Joshua Franklin
In their classic essay about medical education, anthropologists Byron Good and Mary-Jo DelVeccio Good dispel the illusion of the medical humanities—anthropology in particular—as the savior of medicine. “Anthropology in medical schools,” they write, “thus occupies an ambiguous position; critic of the role of the natural sciences and the individualized and mechanistic forms of reasoning about disease and its treatment, critic of the social organization of medicine, and critic of the nostalgic view of the human sciences as the producers of caring” (103). Several decades have passed since this was written, and yet, as a medical student and anthropologist in training, I still wonder exactly how to offer something as an anthropologist working in a medical setting.
Not to oversimplify the intersection of two complex fields of knowledge, I want to focus here on one prominent site where social scientists hope to intervene in medicine: medical education. The particular project that I am involved in is a course at my institution for first-year medical students called Introduction to Medicine and Society. This course was revised through a student initiative, and top-down teaching methods were replaced with what the course designers called a pedagogy of “critical consciousness” (Dao et al. 2017). Taught through a combination of lectures, small group discussions, and individual reflective writing, the aim is to explore social issues—such as race, class, gender and sexuality—through the lens of personal experience and critical scholarship. How can we simultaneously explore the vast work of anthropologists and others on these topics without claiming this knowledge as a form of mastery? How can our efforts be really critical, and not simply a rehearsal of theories and cases?
By design, this course is multidimensional and always in flux, and therefore it is challenging to represent the project as a whole. And yet some themes seem to appear again and again. I have heard one recurrent question in my work as a facilitator and as I worked on revising and updating the course curriculum: “What kind of doctors do you want us to become?” I first heard this explicitly from students about the language used to discuss social justice. As I wondered about how to judge different languages for talking about these problems, it occurred to me that this is exactly the question that such a course, rooted in critical consciousness, hopes to raise. Once I saw it in this way, it became hard not to see the diverse ways that medical students react to the material we present in this course as implicit variations on this question. Students critique the readings in the course syllabus, question the choice of activities we assign during small group discussion sessions, and challenge the choice of lecturers. But what is at stake is not a disciplinary debate about conflicting sociomedical theories—what matters is the values that students see represented in these different discourses of culture and meaning.
In other words: exactly the kind of discourse that a critical consciousness pedagogy seeks to foster. And yet, this critical engagement with the curriculum materializes medical education in a particular way, reflecting also how students see themselves in relation to medicine and its institutions. First, it reifies the division between student and teacher that this critical pedagogy was established in part to complicate. Moreover, it advances a vision of ‘doing justice in the classroom’; that is, the hope that transforming what happens in education spaces is connected to the broader struggle for equity in healthcare.
But finally, and most importantly, I think, it represents a kind of displacement, transforming deep uncertainty about what it means to be a physician into a sharp concern with medical curricula. In Cruel Optimism, in her discussion of the satisfactions of consumption, Lauren Berlant writes about, “the thing within any object to which one passes one’s fantasy of sovereignty for safekeeping” (2011, 43). In this time when education is increasingly seen as a commodity, anthropological and humanistic interventions in medical training may become precisely such a place of safety. As Berlant puts it, “Any object of optimism promises to guarantee the endurance of something, the survival of something, the flourishing of something, and above all the protection of the desire that made this object or scene powerful enough to have magnetized an attachment to it” (48). And I think that critical consciousness, despite its stark differences from older models of cultural competency, is still able to sustain very much the same sort of promise.
This observation is just a point of entry, not a comprehensive discussion of social and humanistic medical education, and of course many medical anthropologists have made a strong case for the ethical necessity of social and humanistic education in medicine. But I want to conclude with a question: what does humanistic and social medical education promise to medical students?
Works Cited:
Berlant, Lauren. 2011. Cruel Optimism. Durham: Duke University Press.
Dao, Diane K.; Goss, Adeline L.; Hoekzema, Andrew S.; Kelly, Lauren A. MS; Logan, Alexander A.; Mehta, Sanjiv D.; Sandesara, Utpal N.; Munyikwa, Michelle R.; and Horace M. DeLisser. 2017. “Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training.” Academic Medicine 92 (3): 335-344.
Good, Byron J. and Mary-Jo DelVeccio Good. 1993. “Learning medicine: the constructing of medical knowledge at Harvard Medical School.” In Knowledge, Power, and Practice: The Anthropology of Everyday Life, edited by Shirley Lindenbaum and Margaret M. Lock, 81-107. Berkeley: University of California Press.
