Pragya Dev and Binod Mishra review Medical Humanities: Ethics, Aesthetics, Politics by Alan Bleakley (Routledge, 2023).
Right from the term’s accidental origin in an obituary in 1948 by historian George Sarton to the present date, medical humanities (MH from here onwards) has been a pertinent field of study for over six decades now. Initially, MH catered to doctors and medical practitioners alone; the agenda was to produce doctors who had mastered “a tolerance for ambiguity, for coming to conclusions when the data are incomplete or capable of being interpreted variously” (Trautmann 25-26). Many scholarly anthologies, essay collections, and special issues have been produced that debate, validate and develop the arguments around MH. A recent contribution of immense significance is Alan Bleakley’s Medical Humanities Ethics, Aesthetics, Politics (2023).
Building his arguments on the premise that “[i]nformation alone can of course cure, but meaning introduces care” (2), Bleakley begins with tracing the genealogy and offering an overview of MH in the USA and the UK and goes on to discuss the importance of arts and humanities in medical and healthcare debates in developed nations. In a country like India where MH as a discipline burgeoned only in the recent decades and has made significant room for itself in medical curriculum (Supe 2012; Shankar 2020), texts like Medical Humanities provide the essential outlook and methodologies in tailoring and customising the discipline in accordance with the requirements of the region. To give an example, in the introduction, Bleakley presents readers with a provocative understanding of the usage of the terms medical humanities and health humanities and consolidates elementary differences between the two: in MH, according to Bleakley, the humanities act as the connective tissue within the MH field whereas health humanities is relegated to the “uncritical use of the ‘available arts’ for therapeutic purposes through public participation” (4). However, the Indian sensibility, as per our understanding, moves beyond this compartmentalisation primarily because of two factors: 1) the pursuit of curing diseases is intricately woven within the realms of faith and religion, and 2) the prevalence of alternate medicine and home remedies.
To elucidate these two points further, let us talk about a prevalent ritual in the Indian states of Bihar and West Bengal. The followers of Hinduism worship Sitala mata as the goddess of smallpox and deemed as the protector of children. Anybody who suffers from diseases like measles and chicken pox visits the temple dedicated to the goddess to pray for good health and prosperity after a span of seven/eleven/twenty-one days. The COVID-19 pandemic also witnessed a peculiar manifestation of this belief in the form of Coronamata (mata is the Hindi word for goddess), who was depicted killing Coronasur (asur in Hindi means demon) (Dasgupta 2021). Additionally, the “medical pluralism in India” (Qadeer 23) indicates the coexistence of diverse medical models that contribute to and strengthen these sociocultural practices. The pandemic has seen a vast population rely on the use of spices (clove, Indian basil, cumin seeds, cardamom, etc.), ayurveda, chanting of mantras and yoga as much as on allopathic medication. For ailments related to the stomach, Indians utilise carom seeds; for good skin, sandalwood and chickpea flour are common household remedies. In these examples, the medicinal qualities of plants are intertwined with the well-being of the users, thereby highlighting the overlap between medicine and health as systems of cure and methods of care. These examples make us revisit the initial question: what makes Bleakley’s book relevant for all of us? One possible answer to this question is the importance of knowledge and perspective. This book, with its detailed accounts from the global north, provides the recent trends and challenges in the field of MH and offers opportunities for the essential exchange of ideas and their productive difficulties and lapses across cultures. Despite our diverse approaches, the core intentions remain similar: to find ways to humanise medical practices by evoking ethics, understanding aesthetics and addressing the attendant politics of, for example, care.
Medical Humanities Origin Stories
Bleakley’s book consists of ten chapters, with each chapter exploring different facets of MH. The first chapter engages with the disputed founders of MH in North America (Adrian Hill or E. E. Reinke) and brings to light decades of key developments in the MH field into the 1970s when it gained momentum in the US. Bleakley discusses the possible reasons for the emergence and popularity of literary studies in medical education by highlighting the overarching influence of biomedicine and its quality being rendered as a moral concern. The chapter explains how the use of metaphors impacts and determines the doctor-patient relationship. It further critiques health humanities for its overarching expectations and idealism and the overshadowing of critical MH by the aggressive marketing of narrative medicine as a business venture in the USA.
Chapter two divulges more “origin stories” from the UK and discusses the waves of MH at length. This chapter is particularly useful to anyone who wishes to understand the genesis and significant arguments and debates in the field of MH. The third chapter begins by reckoning with how “medical humanities remained handmaiden to medicine and offered little in the way of pedagogical innovation within medical education” (35) as it often remained an elective course in medical degrees. This point was further iterated with the publication of a special issue on MH by the reputed Academic Medicine (October 2003). The special issue pondered on the developments rather than the critical engagements in the field of MH in the US.
Next, Bleakley further provides a first-hand account of crafting and implementing the MH programme at the Peninsula Medical School (University of Plymouth, UK). He describes how the curriculum process approach, based on William Pinar’s works, “sees all curriculum content (syllabus) as subject to ways of learning and experiencing that produce identities” (38). He highlights how medical practitioners and other allied fields remain aloof from the critical pedagogical theory and restrict “medical humanities in medical education” from becoming “medical humanities as medical education” (37). For him, “Wissenschaft and Bildung… are central to contemporary curriculum reconceptualisation” (38). While “Wissenschaft is the idea of learning as a dynamic process constantly renewed and enriched by scientific research and independent thought” (Prideaux 24), Bildung delineates the becoming of the scholar instead of their idealisation. The chapter also highlights the appointment of Christine Borland as Visiting Professor of Visual Art at Peninsula Medical School, which unfettered the reductive tendencies of biomedical science into its more nuanced application in medical practice and education.
Thinking Otherwise: Ambiguity and Flux in MH
The fourth chapter titled “The Medical Humanities: A cure for medical education’s ailments?” continues these discussions and gradually delves into another component essential for transcending “information into meaning” (Bleakley 46) by incorporating insights from qualitative social sciences, arts, and humanities. For instance, the chapter endorses “[…]‘thinking otherwise’ about medicine and medical education as ‘thinking with’ the medical humanities – as a ‘second stimulus’ to conventional biomedicine and clinical/communication skills, following a Vygotskian pedagogy” (51). The chapter further discusses case studies in the MH from medical education to strengthen the exposition of MH as it can “… afford a complex, multifaceted medium, akin to psychoanalytic psychotherapy, that can address medicine’s chronic symptoms…[which] allows medicine full expression” (49). Chapter five furthers the book’s case for MH in medical education as it summons and revisits tolerance of ambiguity, i.e., a character trait in medical professionals that perceives any complex, precarious situation as a threat. Scholarly endeavours exploring this facet of medical education conclude that medical practitioners with medical humanities in their curriculum have a higher tolerance of ambiguity and are found to be more empathetic and open to diversity (Geller et al. 2021).
Chapter six addresses the intricate details of medical education being a dynamic and complex curriculum in flux – while it is home to non-linear, precarious encounters, and ambiguities, it also includes linearity and mundanity. This chapter also investigates the intricate relationships and connections between individuals and systems in healthcare and health professionals’ education, along with their resulting impacts, which demand understanding.
Capital and Power
Chapter seven explores medical education’s indispensable utility of ‘capital’- be it intellectual, bodily, transcendental or emotional- and the nuances of its entanglement with power. Bleakley brings in the arguments of Jacques Rancière, describing several occasions where power/politics, ethics and aesthetics coincide, and expands on the different kinds of power within medical culture and how they shape our senses. According to Bleakley, “Intellectual knowing and practical doing are held together by affective glue, by feelings and sentiments” (Bleakley 108). In one of his recent interviews, while talking about ethics and aesthetics, he distinguishes between ethics and aesthetics: ethics, according to him is a ‘moral activity’ whereas aesthetics appeals to form and quality. For instance, using Eduard Pernkopf’s anatomy textbook in medical education might appeal to aesthetic sensibilities because of its detailed diagrams and content but its use can make us rethink and confront our ethical concerns in making use of knowledge produced under Nazism and in direct connection with the Holocaust.
The eighth chapter thoroughly reads case studies that substantiate MH’s “role of mediator and translator between biomedical science and clinical practice” (112). Chapter nine titled “The Narrative Turn” identifies the potential of narrative medicine but also maps out its limitations. Tracing the influence of narrative medicine, Bleakley brings in some relevant questions to reflect on like the distinction between storytelling and research. According to Bleakley, “[t]he effect of the narrative turn in this field has been to flatten the world into a human-centred site, a move with many negative consequences for humans, but more importantly for the planet” (139). The distinction between stories and narratives inevitably ends up making room for poetry, which is the focus of the final chapter of this expansive book. Bleakley asserts that “[p]oetry need not do anything useful in medicine” (152), but it “[…] can do things narrative cannot” (170). For Bleakley, MH resonates with the essential attributes of poetry as it promotes a diverse and complex understanding of the mundane. Bleakley’s book assembles variegated perspectives and fuses them with existing ideas of MH, emphasising the interconnectedness and broader horizons of biomedical practices which embrace and incorporate ethics, aesthetics and politics.
About the Authors
Pragya Dev is a senior research fellow in the Department of Humanities and Social Sciences at IIT Roorkee, India. Her doctoral thesis explores care and vulnerability studies at the intersection of Medical and Health Humanities. Her works have appeared in ASIATIC: IIUM Journal of English Language and Literature, International Journal of Care and Caring and Synapsis: A health humanities journal.
Binod Mishra is a Professor of English in the Department of Humanities and Social Sciences at IIT Roorkee, India and has authored several anthologies of poems and books. He has published in ETropic: Electronic Journal of Studies in the Tropics, Critique Studies in Contemporary Fiction, Green Letters and Feminist Media Studies.
References
Bleakley, Alan. Medical Humanities: Ethics, Aesthetics Politics. Routledge, Taylor & Francis Group, 2023.
Dasgupta, Deepsikha. “New Diseases, Old Deities: Revisiting Sitala Maa during COVID-19 Pandemic in Bengal.” ARI.NUS.EDU.SG, 11 Feb. 2021, ari.nus.edu.sg/20331-75/#:~:text=Research%20Institute%2C%20NUS-,New%20Diseases%2C%20Old%20Deities%3A%20Revisiting%20Sitala%20Maa%20during,COVID%2D19%20Pandemic%20in%20Bengal&text=The%20Goddess%20Sitala%2C%20or%20the,and%20bringer%20of%20good%20fortune.
Howley-Rouse, Amanda. “Vygotsky’s Philosophy of Education.” THE EDUCATION HUB, 13 Apr. 2021, theeducationhub.org.nz/vygotskys-philosophy-of-education/.
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Prideaux, Sue. I Am Dynamite!: A Life of Friedrich Nietzsche. Faber & Faber, 2019.
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Supe, Avinash. “Medical Humanities in the Undergraduate Medical Curriculum.” Indian Journal of Medical Ethics, no. 4, Oct. 2012, https://doi.org/10.20529/ijme.2012.088.
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