Les humanités médicales françaises: input, debates and challenges

Claire Jeantils discusses the medical humanities in France and highlights what the French epistemological and pedagogical traditions might bring to the field.

Whether we think of the medical humanities as a field of research, an interdisciplinary approach, or a discipline; or whether we say: “medical humanities”, “critical medical humanities” or “health humanities”, it is a hot topic. We don’t all agree on the angle we should choose to tackle matters of care and health and this is part of why the field is so vibrant, dynamic and critical. But, in French academic institutions, the field is sometimes perceived as risky and unstable, which explains why there is still some institutional reluctance to help it grow. However, over the past 10 years, the medical humanities have been receiving more attention thanks to the engagement of individual researchers, networks and labs.

Historically, medical humanities represented what was taught in medical school that was not part of the biomedical curriculum. Approaching the medical humanities from this angle helps us understand the current state of the field in France, as it developed and still, today, evolves differently from anglophone countries.

In the US, humanities were first introduced into medical curricula at the beginning of the 20th century. In France, humanities and social sciences arrived in medical school in the 1990s. At the beginning, only doctors were in charge of teaching these “new” disciplines, but as the disciplines evolved and found a stronger footing in universities, scholars from these backgrounds entered medical schools with greater legitimacy. Recently, as research in the UK is turning more and more towards the critical medical humanities, France is looking in the direction of the health humanities (humanités en santé). This direction translates, first, into impacting medicine and healthcare access.

The main debates about medical humanities in France

The position of the medical humanities in France is cause for debate. There are, on one hand, scholars and researchers who aim at transforming medical training and intervening in the clinical realm and, on the other hand, scholars who are afraid that the humanities and social sciences will be subordinated to medicine. For the former, multidisciplinarity will help put into words complex questions about care and health, while also impacting the way medical professionals address these questions on a day-to-day basis. Changing how healthcare professionals perceive and practice medicine will be the root of a wider change, because doctors have an important epistemic role in society. Thus, formulating issues in this way will help de-center society’s medicalized gaze on topics of health, illness, and care.

For the latter, there is a risk that the humanities would simply end up subordinated to medicine, that they would be considered “useful” to humanize the practice of medicine. Indeed, the humanities are more and more threatened by financial concerns and some Liberal Arts colleges in the US have even introduced healthcare courses to attract additional funding. French scholars warn that we risk losing the very nature of research in the humanities if we approach it with a neo-liberal logic of production. Of course, we could argue that these scholars are simply afraid of change. But I also think that this is a political concern and that it is deeply cultural. Thus, discarding it would be risky for the medical humanities if they want a better footing in France.

The second debate is about the disciplinary legitimacy of the medical humanities. Some worry about the lack of a specific methodology. Indeed, in France, there is a rich epistemological tradition; however, this tradition remains so powerful that it sometimes slows down certain research initiatives. Thus, the French medical humanities are facing an important challenge: bringing some epistemological input to the medical humanities without getting bogged down in it. Here, the influence of the philosophy of medicine in France is central to understanding how the field is strengthening its position. Some researchers (e.g. Marie Gaille, Agathe Camus) are also bridging the gap thanks to “field philosophy”, by intervening on practical issues faced by the general public.

The main French approach to the medical humanities

Credit: Université Paris Saclay

The work of the French philosopher Georges Canguilhem (1904-1995) is one of the main influences in medical humanities in France and abroad. He helped explain why medicine needs to be approached in an interdisciplinary way. He perceived medicine as “a technique or an art at the crossroads of several sciences” (1966 (2013), 8) because healthcare professionals are interacting with individuals who have values that are not reducible to biomedicine and the objective sciences that medicine uses. Thus, scholars in the humanities have long been convinced that medicine and care would have to be approached in an interdisciplinary way in order to be ethical and efficient.  Therefore, the issue with the medical humanities in France is not so much about the definition of medicine but, rather, the role of the humanities and social sciences in it, as well as their capacity to interact ethically. For Céline Lefève, interdisciplinarity cannot be avoided because it helps to address all the issues and topics that constitute the continuum of medicine (Plagnol 2021).

The main difference between the critical medical humanities, as they are understood in anglophone contexts, and the French perspective is that the critical medical humanities “are not primarily concerned with clinical issues and do not specifically aim to become part of the medical training, but rather to de-centre themselves from medical expertise, categories and expectations” (Lefève 2021, 20-21). In France, more and more medical humanities researchers warn of the risk of the disconnection of the critical medical humanities from its research object, arguing that the first step to changing medicine is in its training and practice. Thus, they work toward transforming both the humanities and medicine. De-centering the medicalized gaze should not mean turning away from medical education, however. The academy is a space that is able to reframe knowledge in the humanities as well as in medicine. Being afraid that the medical humanities would be absorbed by or subordinated to biomedicine and the so-called “hard sciences” proves that we tend to forget the critical and ethical essence of the work we do as scholars and researchers in the medical humanities.

Research and teaching initiatives

Educational and research initiatives are multiplying in France. Since 2008, The Collège des Humanités Médicales (COLHUM) has brought together humanities and social sciences scholars and teachers who work in health. In 2016, it officially turned its focus towards the medical humanities, in order to promote the field and its teaching methods to public bodies.

The CNRS (National Scientific Research Center) funded an international research network in medical humanities as well as PhD research in 2019, when, at the time of writing this article, it is still not possible to graduate with a PhD in medical humanities in France. This implies that any student in France wanting to specialize their doctoral research in medical humanities needs to work through another discipline, such as literature, history or philosophy. In 2020, the Sorbonne (a prestigious, French university) created an MA in medical humanities, open to students coming from the humanities. L’École Normale Supérieure (another prestigious, French institution) compliments that course by offering a three-year “medicine-humanities” program to medical students who would like to deepen their understanding of what the humanities can bring to care and health. This program offers the opportunity to specialize in one of the humanities’ fields, with a MA thesis written with a medical humanities approach.

In 2020, the book Humanités médicales, l’engagement des sciences humaines et sociales en médecine (Medical Humanities: The Commitment of Human and Social Sciences to Medicine) was published by Céline Lefève, François Thoreau and Alexis Zimmer. This was the first major book in French about medical humanities. It analyses medical knowledge and practices and tries to understand the values and methods of the field. In doing so, it shows that research in the medical humanities helps transform medicine. The authors formulate three main suggestions to navigate the characteristic “entanglement” of the medical humanities (Viney et al. 2015; Fitzgerald and Callard 2016):

  • “Grasping the power relationships intrinsic to biomedical knowledge, technologies and practices”; inspired by the French philosopher Michel Foucault (1926-1984). This suggests that to grasp biomedical knowledge, the medical humanities have to “question the historical, social and environmental conditions and consequences of a produced and situated objectivity” (12).
  • “Taking things ‘from the middle’”; acknowledging that any type of vulnerability does not exist in a vacuum and is linked to a political, economic, social, and epistemological context (14).
  • “Telling and watching other stories”; similarly, here the authors suggest telling stories differently for more diverse representations of the illness experience (16).

The year 2023 has seen yet more new initiatives. A 20-hour MOOC on health humanities in French has been launched, gathering 60 speakers, professors and researchers to help populize this field of research. Likewise, the first issue of a new health humanities journal, Soin, sens et santé, should be published in Autumn 2023. This will be the first international journal led by a French team, publishing open access, with articles in French and in English.

What France has to offer to the medical humanities

France has a lot to offer to the medical humanities, not only because of its strong epistemological tradition. I would argue that we have more pedagogical foundation for interdisciplinarity than we tend to believe, especially in the way we teach the humanities. While France is not particularly known for interdisciplinary research, its education system provides opportunities to connect knowledge in the humanities with different disciplines. For example, in high school, literature is used and taught in philosophy class to illustrate ethical issues and philosophy is taught in the literature curriculum to better understand literary history. And this is even more true at university.

But, more importantly, France now has the opportunity to be part of a francophone medical humanities, as the field is developing more and more in French-speaking countries. This will be necessary to create an adapted cultural vocabulary to think through care, health and medicine outside of the anglophone framework. In doing so, French researchers will have to face the country’s colonial past and its links with the history of medicine, as well as its consequences on today’s healthcare disparities.

The future of the medical humanities in France might not (yet) be as clear as it appears to be in anglophone contexts like United Kingdom, but the number of ongoing initiatives and lively debates show its promise. The challenge now, as Claire Crignon (2023, 100) puts it, is to “make ‘medical humanities’ more than a buzzword and interdisciplinarity more than a pious injunction.”

About the author

Claire Jeantils is a PhD student in medical humanities and contemporary literature at the Sorbonne Nouvelle (Université Paris 3). She researches French and anglophone epilepsy narratives. You can find her on Twitter @ClaireJeantils.

References

Canguilhem, George. 1966 (2013). Le Normal et le Pathologique. Paris: Presses Universitaires de France.

Crignon, Claire. 2023. “Les humanités en santé.” Médecine/Sciences 39 (2): 99-100. https://doi.org/10.1051/medsci/2023023.

Fitzgerald, Des, and Felicity Callard. 2016. “Entangling the Medical Humanities.” In The Edinburgh Companion to the Critical Medical Humanities, edited by Anne Whitehead and Angela Woods, 35–49. Edinburgh: Edinburgh University Press.

Lefève, Céline, François Thoreau, and Alexis Zimmer. 2020. Humanités médicales, l’engagement des sciences humaines et sociales en médecine. Paris: Doin Editions.

Plagnol, Arnaud. 2021. “Entretien avec Céline Lefève.” PSN 19 (1): 15-29.

Viney, William, Felicity Callard, and Angela Woods. 2015. “Critical Medical Humanities: Embracing Entanglement, Taking Risks.” Medical Humanities 41 (1):2-7. http://dx.doi.org/10.1136/medhum-2015-010692.

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