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Medical humanities: lineage, excursionary sketch and rationale
  1. Brian Hurwitz
  1. Correspondence to Dr Brian Hurwitz, Centre for the Humanities and Health (http://www.kcl.ac.uk/innovation/groups/chh/index.aspx), King's College London, Virginia Woolf Building, 22 Kingsway, London WC2B 6NR, UK; brian.hurwitz{at}kcl.ac.uk

Abstract

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines.

  • Ethics

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Medical Humanities the journal started life as a millennial offshoot of this journal and is therefore a beneficiary of the creative energies of Ted Shotter whose activities in the 1960s and 70s led to the setting up of the Institute of Medical Ethics (IME) and the Journal of Medical Ethics (JME). That a medical ethics publishing venture should bud off a medical humanities one may seem unremarkable. The two fields are kith and kin, the original title of the Journal of Medical Humanities and Bioethics in the USA reflecting this even though Bioethics subsequently dropped off the title. Moral issues have long been embedded in forms almost coincident with the arts and humanities—novels, dramas and memoirs that turn on conflicts of principle, value and workings out of virtue. In a broad sense, literature provides ethicists with a vast repository of situations and contexts finely graded by moral ambiguity for their comment and calibration.1–5

However, the field of medical humanities has been woven from intellectual threads and cross-disciplinary currents that predate the establishment of bioethics journals on either side of the Atlantic. And yet the field remains in a state of becoming. Jack Coulehan has recently given up trying to define it: ‘[it's] one of those I-know-one-when-I-see-one terms … the two words hav[ing] about the same level of specificity as ‘medical sciences’…’6 The ‘two words’ first appeared conjoined in 1948 not in relation to medical ethics but in relation to the history of science. In a 60-page bibliography of history and philosophy of science and civilisation in the journal ISIS, George Sarton, its founder-editor, picked out for particular mention a number of recent publications. One was A History of Scientific English by Edmund Andrews,7 about which he wrote: ‘I have read this book with deep interest. It is clear that the author, trained as a physician, had a strong historical and philological instinct. His death at the early age of 48 is a sad blow to the medical humanities, for very much could have been expected from him. The book is of special value, because it combines medical experience with philological insight’ (p. 127).8

For Sarton, medical humanities referred to an endeavour that centred on the task of understanding science and medicine in all cultures and all periods through a disciplined study of its working methods, assumptions, language, literature and philosophy. This bibliography spanned the 7th century BC to the mid-20th century and comprised commentaries and exegeses of works on religion, history, culture and presciences and modern sciences. In it, Sarton quotes approvingly from a work by Ashley Montagu: ‘The humanities and science are still too far divorced from one another in our present compartmentalized state of development. The department of English or literature in our educational institutions can do most to bring what no one should ever have allowed to have been put asunder together again. This should be done in the light of the belief that a liberal education is one in which science and the humanities are combined, in which science becomes one of the humanities, in which the emphasis is upon culture and not upon technics, upon education not instruction…’ (p. 115)8.9

Sarton earlier had urged the instauration of a new humanism with science as its principal object, a humanism capable of critically situating this wellspring of knowledge and progress and of responding to the rapidly growing number of its specialisms. Sarton believed specialisation conferred great explanatory power but conspicuously failed to provide the complementary framework required for understanding the intellectual context and human significance of scientific discoveries and inventions. A synoptic and encyclopaedic study of the sciences was therefore needed in order to ‘bring together for the first time scientists, historians, philosophers, [and] sociologists to coordinate and harmonize their points of view; to broaden their horizon without lessening the accuracy of their thought; to make the accomplishment of their higher task easier in spite of the increasing wealth of knowledge’ (p. 32).10

For Sarton, the ‘higher task’ was the ‘humanisation of science’, to be achieved through understanding its unified (or unifiable) epistemology (p. 32).10 On this account, humanisation flowed not from humanities’ conceptualisations per se—as some seem to have assumed and found unconvincing11—but from the compound of a synoptic multidisciplinary analysis, which positioned philosophically and sociologically informed studies of medicine and science in history.

Medical ethical notions were not central to this conception of medical humanities, but the case for a humanities role in medical education that began to be made in the mid twentieth century did take on an increasingly ethical tinge. Since the 1940s, students of the natural sciences at Cambridge (at their own request) had been provided with a reading poetry course, developed and taught by members of the English faculty.12 Anthony Moore, a surgical trainee who had also studied English at Cambridge began reading literature with medical students as a way to raise their moral awareness, and later published a curriculum of texts and student discussion of them.13 ,14 Hugh Barber, ‘a humanist-physician’ (according to the BMJ) argued that literature helped the professional formation of medical students by immersing them in ‘fallible human nature of which they themselves are part’.15 In the USA, Robert Coles promoted the value of literary reading by clinicians to enable them to examine their own character and responses,16 and Robin Downie espoused literature and poetry courses amongst UK clinicians to help them develop ‘whole person understanding’ through imaginatively entering into the lives of fictional others.17

Contrary to the unbridgeable chasm between science and humanities that CP Snow's The Two Cultures (1959) posited and perhaps helped to entrench, such initiatives were living demonstrations of how different disciplines from across the divide could engage productively with each other. A combined group of clinical and literary scholars formulated very specific clinical gains from literary reading18 and led the way in showing how literature could provide not only resources for healthcare training but also the raw materials for the study of medical ideas19 and healthcare experiences.20

Another thread in the weave of this emerging medical humanities matrix arose in the mid-century from concerns that physicians were being displaced from their central position in the diagnostic process, demoted to the minor role of requesting tests and investigations and basing decisions on information supplied by laboratory scientists, themselves distant from clinical encounters. Science and technology appeared to be shifting the grounds of clinical judgement, undermining conventional notions of the doctor-patient relationship previously predicated on trusting the doctor figure. Notwithstanding the therapeutic gains achieved by bioscience in the first half of the 20th century, clinical practice was thought to be becoming reductive and dehumanising.21 Historians of medicine started investigating the social determinants of health and the political and the economic conditions influencing public health and healthcare services.22 In 1967, a new medical school at Penn State University in Hershey began teaching an innovative curriculum focused on engendering better understanding of families, their resources within communities, the influence of lifestyle and behaviour on the prevalence and impact of disease, and on philosophical, spiritual and ethical aspects of healthcare.23 These courses were developed by the first unit in a medical school anywhere to be designated a Humanities Department and were the forerunners for subsequent humanities and medicine initiatives in the USA, including the founding in 1973 of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. For 40 years, the Institute has fostered a broadly-based vision of the medical humanities, encompassing philosophical, ethical, historical, visual, literary and religious dimensions of healthcare through courses offered to clinical, masters and doctoral students. Within a few years, cross-disciplinary journals were to appear that would become pivotal to the field: The Journal of Medicine and Philosophy (1976), the Journal of Medical Humanities and Bioethics (1979) and Literature and Medicine (1982) all helped to internationalise the field and amplify its impact.

The first UK unit devoted to the area was established at the Centre for Philosophy and Health Care at the University of Swansea, which launched an MA in Medical Humanities in 1997 centred on philosophical inquiry that harnessed contributions from history, medical anthropology and sociology, literature, the visual arts, politics, social policy and theology.24 The Nuffield Trust's decision in 1997 to raise awareness of humanities’ and arts’ contributions to health and wellbeing significantly raised the UK profile of the field. The first meeting it sponsored issued ‘The Windsor Declaration’, which called for undergraduate medical students to study the humanities in order: ‘to help them develop a more compassionate understanding of the individual in society, to inspire empathy with patients and colleagues, and to become more ‘rounded’ people…. [A]ll university medical schools should incorporate the humanities—in particular, moral philosophy, theology, and literature… [to] enabl[e] the doctors of the future to qualify with Bachelor of Arts degrees. History, creative writing and painting should also be considered for inclusion in humanities courses. If doctors are to resist gathering pressures that threaten to reduce their perceived role to that of ‘technician’ they must receive a more liberal education, one that helps to bridge a gulf between science and arts’ (p. 107).25

In suggesting that a central task of the medical humanities is to generate cultural and social understanding of bioscience the declaration was clearly reiterating components of earlier formulations whilst adding new elements such as the teaching of empathy. Soon afterwards Evans and Finlay developed the rationale: Since medicine is concerned… with responding to our illnesses, our physical incapacities and our bodily suffering, then it could not consist of the natural biological sciences alone… [T]he intellectual resources for clinical medicine must be drawn from… the social and behavioural sciences and the liberal humanities disciplines [which]… represent distinct ways of recording and interpreting human experience, including the experiences of health and illness, of seeking and undergoing… and providing… medical care.26

Windsor, in addition, resolved to support arts therapies and community initiatives as potentially health preserving and enhancing activities, which needed more investment and intensive evaluation. The Nuffield Trust helped to set up a UK Forum for Medical Humanities, which in 2002, became the Association for Medical Humanities, a UK membership organisation that promotes the field and holds annual conferences (see http://www.amh.ac.uk/about).

The Windsor meetings were convened in the slipstream of the GMC's highly significant reshaping of the UK medical curriculum set out in its Tomorrow's Doctors (1993), which had supported more opportunities for medical students to study the humanities. But it is fair to say that the Windsor agenda overall has been implemented in only a piecemeal way. Though medical humanities teaching options proliferated and the number of centres and institutes devoted to the field has grown nationally and internationally, the latest edition of Tomorrow's Doctors (2009) omits reference to the humanities.

Fuzzy boundaries, lack of a pithy definition and demonstrable undergraduate teaching outcomes and a loose academic meshwork created from intellectual strands of very different lineages and social purposes, have hindered development of a clear role in UK medical schools.27–29 But the field is capacious; it thrives on multiple cross-disciplinary conversations, is capable of asking critical new questions and of undertaking mixed humanities and experimental modes of research of interest to the research councils. The opportunities for collaboration with other disciplines, especially with medical and bioethics, have never been greater. Medical humanities is one of the most polymorphous, adventurous and lively heirs to that programme of talks and seminars that Ted Shotter inaugurated in the 1960s as ‘The London Medical Group,’30 which to his credit, has extended across the UK.

Acknowledgments

I thank Jeff Aronson for first pointing out to me George Sarton's early use of the term medical humanities.

References

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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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