The Challenges of Bilingual Health Humanities in Canada

Benjamin Gagnon Chainey highlights the current lag between the anglophone and francophone health humanities in Canada, and asks how to explain the fact that none of the seventeen existing health humanities teaching programs are French-speaking.

A common refrain is that excessive reliance on technology and overspecialization dehumanize health systems, and Canada is no exception (Guillaumie et al. 2022). As a response, Canadian universities increasingly integrate courses in the humanities, arts, and literature into their medical curricula, a strategy that hopes “(i) to encourage curiosity about the human condition and healthy skepticism about the nature of medical ‘truth’ and (ii) to model acceptable moral behaviour” (Kidd and Connor 2008, 51), even at the risk of contradicting medical schools’ authoritative, “evidence-based” discourse. Although precise figures do not exist for Canada, in its direct neighbor, the USA, health humanities programs have grown by 266% since the beginning of the 2000s (Klugman 2017), and the figure is possibly even higher when we include related fields, such as narrative medicine.

North of the border, the Canadian Association for Health Humanities (CAHH) lists on its website no less than seventeen health humanities academic programs across the country. However, none of these programs is French-speaking, or hosted in a French-speaking university. In francophone Canada, the study of the relationships between the humanities and health issues is much less established than in the United States, anglophone Canada and Europe – there are fewer researchers, and their work is less institutionalized. In fact, although Quebec boasts three French-speaking medical schools, none of them systematically integrates the humanities into its curriculum.

In a 2023 statement, the Université de Montréal was the first French-speaking Canadian university to announce a greater, and more “official,” place for health humanities in its medical program. The article in the university’s official online newspaper revealed how Quebecois institutions view the health humanities: in contrast to the subversive aim of anglophone Canadian programs, the program at the Université de Montréal seeks to “infuse a good dose of humanism into medical training by giving it an emotional, reflective and social dimension” (Tremblay 2023, my translation). While that article described the university’s proposed program as a “new” approach to medical education, its integration of the humanities into healthcare education would at best allow the university to catch up with its counterparts elsewhere in the Western world, which have been actively promoting the humanities within their medical courses since the early 1990s.

Université Laval, another French-speaking university located in Quebec City, is host to the Canada Research Chair (CRC) in “Medical Humanities and History of Biological Thought.” While the medical humanities typically confront medical knowledge and education with the arts, literature, and social sciences (Shapiro et al. 2009), this chair focuses on the philosophy of medicine, ethics, and the history of life sciences, taking inspiration from the mid-20th century French physician and philosopher Georges Canguilhem, whose famous opus The Normal and the Pathological ([1943] 1989) has challenged definitions of health and illness. While Université Laval’s chair, as the only French-language chair in medical humanities in the country, complements health research with philosophical, ethical, and historical approaches, it is not part of a structured, interdisciplinary undergraduate or graduate health humanities program. That means that while students can, of course, take part in interdisciplinary research projects in health humanities, no degree-granting training is currently offered.

The two examples above constitute the bulk of efforts in researching and teaching the health humanities at universities in the Province of Quebec. The discipline thus remains weakly institutionalized. There are certainly many isolated academic projects exploring the intersection of the humanities and health; however, the umbrella of “health humanities,” which could unite and coordinate them, has not yet taken root in francophone institutions.


Image credit: Laurent Bélanger. Reproduced with permission.


Explaining this delay in francophone Canada

Even if the health humanities seem to align with the strategic plans of French-speaking Canadian universities, which all put “health” among their priorities, none of them has taken the initiative to offer students – especially in a context where enrollments in French-language literature, among other humanities programs, are in free fall [1] – transdisciplinary pathways between humanities, arts, literature and health, preferring to retain the traditional disciplinary silos of existing university programs. Some hypotheses, based on personal experience and cultural observations, can be put forward to explain the situation, although they necessarily overlook the innumerable financial and political issues that dictate the development of university programs in the country. These include bilingualism (including the scarcity of French-language texts for teaching), the place given to Indigenous peoples, and regional disparities (as education is devolved to each province).

In fact, the very term “humanities” does not exist, as such, in French-speaking Canada. It is an Anglo-Saxon notion, to which Francophones prefer that of “sciences humaines” (human sciences), which tends to exclude literature and the arts. In that sense, even if “interdisciplinarity” is a buzz word when writing research grants, French-Canadian literary scholars tend to be suspicious of it, perhaps precisely because they perceive it as a fashionable requirement of funding bodies, rather than a quality of all research aspiring to analyze a problem holistically. While interdisciplinarity would certainly expand each field’s analytical apparatus, literature, my home discipline, distrusts what it perceives as an imposition on and an interference with classical literary research. Some scholars fear that literature will lose its identity if it is melded with another discipline, especially if that discipline is as dominant – academically, economically, socially – as medicine and the health sciences.

This French-Canadian problem resonates with the situation in France, where, as Claire Jeantils (2023, n.p.) notes, although “the humanities are more and more threatened by financial concerns,” many “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.” I think, here, that we wrongly attribute this “neo-liberal logic of production” to the health humanities, because we mistake its efforts to improve healthcare provision for a desire to optimize behavior; indeed, such intervention departs from the humanities’ tradition of analysis and critique. Yet we can think of the health humanities as a Trojan horse that allows new disciplines to integrate – and change for the better? – systems that fail to center their mission on human beings. Arts and literature can become vehicles of social change when they are also considered by the people that they critique, and when they open themselves to voices other than the unanimously progressist chorus that dominates French Canadian humanities.

For that reason, before asking why the humanities and the health sciences cannot come together to establish health humanities programs, French-language universities must deal with the lack of transdisciplinary collaboration within the humanities themselves. The distrust towards transdisciplinarity is perhaps attributable to the fact that, while undergraduate studies in English-speaking North America usually combine a major and a minor subject, thereby exposing students to two disciplines, French-language undergraduate studies typically concentrate on a single discipline. There are bi-disciplinary programs, but these remain the exception and only combine neighboring disciplines (such as math and physics, or literature and philosophy, at the Université de Montréal).

Even then, these bi-disciplinary programs essentially consist of students taking courses in each of the two disciplines in parallel, with little opportunity to confront the assumptions of each. Thus, French-speaking humanities, arts, and literature departments need to ask themselves whether they are ready to put in tension and merge together forms of knowledge. If physicians hesitate to bring literature and the arts into their faculties, the opposite is also true: literary scholars are reluctant to risk building bridges with the health sciences. Therefore, echoing Jeantils’ understanding of the medical humanities’ issue in France, the concern with the development of the field in French-speaking Canada would not so much be “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.” (Jeantils 2023, n.p.)

A second avenue of explanation for French-language universities’ delay in adopting the health humanities lies in the critical tradition, which English-language programs incorporate into all aspects of research and education. Francophone Canada has a strong “critical” tradition, stemming from Marx and the Frankfurt School, or from Foucault, Derrida, and contemporary French theory. That said, the reflexive formulation of that critique towards each of the disciplines – i.e., reflecting on its own assumptions and premises – is considered a specific goal, distinct from the creation of knowledge regarding the discipline’s object. In other words, critical research is its own silo, rather than being incorporated into all facets of research. As an alternative, instead of considering the health humanities as a threat to their discipline, literary scholars (to take an example) could consider dialogue with different disciplines as a critical opportunity to highlight literature’s specific ability to subvert the assumptions of other forms of knowledge.

This reversal of perspective – from threat to opportunity – would address the perceived danger of having one discipline – medicine and health sciences – defining the criteria by which other disciplines – literature, arts, and the humanities – are to be evaluated. Indeed, medicine has a curative aim, which is not that of literature or the arts. Researchers in the latter disciplines may therefore be concerned to see their work reduced to a form of “art therapy” if they were to collaborate with colleagues from medical schools. Even well-meaning attempts to legitimate such collaboration – “Wouldn’t it be nice if it could be proven that literature and the arts can heal people?” – imply that these disciplines should be “useful” and are worrying when usefulness is not defined by the disciplines’ own protagonists.

In establishing interdisciplinary collaboration, francophone researchers could take inspiration from anglophone Canada, where the interest in a critical and comparative perspective, by researchers from all disciplines, allows them to appreciate the contribution of another discipline, even if it calls into question some of their premises, or even their purposes. The aim is not to reinforce the disciplines in their epistemological presuppositions, but to disturb their fixed systems, to deconstruct their disciplinary assumptions.

Possible solutions for French-speaking Canadian universities

For French-speaking Canadian universities to embrace the health humanities, they will need to open themselves to more daring transdisciplinary tensions. They would benefit from exploring transdisciplinary routes structured around socio-cultural and medical issues (the experience of illness, pain or bereavement, the question of consent, the role of caregivers, etc.), rather than limiting themselves to strict disciplinary divisions. This approach would make it possible to create programs that concretely integrate human and community experiences.

In addition, it would be important to further promote critical research and creation, integrating such critical thinking into all research processes. As well as revealing power relations in society, such an approach would upturn the assumptions that are at the very heart of our scientific, artistic, and literary activities, while imaginatively and creatively formulating solutions to the complaint that “the health system lacks humanity.”

The “usefulness” of health humanities, therefore, would not consist in embracing the curative objectives of medicine, but in offering an alternative and creative look at the experience of illness, at the relationships of care and at the place of biomedical knowledge in society. Such a shift in focus does not deny the importance of medical schools’ research and teaching, but extends them so that they can reach out to areas that they cannot always access: those of intimate experience, of the family, of the community, etc. Conversely, the health humanities allow the humanistic, social, literary, and artistic disciplines to enter in a relationship with the health sciences – which they already critique – while defining for themselves the objectives they wish to achieve from this new relationship, rather than accepting those proposed to them by the medical profession.

As French-speaking universities in Canada establish health humanities programs over the next few years, they can attempt to turn some of the weaknesses this article has identified into strengths, which will contribute to their own, original way of approaching the health humanities and of structuring their programs. In addition to drawing from a different set of authors and from different artistic and literary traditions, Canada’s French-language universities can also ask themselves how their traditional attachment to disciplinary boundaries, or their consideration of critique as a distinct academic endeavor, may play a part in asking new questions or approaching new empirical situations when setting up their first academic programs in health humanities.

Notes

[1] For example, according to the Quebec Office of Interuniversity Cooperation, the number of newly registered students in French language literature at Université de Montréal has fallen by 50%, from 2018 to 2022. At Université de Sherbrooke, there has been a fall of 40% and at Université du Québec à Montréal (UQAM), a fall of 37%. Data was provided to the author at his request.


About the author

Benjamin Gagnon Chainey is an author and a physiotherapist practicing at the Université de Montréal Hospital Center (CHUM), who completed a PhD in French-language literature in 2022 (jointly at Université de Montréal and Nottingham Trent University, UK). He is also a postdoctoral fellow at Dalhousie University medical humanities HEALS program, in Halifax, Canada, and the current Communications Officer of the Canadian Association for Health Humanities (CAHH).


References

Canguilhem, Georges. (1943) 1989. The Normal and the Pathological. New York: Zone Books.

Foucault, Michel. 1965. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Pantheon Books.

Guillaumie, Laurence, Olivier Boiral, Valérie Desgroseilliers, Nicolas Vonarx, and Bernard Roy. 2022. “Empowering Nurses to Provide Humanized Care in Canadian Hospital Care Units: A Qualitative Study.” Holistic Nursing Practice 36 (5): 311–26. https://doi.org/10.1097/HNP.0000000000000418.

Kidd, M. G., and J. T. H. Connor. 2008. “Striving to Do Good Things: Teaching Humanities in Canadian Medical Schools.” Journal of Medical Humanities 29 (1): 45–54. https://doi.org/10.1007/s10912-007-9049-6.

Klugman, Craig M. 2017. “How Health Humanities Will Save the Life of the Humanities.” Journal of Medical Humanities 38 (4): 419–30. https://doi.org/10.1007/s10912-017-9453-5.

Shapiro, Johanna, Jack Coulehan, Delese Wear, and Martha Montello. 2009. “Medical Humanities and Their Discontents: Definitions, Critiques, and Implications.” Academic Medicine 84 (2): 192. https://doi.org/10.1097/ACM.0b013e3181938bca.

Tremblay, Mylène. 2023. “Les humanités en santé: d’Hippocrate à 2024.” UdeMNouvelles, October 23, 2023. https://nouvelles.umontreal.ca/article/2023/10/24/les-humanites-en-sante-d-hippocrate-a-2024/.

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