Vivek N. D. reviews Alan Bleakley’s Medical Humanities: Ethics, Aesthetics, Politics (2024), examining the contemporary purpose of medical humanities in medical education.
Health is central to individual wellbeing, societal participation, and the functioning of communities globally. However, much existing scholarship adopts a biomedical and positivist perspective, often overlooking the historical, social, and cultural contexts in which health is experienced and interpreted. The medical and health humanities (MHH) provide a counterbalance to the highly technical and mechanistic medical specialties that students are often required to memorise by rote. As Alan Bleakley, Emeritus Professor of Medical Education and Medical Humanities at Plymouth University Peninsula School of Medicine, has argued: “Modern medicine is traditionally patriarchal, individualistic, and resistant to encouraging democratic, collaborative habits as it socializes its young into hierarchical structures or eats them whole.” (González-Arias, L. M., & Swain, K., p. 516).
Bleakley’s latest book Medical Humanities: Ethics, Aesthetics, Politics (2024), sets out a transformative approach to medical education by redefining the purpose of the medical humanities. Medical Humanities critiques the current instrumental, reductive nature of biomedicine and medical education, advocating for the integration of ethical, aesthetic, political and transcendental values. Drawing from theorists such as Foucault and Rancière, Bleakley highlights the limitations of contemporary biomedicine—such as the focus on systems thinking, the lack of democratic habits, and the production of insensibility in medical education. The book proposes that the medical humanities function as translational media, enhancing the depth and quality of biomedicine by using “metaphor” and “critical reflection” to reinterpret biomedical concepts, rendering them more accessible, ethically layered, and contextually nuanced. It argues that current medical humanities approaches (e.g. narrative-based medicine) have not addressed the deeper issues of medical practice, proposing a more radical, process-based curriculum to enhance medical care by promoting aesthetic sensibility and ethical awareness.
Expanding Biomedical Horizons: Integrating Humanities to Counter Reductionism
In the introduction, Bleakley critiques biomedicine’s reductionist tendencies, using the metaphor of a neuroscientist trying to explain life solely through neuronal activity (Bleakley, p. 1). He writes:
‘Deep in the bowels of academia there is a room with a single desk and chair and the door is shut tight. Here, a neuroscientist sits, fervently believing that the joys and tragedies of life – joyous lovemaking, bringing up children, forming a government, engaging in climate activism – can be explained by the firing of neurons in particular parts of the brain. While this explanation may be complex within its own limited domain, it is reductive in stripping away all other contexts for explanation – personal, social, cultural, historical, and ecological.’ (Bleakley, p. 1).
This critique reinforces his call for a more holistic approach in medical education that integrates the humanities, emphasising that neuroscience should expand beyond a purely functional focus to realise its true potential.
Bleakley notes that many within medicine overlook how the medical humanities can elevate biomedical science by emphasising its aesthetic and qualitative aspects. Rather than merely compensating for biomedicine’s shortcomings, he argues for liberating it from reductionist values to unlock its full potential, including beauty and quality:
‘(…) it reminds us that neuroscience can be nourished and expanded where it shifts away from its base in utility and function to embrace aesthetic (beauty, form), ethical (justice), political (power), and spiritual (transcendental) concerns. Enter the medical humanities in medicine and medical education, where the primary function of this eclectic range of approaches drawn from the arts, humanities and qualitative social sciences is to raise the aspirations of biomedical science from the instrumental to embrace a spectrum of values and qualities. Biomedical science’s potential is realised as it engages with other disciplinary forms such as the arts and humanities in processes of translation.’ (Bleakley, p. 3).
Another significant contribution Bleakley makes to these emerging fields is his distinction between the “medical humanities” and the “health humanities”. He defines medical humanities as a plural field that merges arts, humanities, and social sciences to enhance qualities in medicine, advocating for “appreciation before explanation” (Bleakley, p. 4). In Bleakley’s view, this field focuses on improving patient care and critically analysing medical culture. In contrast, health humanities encompass a broader range of health and social care practices. Bleakley emphasises the importance of maintaining this distinction, noting that medical humanities prioritise education and critical analysis, while health humanities emphasise public participation and therapeutic arts.
The book draws on critical health psychology and liberatory pedagogy, introducing ‘sly civility’, a term coined by Homi K Bhabha, as a form of resistance to biomedicine’s dominant functionalist discourse (Bhabha, p. 71-80). Influenced by thinkers like Thoreau, Gandhi, and Fanon, ‘sly civility’ critiques biomedicine’s instrumentalism, while seeking to restore the aesthetic, ethical, political and spiritual sensitivities that traditional medical education has suppressed (Bhabha, p. 71-80). Here, resistance is not overt but rather expressed through subtle, indirect acts that undermine authority — a nuanced, slanted exertion of power.
Bleakley explores the significance of medical humanities across ten chapters, emphasising its establishment and marginalisation. He argues that integrating the humanities can enhance medical education and patient care by promoting a more complex, non-linear understanding of healthcare. In Bleakley’s view, bringing the medical humanities into medical education would assist medical practitioners to navigate ambiguity, improve their clinical competencies, and enrich the overall healthcare experience. The book advocates for patient involvement and aims to transform biomedicine by incorporating aesthetic, ethical, political, and spiritual dimensions. Bleakley reasons that by engaging with patients not merely as cases but as co-creators of knowledge, medical practitioners can foster more empathetic, ethically grounded, and contextually sensitive care.
Diagnosing Medicine: The Therapeutic Role of Medical Humanities
In chapters 1-3, Alan Bleakley guides the reader through the origin myths of the medical humanities, illustrating its evolution and coming of age as a critical discipline. He takes examples from the US, UK, and New Zealand, that interrogate the complexities of medical practice and education. In the early 2000s, Bleakley played a key role in developing a holistic curriculum for the Peninsula Medical School, affiliated with Plymouth and Exeter universities (Cooper). Responding to the traditional model, which delayed patient contact until Year 3, he and his colleagues aimed to redesign the curriculum to foster early and ongoing clinical interactions and emphasise communication skills, inspired by the General Medical Council’s Tomorrow’s Doctors report. This model of involving medical students in the clinical settings from the first year has now been widely adopted by leading medical schools in the UK.
Bleakley uses “critical” as a multifaceted approach — political, ethical and aesthetic — to expose the underlying motivations behind medical representations, which refer to the ways medical knowledge, bodies, and patient experiences, are depicted and interpreted within clinical and educational contexts. He asserts that both medicine and medical education, along with their practical realities, exhibit symptoms requiring treatment, particularly in revealing repressed issues that manifest in distorted forms, as discussed in chapters 4 and 5. Bleakley argues that medicine, like a patient, exhibits symptoms of dysfunction, such as neglecting empathy and patient narratives. He suggests that the medical humanities act as a therapeutic intervention to address these issues:
‘ (…) like all knowledge structures and institutions, medicine shows chronic symptoms. These symptoms cannot be ignored because they frustrate the development of medicine through lag in medical education. It is the medical humanities that can act as the intervention, tonic and even cure for medicine’s contemporary malaise. Offered primarily as a pedagogical approach within medical education, the medical humanities afford a complex, multifaceted medium, akin to psychoanalytic psychotherapy, that can address medicine’s chronic symptoms.’ (Bleakley, p. 49)
This critical lens invites readers to question established norms and recognise the inherent flaws within the medical system.
Rethinking Medical Education: Complexity, Sensory Training and Prescriptive Culture
In chapter 6, Bleakley discusses viewing medical education as a complex, dynamic system, framing the curriculum as a process. He emphasises the value of “complexity” as both a factual condition and a mode of thinking—often termed meta-thinking—encouraging reflection on the thinking process and actions within intricate environments. To quote Bleakley, “Complexity is both a condition of fact and circumstance – an event – and an experience or a way of thinking. Complexity is often described as meta-thinking, or a way of thinking about thinking. It is primarily a way of thinking about doing where activities are situated in complex environments” (Bleakley, p. 77). To this end, Bleakley outlines four crucial reforms for transforming medicine and medical education: embracing whole systems thinking, moving from hierarchies to authentic democracies, ensuring global healthcare equality and incorporating psychotherapeutic training early in medical education to foster a more holistic, patient-centred, and equitable healthcare system (Bleakley, p. 94).
Chapter 7, addresses resistance in sensory education, linked to the shift from hierarchies to authentic democracies. It highlights the senses as essential capital in medicine and medical education, influenced by hierarchical interests. Bleakley avers, ‘Given the critical importance of using the senses in diagnostic work, one might think that focused education of the senses would be a curriculum priority for medical education. This is not the case – education of the senses is not meticulously planned but left largely to change encounters in work-based learning that itself is largely spontaneous’ (Bleakley, p. 95). Thus, Bleakley questions how to achieve a democratic distribution of sensibility in medical practice amidst entrenched hierarchies. Chapter 8, examines the prescribing process of pills and drugs, often neglected in undergraduate medical education (Bleakley, p. 112). This practice fosters a “prescriptive culture” influenced by the pharmaceutical industry’s economics, which promotes both prescription and over-the-counter medications. Notably, the mood-enhancing drugs discussed reflect the euphemism ‘better living through chemistry’, derived from DuPont’s 1930’s slogan and later popularised by DJ Fatboy Slim’s 1996 album title (Bleakley, p. 113).
Narrative Medicine Revisited: From Historical Metaphors to Critical Reflection
In Chapter 9, Bleakley examines the narrative shift in medical humanities through E.L. Doctorow’s Ragtime, analysing Robert Peary’s 1909 North Pole expediton. Peary’s struggles with exhaustion and self-doubt amidst environmental challenges serve as a metaphor for the uncertainties in medical humanities, which rely on fiction rather than biomedical certainties (Bleakley, p. 136). This chapter emphasises the role of patient narratives in diagnostics, linking narrative-based medicine closely with medical humanities. Bleakley’s use of historical examples demonstrate how narrative approaches in medical humanities can uncover deeper, often neglected aspects of medical practice that extend beyond clinical facts. Chapter 10 historicises narrative studies by tracing its origins to post-WWI revolutionary Russia, where art had to align with strict ideological frameworks. Initially focused on art for its own sake, Russian Formalism evolved into Marxist interpretations, with Terry Eagleton marking 1917 as the start of modern literary theory through Victor Shklovsky’s essay “Art as Device.” He contends that understanding the bio-scientisation of narrative medicine requires examining these foundational concepts (Bleakley, p. 154). Bleakley argues that, Russian Formalism introduced “close reading”, which parallels the reductive view in biomedical clinical medicine that focuses solely on symptoms, neglecting the social conditons affecting health and highlighting the need for a broader, context-inclusive understanding.
In the concluding chapter, Bleakley critically assesses narrative-based medicine, particularly Rita Charon’s influential model, arguing it has been overly descriptive rather than critically analytic. While recognising Charon’s innovation, he suggests it operates as an unacknowledged imperialistic device. He concludes by stating:
‘Have we unfairly caricatured generic narrative medicine and its commercial apogee in Narrative Medicine™? Readers can decide. From our roost in poetry pulpit, we recall Samuel Beckett’s comparison of his own work with that of James Joyce from an interview in the New York Times (Shenker 1956): “He’s tending towards omniscience and omnipotence as an artist. I’m working with impotence, ignorance”. We leave “knowing” to narrative medicine as we proudly side with impotence and ignorance, defamiliarising clinical encounters so that they are made strange, comprised in ambiguity, and recognised as such. Here, we trudge in what Donald Schön (1984) famously called the “swampy lowlands” of values conflict rather than the “high, hard ground” of certainties.’ (Bleakley, p. 171).
In summary, Bleakley’s call for a transformative integration of the medical and health humanities challenges the entrenched paradigms of biomedicine. It also invites a reimagining of medical education that embraces complexity, ethical awareness, and the richness of human experience, ultimately fostering a more compassionate and holistic approach to healthcare.
About the author
Vivek N.D. teaches Political Science at Vidyashilp University, Bangalore, India. His areas of research specialisation include global health governance, development issues and non-traditional areas of international relations. He has a PhD in Political Science from the University of Hyderabad.
References
Bhabha, H. K. (1985). Sly Civility. October, 34, 71–80.
Bleakley, Alan (2024). Medical Humanities: Ethics, Aesthetics, Politics. Routledge.
Cooper, H (2022). Review of Medical Education, Politics and Social Justice, Alan Bleakley (Routledge, 2021). The Polyphony. 19 December 2022.
González-Arias, L. M., & Swain, K. (2024). Poetry for rewilding the medical and health humanities. Lancet (London, England), 404(10452), 516–517.
