Manifesto for a Multilingual Medical Humanities

Steven Wilson reflects on the importance of linguistic sensitivity in the medical humanities.

The last ten years have witnessed extensive reflection and debate on the central preoccupations and methods of the medical humanities, testifying to the critical ambition and buoyancy of the field. In a special issue of Medical Humanities, William Viney, Felicity Callard and Angela Woods (2015, 2) argued for a critical medical humanities exemplified, among other factors, by paying “greater attention not simply to the context and experience of health and illness, but to their constitution at multiple levels”. Anne Whitehead and Angela Woods (2016, 8) subsequently characterised approaches in what is often referred to as “second wave” medical humanities as the “mobility, fluidity, movement” that allow for a type of “creative boundary-crossing” through which new representations and understandings can emerge.

This reference to “boundary-crossing” recalls the metaphor famously used by Susan Sontag to express one of the transcending concerns of the medical humanities: what it means to be ill. “Everyone who is born holds dual citizenship”, writes Sontag (1991, 3), “in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” If the (lived) experience of illness is to be understood as one of boundary-crossing, into culturally unfamiliar and bewildering terrain, what cultural codes – or vocabularies – are needed to articulate and translate that experience, so that it might be shared? How might such articulations be understood in the absence of commonly understood reference points? And how might an embrace of alterity – of the foreign – expand, enhance and perhaps even challenge representational orthodoxies in the medical humanities more broadly?

“Boundary-crossing” is, self-evidently, a methodological concern; yet, as Peter Koehn (2020) reminds us in his book on the interaction of political, economic, social, cultural and climatic forces in global healthcare, the dynamic intersections of human movement that characterise the contemporary world have reoriented attention onto the medical implications of (geo)political and societal border crossings. In multicultural settings, whether they be cities made up of large diasporic populations; centres for migrants, refugees and asylum seekers; or immigrant communities which include people who become displaced because of climate change or war, there is an ethical imperative to ensure culturally-sensitive medical practice and care. Indeed, such an ethical imperative is likely to lead to more effective communication and better healthcare outcomes. But beyond practice-based medicine, or even medical education, the medical humanities have much to gain from engagement with forms of cultural diversity that bring us into contact with what Sontag termed “that other place”.

A journey towards otherness is one in which we are confronted with a rich cultural diversity of values and experiences. Such a process necessarily implies an encounter with unfamiliar spaces and places; yet it also has the potential to take us towards a deeper moment of encounter in which we bear witness to, appreciate and attempt to understand the perspectives of other people whose cultural norms and political realities, encoded linguistically, differ from our own. To head towards and subsequently enter into “that other place”, not only with curiosity, but with a genuine desire to learn, even to empathise, is to embody some of the underpinning values of care.

As Rachelle Arkles (2016, 81) has noted, as a non-Indigenous researcher engaged in a study of the care offered to an Aboriginal person, “‘Entering-into-experience’ is entering into a specific form of embodied awareness as a resource for knowing the world”, which in turn leads to forms of sense-making that validate the experience of others. Yet the reverse also applies, for to “enter into experience” equally heightens our sensitivity to the need for linguistic hospitality when others make the journey to “our place”, so that we create meaningful spaces of relationship, connection and, in its most literal sense, conviviality. At the “boundary-crossing” at which we “enter into experience”, it is crucial that linguistic difference does not operate as a barrier to participation, but serves instead as a gateway into critical reflection and cultural understanding.

Reflecting on the 2018 Oslo Cultural Crossings of Care conference, which was also intended to discuss health humanities “across boundaries”, Brandy Schillace (2018) noted that representation at that event was “largely Eurocentric (or US and Eurocentric)” and that “so much of what we accept in academic journals relies on standards that privilege white and Western ideals”. As the Editors of the Edinburgh Companion to the Critical Medical Humanities (2016, 2) also acknowledged, there has traditionally been an “implied or assumed generality of a UK or US mainstream” in the medical humanities. Recent years have nonetheless seen significant progress towards a more global, culturally-rich medical humanities. As Editor-in-Chief of Medical Humanities, Schillace pledged to begin “an ever-broadening emphasis on
Global Outreach”:

Given our present moment, with crises of health brought about by climate change, political upheaval, social injustice, and the straining of public health systems, we must seek international and cross-cultural dialogue. Global problems need global communication and an understanding that those most likely to be affected by crisis – those most vulnerable to the exigencies of system failure – are also the least likely to be heard.

A special issue of the same journal in 2022 was entitled “Global Health Humanities” and spanned contexts from the Dominican Republic to Africa, and India to Iran. In their editorial to the special issue, guest-editors Narin Hassan and Jessica Howell frame the global health humanities with reference to cultural context, and in particular the historical legacy of colonialism in global health interventions, thus building on the work of Eugene T. Richardson in Epidemic Illusions: On the Coloniality of Public Health (2020).

Hassan and Jowell (2022, 133) stated that the advent of the pandemic necessitated “a critical re-evaluation of the basic tenets of Global Health Humanities as a developing field”, as “daily news and information around issues of health, contagion and global interconnectedness have asked us to shift and rethink the very questions that need to be posed.” Yet responses to the COVID-19 pandemic have drawn renewed attention to an issue that remains endemic in the medical humanities, even after its shift to a more global framework. While the critical centre of gravity of the field has rightly tilted away from the Anglosphere in recent years, anglophone-based sources and scholarship remain dominant, even though the native language of over three quarters of the world’s population is not English.

Given the axiomatic links between language and culture, a more multilingual medical humanities would incontrovertibly lead to a more comprehensive encounter with the voices and perspectives of diverse global populations. This is all the more important given the genesis of the medical humanities as an endeavour to recalibrate the role of subjective experience in medical epistemology and clinical practices. If English remains the language of science and of medicine, as its sub-discipline (Gordin 2015), the medical humanities have a particular responsibility to ensure that the codes, contexts and values that underlie different facets and articulations of medical experience and concerns do not become constrained by assumptions and perspectives grounded in cultural, and therefore linguistic, uniformity.

During the pandemic, 85% of scientific articles on COVID-19 were published in English-language journals (Taskin et al. 2020). Such linguistic dominance can be pervasive, especially in a pandemic context where a central body such as the World Health Organisation is seeking to coordinate a public health response. As a result, NGOs including Translators without Borders and the Health Information Translations collaboration had to develop initiatives to bridge the linguistic divide in science in a context where “most of the world’s population – some six billion people – [have] little or no access to a large body of public health information because it is in English” (Adams and Fleck 2015, 365).

A recent British Academy-funded project which I co-led investigated the languages (plural) of COVID-19, in order to consider the importance of linguistic sensitivity, (inter)cultural knowledge and translational mediation in the frontline response to the pandemic. Bringing together scholars and practitioners from translation and interpreting studies, modern languages, linguistics, cultural studies, Deaf studies, literary studies, intercultural communication, journalism and the medical humanities, the resulting open access book and policy paper demonstrated that the COVID-19 pandemic was inextricably associated with questions of linguacultural identification, and that linguistically constrained responses led to a lack of inclusion, access and trust among local communities. The convergence of expertise in medical humanities, translation and multilingualism in the project allowed for genuine interdisciplinarity and a more transnational, holistic response to a global health crisis. By challenging linguistic normativity, it not only underlined the importance of effective interpreting and translation in navigating the multilingual world, but taught us many of the lessons to be learned from stepping into an engagement with differences in articulations of and responses to the pandemic in varying national contexts.

More generally, sustained engagement in multilingual literary, philosophical, artistic and testimonial contexts has the potential to draw international cultures, histories, experiences and, crucially, voices, into ongoing scholarship, resulting in a more pluralistic, polysemic medical humanities.[1] By analysing what new facets or understandings of human experiences of medicine might be revealed by a linguistic, cultural and translational encounter with the native tongues of the world’s majority non-anglophone population, we hold open the tantalising possibility of more comparative work in the medical humanities, in which “the other place” – going back to Sontag – is not situated in binary opposition to anglophone perspectives and scholarship, but becomes productively “entangled” with it. To put it another way, the medical humanities might find significant traction in paying close(r) attention to those places and spaces – those border-crossings – where cultures and peoples meet, and where translational encounters give access to other outlooks.

As we continue to reflect this year on where the field is going, a commitment to multilingualism in the medical humanities holds the promise of expanding the horizons of influence that frame much of our work, further diversifying the perspectives that are included. In that vein, there will be a series of articles following this one, which will each reflect on the current foci of medical humanities research in various non-anglophone contexts. The Polyphony, with its explicit aim of bringing together different voices, seems the ideal place to begin a critical conversation about our commitment to, and what we can learn from, a multilingual medical humanities

Notes

[1] See, for example, the 2022 special issue on “Languages and Cultures of Pain” in the Journal of Romance Studies: Contents | Journal of Romance Studies 22, 4 (liverpooluniversitypress.co.uk).

Acknowledgements

I am grateful to Marta Arnaldi for the many conversations we have had in recent years, and which have encouraged me to think more deeply about the ethical imperatives for approaching translation as an act of care.

About the author

Steven Wilson is Senior Lecturer in the School of Arts, English and Languages at Queen’s University Belfast. His research is situated at the interface of French Studies and the Global Medical Humanities. It explores the ways in which modern French literature and thought, from the nineteenth century to the present, contribute to cultural understandings of disease, illness, pain, medical practice and dying/death. He collaborates in a wide range of national and international scholarly networks, has led multidisciplinary research projects across languages, cultures and societies, and is committed to public engagement on the importance of multilingualism and intercultural knowledge in global healthcare, including through policy work. He is on twitter @DrStevenWilson.

References

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