffman and Inoue describe health humanities as “an intentional social movement” (p.205) and a “new framework that is equal parts inquiry and action, and equal parts academic field and social movement” (p.212), although admit that it remains constrained by the structure of health care and academic environments and the way money flows to, and through, these two institutions. In a chapter in visual arts, Victoria Tischler reminds us that the economic disparities between partners in co-creative enterprise of health humanities still exist and need to be addressed to ensure equitable participation by those she describes as creatives.

A book like this that offers something for everyone runs the risk of being not enough for anyone; but in a world turned upside down by COVID, it is the perfect time to graze on a range of ideas as we strive to reorient ourselves and create something new, something that will address historic inequities and the injustices revealed by a pandemic which has left nobody untouched by health as a public good. The editors could not have anticipated the events that followed the publication of this book in early 2020, but those reading this book now will be unable to read from any other perspective. Travis Chi Wing Lau’s chapter on Jenner and smallpox vaccination provides historic context to the pro/anti-vaccinator tension and foreshadows what would have been previously been considered as unimaginable resistance to vaccination. In an unexpectedly prescient chapter, Steven Schlozman warns:

“If we choose to accept the inhumanity of health care, then we will someday become the inhumanity itself. The systemic lack of empathy becomes its own zombie, and the pandemic spreads as mindlessly and ruthlessly as any pandemic worthy of a blockbuster film […] By realizing what we are becoming, we allow art and all of humanities to mirror what it reflects best—the perils of the path we are on, so that we can choose something better.” (p.194)

The “creative public health” of health humanity is all the more necessary as we come to grips with the failings of our systems and confront the need for their redesign. While we might not be directly implementing the ideas and programs described by the authors, we are encouraged to think more critically about our educational and care systems and to gather new ideas to inform the choices we be able to make as we move through, and one day away from COVID-19. We will need to tell these stories together, we cannot tell a shared story alone.

In the introduction Paul Crawford presents “health humanities as an increasingly global field”: unfortunately, the book features writing primarily from the UK and the USA. There are two overview chapters on the state of affairs in Australia and New Zealand, and the possibilities of health humanities in Africa; as well as scattered contributions from Canada, Spain, and Japan, but it would have been wonderful to hear from a more international collection of voices.

Inclusivity and democratization extend beyond our systemic, academic and creative silos and must include patient and consumer partners. Alastair Macdonald’s chapter, “Co-design as a democratising force”, brings formal principles of co-construction and evidence-based design to the discussion and makes clear that the end user is a key participant in this process.

In order to be deserving partners in the enterprise of health humanities those of us in medicine must recognize our privilege and cultivate a willingness to follow as well as lead. Addressing Black and ethnic minority perspectives in health humanities, Nehal El-Hadi frames equity as an essential element of health humanities and speaks about “radical interdisciplinary” (p.43), “responsible inclusivity” (p.46) and the need “to address social inequality in medical and health care practice” (p.43).  Crawford, Boivin and Richardson introduce Indigenous health humanities and warn that any possibility of reconciliation must be “linked to the meaningful action of decolonizing health care and other social institutions” (p.102). DasGupta also warns that “medicine cannot imagine more racially just futures until it grapples honestly with its racially unjust past and present: its complicity in, dependence on, and enacting of racial violence” (p.33). If we can do this humbling work, “the health humanities [can] imagine a more racially just future” (p.36).

Perhaps my favourite expression of health humanities comes from Lan A. Li: “classical poetry did not distinguish between the lyrical and empirical because it assumed that its readers shared a common language of reality. Poetry assumed a shared intersubjectivity” (p166). Health humanities demands the same of us. Like the discipline of health humanities, this book is inclusive and serves up a broad discussion for those curious about how we move forward to transform health, healthcare, and well-being. As my own university grapples with issues of EDIIA (equity, diversity, inclusion, Indigeneity, and accessibility) and my country finally begins to confront the real effects of the racism of our government and health care institutions, acknowledging the need for truthful engagement and reconciliation with Indigenous communities and individuals, our Dean has just framed her strategic plan as Radical Collaboration.  Now isthe time for health humanities and this book offers evidence of others already doing this vital work. The task is not easy but we are not alone.

*****

Shayna Watson is a family physician and medical educator at Queen’s University in Kingston, Ontario, Canada.

The Routledge Companion to Health Humanities, edited by Paul Crawford, Brian Brown, and Andrea Charise (Abingdon and New York: Routledge, 2000).

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