As part of our ‘MedHums 101’ series, Blaise Sales explores how the imaginative, reflective and analytical skills of the literary field are a vital component of multidisciplinary approaches to medicine in the 21st Century.
For those new to the field of medical humanities, the pairing of certain humanities approaches with medicine may seem fairly straightforward. After all, philosophy has been intertwined with medical understanding and ethical practice since BCE times; the history of medicine is self-explanatory and has its own GCSE module in the UK; and the politics of how medicine and society interrelate is glaringly evident in the wake of COVID-19.
However, I’ve found that the role of literature can cause some head-scratches. After their initial confusion, people often try to clarify my MA subject as “the representation of medicine in works of literature?”. Well, that is a part of it. But as Angela Woods and Anne Whitehead point out in the Edinburgh Introduction to the Critical Medical Humanities, the ‘literary’ is more than just a set of texts that fit the criteria of prose, poetry and fiction; it is also a critical orientation with a distinctive methodology (Whitehead and Woods 2016). Literary analysis asks important questions about language, form, function, context, narrative – features found in all cultural systems and artefacts, not just the literary text.
The related field of ‘Literature and Science’ studies challenges the culturally enforced, hierarchical distinction between ‘useful science’ and ‘useless literature’ (Squier 1999). As George Levine puts it in a seminal essay-collection: “Literature and science, whatever else they may be, are modes of discourse, neither of which is privileged except by the conventions of the cultures in which they are embedded” (Levine 1987). So in what ways can the separate fields of literature and medicine be mutually ‘useful’ to one another? And why is the ‘critical’ approach of the current, ‘second wave’ of the medical humanities so important to thinking about how we can answer this question without reducing or conflating the specific analytical tools and knowledge that both disciplines have to offer (Bleakley 2013)? To answer these questions, let’s journey back to the early ways in which ‘literature’ and ‘medicine’ were connected in the ‘first wave’ of the Medical Humanities’ lineage.
Narrative medicine, pathography and the ‘first wave’ of medical humanities
For Rita Charon, Professor of Clinical Medicine and author of Narrative Medicine (2006), the relationship between literature and medicine should not be considered a new phenomenon; rather, this connection is ‘enduring because it is inherent’ (Charon 2000). Charon helped to establish ‘narrative medicine’, an approach to medical education that uses the ‘literary’ method of narrative interpretation to help clinicians understand the complexities of a medical condition on an empathic level that foregrounds patient experience. In the US, Kathryn Montgomery Hunter’s Doctors’ Stories (1991) is one of the first examples of narrative medicine, while in the UK, Trisha Greenhalgh and Brian Hurwitz’s Narrative Based Medicine (1998) helped to initiate this approach. Like Arthur Frank’s The Wounded Storyteller (1995), narrative medicine’s emphasis on the patient’s subjective experience as a mode through which to make sense of illness was very influential to the concerns of first wave medical humanities: namely, the shifting of authority from a narrow biomedical purview to the patient’s lived experience. Indeed, the literary genre of ‘pathograpy’ (illness memoir) long preceded the establishment of the medical humanities, with famous examples including Virginia Woolf’s On Being Ill (1925) and Audre Lorde’s The Cancer Journals (1980).
While Charon and Frank’s emphasis on narrative storytelling in both the clinician’s practice and the patient’s healing has played an important role in these first wave approaches, it has been criticised on two fronts. Firstly, it erroneously assumes that the ‘literary’ and ‘narrative’ are synonymous. Clark frames and contains illness as a linear journey from ‘chaos to quest’, from ‘mystery’ to ‘mastery’ (Bates and Goodman 2014). But very often, a patient’s experience of illness resists and exceeds the capacities of this sort of pre-assumed ‘metanarrative’ and requires other mediums of expression and forms of sense-making (Woods 2013). Secondly, it assumes that the ‘literary’ component is only an ‘additive’ to what medicine already does (Evans and Greaves 1999). The ‘literary perspective’ is injected into pre-established medicine, rather than changing or challenging the modes in which medicine as a discourse and a cultural institution operates in any foundational way (Whitehead 2013). This is where the ‘critical’ aspect of the second wave medical humanities enters our discussion.
The critical, the speculative, and the ‘second wave’ of medical humanities
In the manifold history of human thought, the notion of a taxonomical and bounded ‘discipline’ only emerged in the nineteenth century (Squier 1999). The critical medical humanities challenges thinking along disciplinary lines: it exposes the historicity and provisionality of the concept of a bounded ‘territory of knowledge’, and uses the ‘disruptive rebellion’ of critique to challenge some of the assumptions masked beneath the ‘neutrality’ and ‘objectivity’ of medical science (Viney, Callard and Woods 2015). As Susan Squier puts it, there is ‘nothing inherently literary or scientific, only what disciplinarity makes so’ (Squier 1999). So, if we can do away with the problematic framing of ‘literature’ and ‘science’ as binary opposites, in what ways can the ‘literary’ and ‘scientific’ interrelate and provoke one another?
One assumption that the critical medical humanities challenges is that of a ‘materialist’ medical science and a ‘discursive’ or ‘socially constructed’ literature. This distinction obscures the discursive mediums through which medical knowledge gets communicated as textual representations that can be analysed through literary methodologies (Squier 1999; Waugh 1997). From the other side, this distinction obscures the inescapable materiality of discourse, for the material world has a shaping effect on the literary as well as the scientific. There has been a ‘material turn’ in literary studies, with philosophers like Karen Barad calling on us to rethink certain concepts, such as the distinction between ‘objective’ and ‘subjective’, and ‘matter’ and ‘meaning’, in light of discoveries in 20th Century physics (Barad 2007).
The science of an era spills into and influences its literature, but what value might the imaginative space of literature contribute to science and medicine beyond the classic, dismissive answer of inflecting science with some ‘humanity’ or making it more accessible to the general public? Works of fiction do more than simply mirror and reproduce scientific knowledge. They open up an intermediary space through which to reflect on, question, ironise, juxtapose and re-imagine, through techniques like ‘cognitive estrangement’ (Suvin 1979). Authors like China Miévelle, Octavia Butler and Ursula Le Guin demonstrate how the themes and techniques of ‘fantasy’ can challenge the status quo. Meanwhile, Margaret Atwood’s ‘speculative fiction’ is by no means separate from the ‘real’ world. For Atwood, ‘speculative’ is ‘when you have all the materials to actually do it’ (Case and MacDonald 2003). Her dystopic novel The Handmaid’s Tale (1985) only used events that have occurred in human history.
Neither ‘literature’ nor ‘medicine’ operates in a vacuum. At this time when Atwood’s MaddAdam Trilogy seems to be becoming more of a living reality through the multiple, interrelated health and environmental crises we face, we require the widest possible ways of sharing and improving knowledge about all levels of human and planetary health. The imaginative, reflective and analytical skills of the literary are a vital component of multidisciplinary approaches, and as author Alexis Wright warns, we do without these skills at our peril.
Barad, Karen. 2007. Meeting the Universe Halfway. Durham: Duke University Press.
Bates, Victoria, and Goodman, Sam. 2014. ‘Critical Conversations: Establishing Dialogue in the Medical Humanities’. In Victoria Bates, Alan Bleakley and Sam Goodman (eds), Medicine, Health and the Arts: Approaches to the Medical Humanities. Abingdon: Routledge: 3-13.
Bleakley, Alan. 2014. ‘Towards a Critical Medical Humanities’. In Medicine, Health and the Arts: 17-26.
Case, Eleanor, and Macdonald, Maggie. 2003. ‘Life After Man’. In New Scientist. https://zephr.newscientist.com/article/mg17823935-000-life-after-man/
Charon, Rita. 2000. ‘Literature and Medicine: Origins and Destinies’. In Academic Medicine, 75: 23-27.
Charon, Rita. 2006. Narrative Medicine: Honoring the Stories of Illness. Oxford and New York: Oxford University Press.
Evans, Maryn, and Greaves, David. 1999. ‘Exploring the Medical Humanities’. British Medical Journal 319: 1216.
Greenhalgh, Trisha and Hurwitz, Brian (eds). 1998. Narrative Based Medicine: Dialogue and Discourse in Clinical Practice. London: BMJ Press.
Levine, George (ed). 1987. One Culture: Essays in Science and Literature. Madison, Wisconsin: University of Wisconsin Press.
Lorde, Audre. 2020. The Cancer Journals. London: Penguin Books Limited.
Montgomery Hunter, Kathryn. 1991. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University Press.
Suvin, Darko. 1979. Metamorphoses of Science Fiction: On the Poetics and History of a Literary Genre. New Haven, Connecticut: Yale University Press.
Squier, Susan. 1999. ‘From Omega to Mr. Adam: The Importance of Literature for Feminist Science Studies’. In Science, Technology, & Human Values 24: 132-158.
Viney, William, Felicity Callard, and Angela Woods. 2015. ‘Critical Medical Humanities: Embracing Entanglement, Taking Risks’. In Medical Humanities 41 (1): 2–7.
Waugh, Patricia. 1997. ‘The New Prometheans: Literature, Criticism, and Science in the Modern and Postmodern Condition’. In European Journal of English Studies 1: 139-164.
Whitehead, Anne, and Angela Woods. 2016. ‘Introduction’. In The Edinburgh Companion to the Critical Medical Humanities. Edinburgh: Edinburgh University Press: 1-31.
Whitehead, Anne. 2014. ‘The Medical Humanities: A Literary Perspective’. In Medicine, Health and the Arts: 107-127.
Woods, Angela. 2011. ‘The Limits of Narrative: Provocations for the Medical Humanities’. In Medical Humanities 37: 73-78.
Woolf, Virginia. 1947. ‘On Being Ill’. In The Moment and Other Essays. http://www.gutenberg.net.au/ebooks15/1500221h.html#ch3
About the author
Blaise Sales is a second-year PhD student at the University of Leeds. Her PhD explores the relationship between recent models of embodied cognition and ecocritical thought in contemporary novels. Before this, she completed an MA in Medical History and Humanities at the University of York, and a BA in English at King’s College London. She is available to contact at firstname.lastname@example.org or on Twitter @blaise_sales.