Against Medical Humanities?

Travis Chi Wing Lau // As I have wrestled with in both my review of Sari Altschuler’s The Medical Imagination and in my essays about interdisciplinarity and disciplinary difference, I remain deeply interested in the question of methodology and how we define our fields of study. Like the concept of genre, a field sets expectations: it 1) defines the parameters and methods by which we ask and address research questions, 2) determines the objects of study, and 3) imagines the stakes of the answers to those research questions. The medical humanities, itself composed of multiple disciplinary approaches (some of which are in tension with one another), tends to elude a singular definition of the field and its methods. I want to think through Melanie Jones’ provocation in her ACLA seminar, “Literary Diagnosis and the Anti-Medical Humanities,” where she reminds us that “alliances forged between literary representation and medical discourse are new and fragile.” What gets lost, Jones suggests, in this anxiety over reading the literary and the medical together so readily are moments that refuse the coherence of a field—where “writers…resist the assimilation of the literary into the medical, and vice versa.” What does the health humanities, often conflated with but different than the medical humanities, enable us to do and what are its limits? Does medical humanities, as a field taught and practiced primarily in medical schools, actually reproduce precisely what medical humanists claim to be invested in critiquing?

A mainstay of the medical humanities has been a persistent impulse to define the field, “whether it is taken to be a discipline or a field of enquiry, or a set of interventions, shared values, or interdisciplinary collaborative relationships.”[1] Piece after piece, anthology after anthology attempt to outline what the medical humanities does. This, I think, emerges out of tensions across the fields that compose the medical humanities and resistances to the field’s interdisciplinarity that require uneasy partnerships between what C.P. Snow has called “the two cultures.” Critics of the medical humanities have put pressure on the fact that this field presupposes a relationship between medicine and the humanities that, as Jones implies above, only recently came to be through the institutionalization of medical humanities in medical education. Versions of this critique center on how the medical humanities typically gets housed within schools of medicine as medicine, which scholars like Rita Charon have argued is a crucial justification for the field’s value and relevance. Rather than simply exercises in empathy or the “soft” skills of the humanities being forced upon medical students, narrative medicine, for instance, is understood as a means of refining and enhancing the practice of medicine. But the fact remains that the medical humanities, as a field or set of fields that often critiques medicine as an institution and industry, is seldom in an institutional place to do so or can do so only superficially.

The medical humanities have become increasingly popular in medical schools and STEM departments often because institutions and administrations can point to it as a symbol of interdisciplinarity while coopting it as a “safe” field that remains in service of medicine. This seems particularly evident in the ways medical schools have begun to advocate for applicants who demonstrate “interdisciplinarity” in their training and interests, while simultaneously relegating the medical humanities to “electives” in their curricula, hiring a singular humanities scholar to somehow represent the field in a medical school, and even lauding clinicians and researchers as doing “interdisciplinary work” when they merely gesture to the humanities as supplemental to a more “rigorous” scientific method. As one colleague put it to me at a recent conference, “is the medical humanities just another means by which medicine and the sciences will render us more obsolete and irrelevant?”

In response, medical humanists have made powerful cases that the medical humanities should foreground its humanistic methodologies as medical competencies that are essential to compassionate medical care. Historians, sociologists, and literary scholars have demonstrated how humanistic inquiry can in fact train medical professionals to be nuanced critics of their own fields by creating opportunities for engagement with understudied histories and the social and cultural dimensions of medical practice and theory. To do what Roy Porter has called “medical history from below” not only in literature classrooms but in medical school classrooms has profoundly impacted how future clinicians understand what they do and why they do it. While I firmly believe in the value of this work, which so many younger scholars are modeling in innovative ways through their research and teaching, I am concerned about medical humanities’ institutionalization in medical schools and health studies programs, a phenomenon coinciding with shifts in nominalization like adding the prefix “critical” to the field’s name or conflating “medical humanities” with “health humanities.” These kinds of changes are not unique to the field, but they raise questions about the directions in which the field might move. Shouldn’t the field of medical humanities already be critical and if it wasn’t, is this a byproduct of its institutional history and formation?

In their articulation of critical medical humanities, William Viney, Felicity Callard, and Angela Woods express an urgent need for self-reflexivity among scholars working in the field. Yet strikingly, they qualify that this “reflexively critical stance is not in the service of a particular political agenda or particular epistemological priorities, or indeed, in favour of a precise programme of reform.”[2] I understand this to mean an openness to dissent and to interrogations of procedural and intellectual norms of the fields that organize and compose the medical humanities. I, for the most part, resonate with their refusal of “a territorialized conception of the medical humanities—one in which a vaguely defined community is said to occupy, defend and advance a ‘domain’ or ‘field in the face of some real or imagined combatant” in favor of a “critical openness, plurality, and cooperation.”[3] But I remain deeply uncomfortable with their characterization of current medical humanities as either “servile” or “hostile, dogged, sceptical, and separable from the medical practices it seeks to target.”[4] The authors prompt humanists to recognize that their own methodologies are historically bound up with the sciences, but this characterization of the field unfortunately echoes familiar, reductive indictment of the humanities, particularly of minority fields like queer studies or disability studies: that these fields are peddling a political agenda that is hostile precisely because they are critical of institutions and norms and see themselves as outside of them. Quite frankly, I do not understand how any version of critical medical humanities, if it is to have any critical purchase in our present, can be both critical and apolitical.

The authors’ reliance on phrases like “heterodoxy,” “messy and mixed hybridities, collaborations and dilutions,” and “diverse ways of doing medical humanities” all seem to reproduce what Sara Ahmed and others have observed as the strategic deployment of neoliberal buzzwords like “diversity”[5] as a convenient stand-in for what remain significant disciplinary and institutional tensions. To be clear, a plurality of approaches does not necessarily lead at all to “innovative” research or useful interventions into public debates. In fact, this “melting pot” model of just having multiple voices present in the same room without accounting for or working through differences in training, institutional privilege, and goals characterizes much of the attempts at interdisciplinarity at many academic institutions. The authors also presume equal playing fields for the disciplines involved, yet with the very fact that so much of the medical humanities are funded and run by medical schools while so many humanities departments are consistently being defunded and adjunctified, these seem hardly the conditions for the kind of egalitarian “heterodoxy” the authors idealize as generative because of its messiness. I absolutely agree that scholars need to begin resisting “strategies of critique that rely simply on inter-discipline condemnation,” but those critiques of medicine (particularly those that are carefully historicized and theorized) also give the field its critical purchase and stakes.[6] What kinds of truly interdisciplinary collaborations can we expect in the current state of the academy when so much of the work is being done by those in contingent and precarious positions, especially from the humanities side? How do we really foster interdisciplinary solidarity, partnership, and collaboration in such institutional conditions?

I want to stress that I fully believe that this interdisciplinary work can be done, and is, for that matter, already happening in the developing forums for health humanities and in community spaces where health humanities activism and scholarship meet. If we are to pursue a truly “entangled” health humanities, as Viney, Callard, and Woods propose, we cannot and should not abandon disciplinary difference in favor of some vague sense of polyvocality or multiplicity. The disregard or purging of such difference in favor of entanglement risks erasing the very power dynamics that continue to impact not only marginalized patients navigating the medical-industrial complex but also the practitioners themselves. If we want to move toward more patient-centered, ethical care and do responsible scholarship, we cannot afford to be sloppy with our interdisciplinarity.

[1] William Viney, Felicity Callard, Angela Woods, “Critical Medical Humanities: Embracing Entanglement, Taking Risks.” Medical Humanities 41 (2015): 2—7.

[2] Ibid. 3.

[3] Ibid. 4.

[4] Ibid. 4.

[5] Ibid. 3-4. See Sara Ahmed’s On Being Included: Racism and Diversity in Institutional Life (Duke UP, 2012).

[6] Ibid. 3.

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