What is a medical humanities project?

William Viney examines the projectification of academic research and argues for critical responses to the normalisation of casualised work cultures in medical humanities funding schemes

My career has been ‘fixed-term’ and privileged. Academia has never offered me enduring employment but I have found project work in abundance. Over time I have grown sensitive to the rhythm of projects, how they start and often fail to end cleanly. Project leftovers make me rethink the dominance of the ‘project form’ or ‘project genre’ in the medical humanities, and what the consequences of understanding experiences of health and disease might be when our work is carried out on a fixed-term basis. Though I find projects everywhere in medical humanities research, and they are often used as exemplary case studies for how to do the medical and health humanities, the technical influence of projects continues to go undocumented and under-theorised.

I think critical attention to how the project shapes a more critical medical humanities is important, since the critical medical humanities was partly launched and sustained via the celebration of interdisciplinary and collaborative projects (see Woods and Whitehead 2016; Fitzgerald and Callard 2016; Macnaughton 2023; Fernyhough 2024). As the medical humanities has developed research agendas independent from medical education, the desire to be more interdisciplinary, collaborative, inclusive, and experimental has meant that the project has become a competitive measure of intellectual, practical, ethical and creative work together. This work might be more ‘critical,’ but it is also discrete and temporary. To my knowledge this fixed-term bargain has rarely been acknowledged, and I wonder why this should be so.

Projectification and Academia

The medical humanities are not in a unique situation. They share a ubiquitous form of contemporary life and economic activity. Andrew Graan (2022) notes important historical tendencies that have made the project a 20th and 21st century artefact – the managerial, material and imaginative vehicle for joining technical solutions to technical problems, hence making these a series of technical achievements. Graan suggests we should pay attention to how projects go hand in hand with the shorthand representation of domains, the spatio-temporal enclosures that can be numbered and made visible with specific data and resources. In turn, projects allow logistical forms of governmentality to interlink state and society with a visionary desire to ‘do good’ (Li 2007) and this means their existence are intimately linked to systems of social reproduction. Wherever projects appear politically neutral they are likely to exhibit a quality of ‘anti-politics’ that James Fergusson (1994) described decades ago in the field of international development. In the economic life of the project human lives – contract workers, participants, ‘patients’ – are rendered as technical inputs and outputs, so the performance of projects can be measured, graded, and optimised.

I have found medical humanities practitioners use projects to assemble resources and promise noble objectives – greater insights through inclusivity, critical expansiveness and democratisation across territory and time. And they use projects to press competitive advantages when bidding for limited institutional or grant funding. When researchers apply for funding, they usually write grant applications that assemble hypotheses, methods, data, technologies, sites, collaborators, specifying a workforce of contract researchers and other practitioners. The skill of this work leverages diverse kinds of power contained by and expressed through the project, as a managerial, material and imaginative way of thinking about work. This can be thrilling and difficult. And the extensive planning of projects requires applicants to use an abstract calculus – long before the money has hits university accounts work packages are numbered and named, Gantt charts plot and mark out milestones. But projects are not only a planning device, used to win competitions for grant money. They are an intellectual and technical form, that shapes how we value people, places and things.

Attending to Tasks

I want to suggest that projects are more than arbitrary containers. They are a cultural and political sorting mechanism, used to divide and stratify people according to task. Some tasks proliferate in project time, particularly structurally invisible tasks associated with administration, finance and documentation, while others narrow in scope, such as what counts as an inquiry or research outcome. It interests me that projects attempt to resolve research aims, questions, collaborating organisations, methods, and outputs before beginning their work. In this sense they are an organisational form antithetical to discovery research. Tasks of administration, finance and documentation do not converge smoothly with academic employment, pay and reward structures, professional expectations around behaviour and conduct, or training and career progression. Principal Investigators (PIs) must learn to sort and allocate these tasks, and this can mean the health and wellbeing of staff can be put in tension with project outcomes. This can be challenging to medical humanities researchers who do speculative, creative or unpredictable work, and can generate contradictions of care whenever medical humanities research engages communities who have been neglected in the past. Projects generate discomfort, exploitation and interpersonal conflict. But in my experience, and for the sake of the project, complaints cannot be directed to the project as a form. It is much more common to see problems of form attributed to disciplinary hierarchies, epistemological differences, interpersonal and individualising clashes around conflicting work ethics and professional conduct – rarely is the project held accountable.

While it might be easier to document the effects of projects on contract researchers in terms of casualisation, for whom professional and personal lives are directly affected by project progress and termination, medical humanities involve patients and patient groups, clinical and other professionals, demographic groups, even whole populations. Increasingly, public contributors are ‘included’ in projects as co-workers, with a ‘diversity’ of lived experiences and identities instrumentalised for project ends. (Of course, personal and professional biographies are rarely singular, and medical humanities researchers often have considerable experience as service users, while public contributors are frequently skilled in research activities.) It interests me that advocates for a more critical medical humanities have displayed a desire for risk and experiment, but their projects also want to distribute risk and experiment to people who may want sustainable and enduring research experiences. In general, public partners are not able to witness (and may not be allowed to understand) the project as a whole, or even in part. In an era of projects, systemic inequalities of power continue: how does the project manage dissent against project short-termism? How can long-term research governance be made equitable and inclusive, when research activities remain so short-lived?

Responsibility and Temporary Assets

For a critical research field with limited anchorage in educational settings, the gains felt by medical humanities projects remain short-term, at least in terms of building new skills and developing sustainable interventions. One consequence is that casualisation has been rapacious, as it has been in other research-intensive humanities and social sciences. Through projects, a very precarious career can be strung along on a mix of exploited optimism, fixed-term promises and longer-term hopes, and the good intentions of less precariously employed colleagues. Projects may achieve greater inclusion and diversity but, again, on a temporary basis, before it all gets wrapped up. The permanently employed remain, others move on.

Principal Investigators (usually academic staff on permanent contracts) retain responsibility for the project’s progress and exercise unique executive functions for the work they have designed. Success depends on them but is also dependent on managing contract labour, as well as any relationships external to the university – other researchers, study participants and public contributors, community groups, technicians, creative practitioners, and administrators. Contract workers, for example, can be disproportionately responsible for fundamental but non-transferable parts of the project, those that might be difficult to circulate as technical outputs and outcomes, such as recruiting participants, collecting and analysing data, or engaging with communities. The hierarchies between people and institutions may undergo subtle transformations during project work, but perhaps for the first time, researchers, study participants and public contributors, technicians, creative practitioners, and administrators will find their labour and identities converted into temporary assets in relation to the production of university-based knowledge.

Projects as Funding Model

There is industrial uncertainty in UK higher education. In recent years this uncertainty has been experienced by staff through industrial action on pay, pensions, and other terms and conditions. The sector has long faced mass redundancies but these now swell in scale, particularly in the social sciences and humanities. For researchers of the medical humanities who have completed their PhDs at any point in the last 10 years, fixed-term research projects can look like life rafts. For more permanently employed staff, time away from institutional stress is a way to find meaning amidst sectoral decline. I think it is important to question how the project came to rule the medical humanities, at a time when universities in the UK and overseas adopted new financial models, at a time when university employers sought to discipline their workers and keep as many of them as possible on temporary contracts.  

Projects are a funding model. They facilitate the outsourcing of financial investment in research via unelected, arms-length government bodies, charities and other voluntary sector organisations. The medical humanities must constantly prove itself worthy of investment. Challenging the integral unit within their funding model is hard to do when projects pay your bills. If precarity has a logic at all it is a logic that seeks to optimise the productivity of limited resources, and thereby extends the economic ideology that evaluates human activity in terms of profit. Can an organisational form, suited to profit maximisation, be usefully adapted to understand illness and health? It seems to me that the critical medical humanities might want to inspect the sustainability and durability of the project as a way to collaborate. If the field thinks it takes equity and equality seriously then it might want to ask what the project does to hinder such values.

Where Do We Go from Here?

Perhaps it is time for funders and research institutions to do some critical medical humanities work of their own. The project form insulates funders from criticism, or confronting the harms they are doing to researchers or research environments. Funders defend the project as an efficient instrument used to make funding decisions. They measure their success in projects, too. The current project system is an ethnocentric and ableist system, one that privatises financial and psychological harms, and privileges applicants who are supported to ‘win’ an unfair contest. It is time for government and charitable funders – particularly those distributing profits from tax-efficient investment portfolios – to make greater efforts to address how their grant schemes manufacture poor research cultures, including workforce inequalities and workplace casualisation. EDI work can begin to tackle more upstream problems. Medical humanities researchers can also question the wider ethics of research participation. This can include supporting public contributors to make informed choices about not participating in projects designed to extract lived experience for short-term gain. Finally, researchers of all kinds can be more aware of the political economy of the project, including how it puts unnatural limits on our collaborations and our creativity.

About the Author

Willam Viney is Honorary Fellow at the Institute of Medical Humanities, Durham University, and Research Fellow at the British School at Rome. His latest book is Twinkind: The Singular Significance of Twins (2023).

Acknowledgements

I would like to thank members of the research network Ends of Knowledge: Health, Illness, and the University, led by Jamie Rákóczi and Harriet Cooper, and thanks to Angela Woods and the editors at The Polyphony for their encouragement and feedback.

Bibliography

Callard, Felicity. 2024. ‘Towards a Critical-conceptual Analysis of “Research Culture.”’ Area 56: e12905.

Callard, Felicity, and Des Fitzgerald. 2016. ‘Entangling the Medical Humanities,’ In: The Edinburgh Companion to the Medical Humanities, ed. Anne Whitehead and Angela Woods, 35-49. Edinburgh: Edinburgh University Press. 

Ferguson, James. 1994. The Anti-Politics Machine. Development, Depoliticization, and Bureaucratic Power in Lesotho. Minneapolis: Minnesota University Press.

Fernyhough, Charles. 2024. ‘Entanglements in the Medical Humanities.’ The Lancet 403: 710-711.

Graan, Andrew. 2002. ‘What was the Project? Thoughts on Genre and the Project Form.’ Journal of Cultural Economy: 1–18.

Krause, Monika. 2014. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. Chicago: The University of Chicago Press.

Li, Tania Murray. 2007. The Will to Improve: Governmentality, Development, and the Practice of Politics. Durham: Duke University Press.  

Macnaughton, Jane. 2023. ‘Does Medical Humanities Matter? The Challenge of COVID-19.’ Medical Humanities 49(4): 545-552. 

Whitehead, Anne, and Angela Woods. 2016. ‘Introduction,’ In: The Edinburgh Companion to the Medical Humanities, ed. Anne Whitehead and Angela Woods, 1–31. Edinburgh: Edinburgh University Press. 

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