A Review of Literature on Medical Humanities

Journal of Critical Reviews

ISSN- 2394-5125 Vol 7, Issue 12, 2020

INTEGRATING HEALTH AND THE HUMANITIES CURRICULUM: A REVIEW OF LITERATURE ON MEDICAL HUMANITIES

Shibashish Purkayastha

PhD Research Scholar (English), Department of Humanities and Social Sciences, Indian Institute of Technology, Guwahati. Email ID: [email protected]

Received: 10.03.2020 Revised: 11.04.2020 Accepted: 12.05.2020

Abstract This paper intends to survey a portion of the extant scholarship in the field of Medical Humanities and examining its significance to the investigation of clinical training and the humanities. It will likewise review a few works of fiction and non-fiction which narrativize illness from the perspective of the physician and the patient. By investigating the existing literature in the field, the paper seeks to uphold the fact that the intervention of the humanities into the domain of medical sciences has improved and in fact, enriched the field. Medical Humanities is an evolving scholastic discipline, an interdisciplinary field of enquiry that draws on history, politics, literature, cultural theory, drama, bioethics, religion and investigates their interrelationships. It looks to analyze how they can be coordinated for a bigger strategy execution and praxis. This article maintains that, by consolidating the information from each of these fields and coordinating it to clinical practice and humanities and the social sciences can indeed be a worthy move.

Keywords: medical humanities, social sciences, curriculum, narrative medicine, interdisciplinarity

INTRODUCTION Ethics extensively alludes to the ethics of healthcare. It A portion of the significant objectives of clinical sciences was develops in consonance with science and technology. For the scattering of logical information, commitments to the field example, for a case which identifies with body enhancements of clinical instruction and advancement of moral enquiry in the in which the ethics of the training are questioned on the field of scientific research and clinical practice. As Des grounds that bio-clinical practices are making changes to the Fitzgerald and Felicity Callard in their essay “Entangling the individual’s body to improve its appearance. Clinical Ethics Medical Humanities” contend that the Medical Humanities is an alludes to the feeling of regard that healthcare experts have for interdisciplinary undertaking with an integrationist intent the patients’ families. This brings into question a specific (Fitzgerald and Callard, 2016). They further proceed to connect professionalism, expertise and respectability that they have to it to the different contraptions of biomedical sciences. In spite their patients. Literature and Medicine is an amalgamation of of the fact that the way of thinking of medication has picked up the literary and the clinical practice. The basis for utilizing momentum in the ongoing years, very little consideration has literature in medication is threefold: perusing the accounts of been given to it. As Michal Lytovka opines that, it tends to be patients and expounding on their encounters gives specialists a helpful to apply certain philosophical precepts throughout the superior comprehension to analyze their patients, it history of medicine, medical ethics, literature and medication, additionally brings the partialities and the inclinations of the amongst others (Lytovka, 2017). This contention set forth by clinical professional into the center and it requires critical Lytovka will be helpful in my assessment of the current thinking and mindfulness about these issues in medication. assemblage of information that manages the mediation of Brian Dolan in his exposition “One Hundred Years of Medical clinical humanities into the field of literature and social Humanities: A Thematic Overview” proceeds to clarify that the investigations. I will allude to certain works of fiction and non- discipline of medical humanities grasps the inventive fiction alongside certain journal articles and compilations expressions including music, painting and dance. They help in which talk about the integration of the two divergent overcoming a deficit in the discipline, widening the reasoning disciplines. The purpose of the review is to inspect the aptitudes and research capacities of the students in the clinical relationship of humanities with health and clinical practices. sciences (Dolan, 2015, p.1). He writes that the primary branch Medical Humanities, as a discipline, is for the most part, of Medical Humanities was set up in New York University in concerned about preparing clinical specialists with information 1948, however chronicled guidance in the Department of from various allied disciplines. It remains as opposed to Health Medicine at Johns Hopkins University had begun during the Humanities, which joins health and social care disciplines to 1930s. He opines that the discipline of medical humanities expressions of the social sciences and the humanities. Health should look past its mechanical perspectives to dig further into Humanities, then again, alludes to the use of the innovative the social conditions behind the ailment empowering expressions and expressive arts and the humanities disciplines, individuals to adapt to them. The motivation behind the for example, literary studies, philosophy, law and religion to incorporation of the clinical sciences with the humanities was talk about advancing human health and well-being. In the to give a more extensive foundational knowledge that was health humanities, health is comprehended dependent on the absent in regular clinical instruction up to that point. Dolan constructivist theory instead of the positivism of science. It puts further expresses that, bringing the humanities into clinical together its comprehension with respect to dialogical and training has for quite some time been viewed as assisting with different facts as opposed to the monolingual truth of scientific adjusting the rigors of rote retention and to provide inquiry. The health humanities do not look to set an option in commitment on the social milieu that impacts human services contrast to the medical sciences but however offers an even conveyance, patients’ convictions, and doctors’ emotional minded way to deal with health and its advancement, and can equanimity (Dolan, 2015, p.9). function in a way that is conducive for the health sciences. The medical humanities, then again can help clinical specialists with In spite of the fact that The Society of Health and Human Values viewing and tackling issues from more than one viewpoint as is started an exchange between the humanities and the medical the case with visual studies or the theater arts. In the field of sciences, and individuals from this gathering originally medical humanities, three critical terms stand apart which are distributed a book by Joanne Trautmann and Carol Pollard on investigated at length in the field of clinical practice. These are Literature and Medicine: An Annotated Bibliography in 1975. Bio-Ethics, Clinical Ethics and Literature and Medicine. Bio- Joanne Trautmann was additionally the primary supervisor of

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INTEGRATING HEALTH AND THE HUMANITIES CURRICULUM: A REVIEW OF LITERATURE ON MEDICAL HUMANITIES the journal Literature and Medicine which appeared in 1982. punishment by specific religions, for example, Christianity. The Society of Health and Human Values distributed another Cancer, then again, influenced individuals who needed collection in 1987 titled Literature and Medicine: A Claim for a enthusiasm and conviction; to individuals who stifled their Discipline, which discusses various socio-political occasions sentiments. She construes that, up until the twentieth century, which could most likely give a fruitful ground to the the two ailments were related with certain mental attributes of improvement of the discipline. The possibility of ‘innovatively’ the patients. She proposes that use of metaphors to portray an looking at parts of the human brain, rather than a minor clinical ailment will bring about an association with the repressed assessment was proposed by Dr Rita Charon, a doctor at passion and the illness in itself. She dissuades one from taking Columbia University. Following the strides of Joanne frequent recourse to metaphors in portraying illness (Sontag, Trautmann, she focused on the development of “narrative 2001). This assessment of hers prompted serious criticism medicine”, which had become another part of literature, from essayists who opined that utilizing metaphors helped looking at the relevance of literature to clinical practice. She patients to build up a symbolic language and this helped them paid customary visits to the Department of English, Columbia recuperate from their disease. E. J Cassel’s acclaimed article University to see how stories were developed. She even took up “The nature of suffering and the goals of medicine” expounds a course in English and eventually earned a Master’s Degree on the connection between suffering and organic illness. In and a Doctoral Degree in Literature. She had come to portraying a progression of patients who were enduring and understand the way that understanding the elements and the experiencing clinical treatment, he further underlines the exchange of the literary and the clinical would empower her to nature and reasons for suffering. Suffering influences the improve as a specialist. Eugene F Cordell in “The Importance of ‘personhood’ of the individual, instead of, it only being an the Study of the History of Medicine” recognizes antiquated and epitomized understanding, is the thing that he is by all accounts current students of history, the former giving no consideration suggesting. He makes an important observation that the task of to basic research yet confining themselves exclusively to doctors and clinical professionals is two-fold: they should depicting real encounters, the latter took an interest in the willingly volunteer to not only cure the illness but also ward off occasions of history, being an onlooker to it, investigate turns the suffering of the individual (Cassel, 1994). Vincent into a significant element of the cutting-edge antiquarian. He Colapietro in his “Signs of Illness” situates illness in various weighs on considering the great names in pathology and archeological, phenomenological and clinical contexts. He histology-Corvisart, Skoda, Charles Bell, Marshall Hall et. al. By proceeds to discuss illness as an alteration of one's drawing a genealogy of the historical backdrop of medication, comportment to the world (Colapietro, 2000). Since illness he suggests that one can profit incredibly by considering these prompts a distortion of one's orientation to the world and the extraordinary lives. He further opines that “it would be very everyday. He says that pathological analysis of illness “occlude little to our credit if we didn't see further than they; but, to the paradoxes of illness” (Colapietro, 2000). So, it is upon imagine, as some appear to do, that they were blind and saw literature to make these occultations noticeable. Belinda Jack in nothing, indicates a very shallow knowledge, and a judgment her article “The rise of the medical humanities” proceeds to warped by the greater relative size of near objects” (qtd. in inspect the representation of medication in literary texts since Dolan, 2015, p. 42). Suzanne Poirier in “Teaching Literature and the Greek period. She starts by referencing the antiquated Medicine: An Overview and Commentary” discusses her own Greek Hippocrates- a physician who maintained that the act of encounters in the wake of stating “Teaching in Literature and loving medicine and humanity go hand in hand, thereby hinting Medicine”, when the field of literature and medication was at the long association between medicine and the humanities. moderately new in academic parlance. Literature has Further down the ages, she discusses medical professionals and consistently been an impression of the cultural mores. Taking specialists who had taken to composing fiction and non-fiction. off from this oft cited line, Poirier discusses literature as a She discusses authors, for example, Tobias Smollett, the writer, dynamic and mixed field. In spite of the fact that she refers to in dramatist and artist Oliver Goldsmith. She specifies John Keats her essay that numerous clinical specialists have offered their who resorted to writing poetry on account of the physical and contradiction to the investigation of medication from a social mental trauma he had to undergo because of the sheer horror point of view, yet the discipline has advanced impressively, of performing surgery on patients without anesthetizing them. which contemplates the interventions of the two disciplines (Jack, 2015). Jack also cites the example of Friedrich Von which encourages the doctor to comprehend their associations Schiller who was a physician, surgeon and a poet. She, with their patients better (Poirier, 2015). It likewise additionally discusses how the field of literature influenced encourages them to find the relationship of the patient with psychiatrists, such as R.D Laing and C.P Snow. She, at that point their sicknesses. Virginia Woolf's celebrated essay “On Being proceeds to look at the relationship of poetry with the medical Ill”, appeared in The Criterion in 1926, and was later distributed humanities. She proposes that poetry can discuss under the title Illness: An Unexploited Mine. Woolf, in her article, unremarkable and dreary encounters of individuals as well. In underscores the way that sickness is as serious a subject of her article Jack avers that good and often brilliant poetry has literature as affection, disdain and retribution. Woolf composes the ability to understand the unexplained and it is through this, that in relation to the commonality of illness as a condition and the therapeutic and healing processes of literature are brought its potential to bring about significant changes in the lives of the to the forefront of the patient. In the concluding segment of her people, it was quite astonishing to her that it had not gained article, Jack maintains that laughter could be said to have currency in literary representations until the time she was therapeutic potentials and quotes the English Romantic poet writing. She also seems to lament over the scarcity of literary Lord Byron who had attached singular importance on how texts (both fiction and non-fiction) which solely depict love, laughter can act as a salve at times (qtd. in Jack 2015). hatred, jealousy and intrigue of all kinds without depicting serious health conditions and disorders. Literature, during the Joanna Szczotka in “Philosophy of Self and Its Impact on time in which Woolf was writing, had not started paying Modern Psychiatry: A View from Psychiatry and Neuroscience” adequate attention to the interrelationships that could be provides an account of how the thought of self, mind and possibly drawn between literature and medicine. Woolf, in her consciousness have been integral to philosophical analysis. She essay, discusses the obvious nonattendance of the portrayal of recognizes two traditions of thinking; that of Descartes and sickness in literature since works of fiction and non-fiction had Hume. Descartes thought about the self as strong and been preoccupied with the mind paying no enthusiasm to the ontologically unmistakable from the physical world while illnesses of the body. Susan Sontag, an American essayist in her Hume imagined the self as a procedure, that is, there is nothing popular book Illness as Metaphor which appeared in 1978, stable or enduring about oneself. Szczotka proceeds to critiques the discourses and the notions which puts the fault characterize the self as a simple sensation, having a subjective onto the casualty without considering the idea of the ailment. encounter of the world, which recognizes me and not-me. She She discusses cancer and tuberculosis in her book. She looks at further posits that research in medical sciences-particularly Tuberculosis as an imaginative malady, which even drove neurology and psychiatry, following the convention of Hume, sound individuals to look afflicted. It was likewise seen as a believes in the multiplicities of oneself. She cites the example of

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Stanislaw Lem’s Dialogues which discusses the issues of the vulnerable subjectivity. A popular neurosurgeon that he was coherence of oneself (Szczotka, 2017). working at Stanford, the book underscores the numerous ways he came to envision himself as a medical student, a successful Anne Hudson Jones’ article “Literature and Medicine: An neurosurgeon, a patient and a philosopher. A portion of the Evolving Canon” traces the relationship of literature and inquiries that Kalanithi grapples with in the book include how medication to the antiquated occasions. A portion of the should one deal with certain existential questions when one writings that she refers to include The Book of Job, Sophocles’ comes face to face with their mortality, how does one cope with Philoctetes, George Eliot’s Middlemarch, Gabriel Garcia the numerous challenges that the vulnerable body presents to Marquez’ Love in the Time of Cholera among others. She itself, as it sways uneasily between life and death, what are the proceeds to state that the brevity and subject matter of these ways in which one copes with a fading present in relation to texts make them ideal texts to be instructed in clinical practice. one’s relation with their family and friends. The passing of In writings, for example, Thomas Mann’s The Magic Mountain Kalanithi in 2015 and the eventual publication of his memoir or Albert Camus’ The Plague, the stylistic and the literary caused a stir among the audience by the amount of narrative aspects of it alongside their profoundly charged passionate empathy and humility the text generated. He wrote that, in the atmosphere, make them educationally valuable. Rebecca course of writing this particular book he lived by the words of Skloot’s The Immortal Life of Henrietta Lacks is an enduring Samuel Beckett about the need to move on despite all odds that work of non-fiction which gives a comprehension of the literary life poses. (Kalanithi, 2016). This book brings to the fore some and the clinical. The book revolves around Henrietta Lacks and of the important observations and reflections on the the interminable cell line which originated from her disease relationship between the physician and the patient, life, cells. It is an agonizing tale about racism, scientific ethics and literature and mortality. her family’s excruciating encounters with both. Siddhartha Mukherjee, in his medical biography-The Emperor of All Arthur Kleinman’s crucial work The Illness Narratives: Maladies, follows the historical backdrop of the science with Suffering, Healing, and the Human Condition is a testament logical exactness and precision while cursorily referring to which brings in information from a wide corpus of disciplines patient histories. Mukherjee describes centuries of revelations, such as anthropology and medical history. The book posits to misfortunes, triumphs and failures, depicted from the critique a portion of the Western biomedical practices and perspectives of ancestors and companions concerning how brings to bear a portion of the viewpoints by non-Western they managed this adversary. Mukherjee goes on to provide a specialists and patients. The thrust areas of the book are historical overview of living with this malady right from the numerous ways in which a patient can envision modes of classical times in which a Persian queen’s slave removed her recovery, concentrating basically on “chronic illnesses” and malignant tumor and right down the ages to the nineteenth how they perpetrate suffering on the individual. The initial century with the developments in medical sciences, in general chapters of the book are dedicated to examining the numerous and neurology and oncology, in particular. The Emperor of All ways in which subjective accounts of patients can come to the Maladies expounds on certain patient narratives who have aid of physicians. He distinguishes between three terms: navigated troublesome ways to endure and to build the store of “illness”- the individual [subjective] experience, “sickness”- the human knowledge. Dr. Lisa Sanders in her book Every Patient larger cultural imaginary and the societal construction of it and Tells a Story: Medical Mystery and the Art of Diagnosis, along the “disease”- a change in the psychological makeup of the person lines of Virginia Woolf's “On Being Ill” which indicated that concerned. Kleinman further maintains that illness refers to the through Illness one can find various territories of the creative ways in which the patient or their family members and mind. In her account, she refers to a patient who had lost a acquaintances come to an understanding of the altered health significant part of his memory, rendering him incapable of condition or debility, once the condition has set in. It is basically recounting a substantive portion of his life. She then, goes on to the subjective dimension of experience such as respiratory describe the experience of two patients living with Lyme problems, cramps, nasal conditions, which possibly requires disease whose conditions improve with medical intervention, medical intervention. Illness is something being lived through but the resultant side-effects of medicine remain which the body, and envelops “the accessory actions and attitudes eventually take their lives. In a third example, Sanders refers to towards illness in the sick person and those around them” a patient in the ICU lying in a deplorable state and the (Kleinmann, 1988, p. 33). Illness issues are difficulties made physicians unable to determine as to what is causing her pain. straightforwardly or in a roundabout way because of the In Lisa Sander’s book, she being a physician herself, goes on to conditions created by the ailment, regardless of whether a loss provide the lived realities of patients and the times when even incurred at the personal front or personal freedom or decision- doctors do not find an adequate mode to diagnose their making abilities; these illness problems pertain to the condition and seems to suggests ways and modes in which subjective realm of the patient who, upon visiting a doctor physicians can diagnose better. Another telling work of labels it under a particular disease. Disease is the changes in the medication and literature, which has a logical accuracy and functioning of the body from what is perceived as a norm as per clarity, is Dr. Atul Gawande's Being Mortal: Medicine and What certain set standards. Kleinman introduces another term- Matters in the End. This memoir is an outline of how individuals sickness which refers to a particular understanding of a value a long-lived life over a worthy one, infantilizing the old condition by the entire populace. Kleinman cites the example of among numerous others. Is it time the clinical calling numerous patient welfare groups. reexamined its way to deal with the old and the terminally ill? Should doctors be trained to prepare people to die as opposed In “The Physician as Storyteller,” Abraham Verghese considers to just be kept alive to the extent that this would be possible? In his own advancement as an author of stories and how his the same book, Atul Gawande addresses these inquiries and comprehension of character, illustration, and plot helped him contends that an acknowledgment of mortality must lie at the to disentangle and acknowledge the complexities of patients’ core of the manner in which we treat the withering. Paul encounters. First conveyed as the Nicholas E. Davies Memorial Kalanithi’s When Breath Becomes Air, is a significantly moving Lecture at the 2000 American College of Physicians, Verghese’s memoir by a youthful neurosurgeon confronted with the final piece gives a declaration of the intensity of stories to permit stages of a debilitating illness and thus, he goes on to question patients’ voices to be heard (Verghese, 2015). G. Thomas certain commonly held assumptions as to what constitutes a Couser’s “What Disability Studies has to offer to Medical worthy life. He was diagnosed with a terminal cancer and his Education” he proceeds to contend that Disability studies can transformation from a doctor to a patient occurred so rapidly be of incredible incentive to clinical training first, by putting the which left him no option but to question the basic assumptions clinical worldview in the wide setting of an arrangement of underlying philosophy and mortality. In the book he explains methods of comprehension and reacting to disability that have how his desires for a future that he and his wife had envisioned, developed in the last two thousand years; second, by reminding dissipated. This poignant memoir accounts the growth of medical professionals that individuals with handicaps have Kalanithi as a person during the course of his disease, his experienced just as benefitted clinical treatment in the last two understanding of life and people around him, in relation to his hundred years; at last, by giving access to a particular

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