Medical Humanities Blog

History of Medicine & Narrative

As the Annual ASBH meeting draws near, I was interested to read Giskin Day's account of the recent (UK) Medical Humanities Association Conference, which took place earlier this month.  She notes a relatively controversial presentation by John Wiltshire, in which he argued that

the 'true' history of medicine has not yet been written: what we have is a history of profession and institutions. History is made up of narratives, but the performative act of medicine robs the patient of the opportunity to shape his/her own story into narrative (for Wiltshire, narratives are primarily written, addressed to a reader and involve an intellectual presence that mere story does not). The 'true history' of medicine is the formal patient narrative which also serves as a valuable critique of medicine, for example Fanny Burney's description of her mastectomy.

This provokes many interesting questions, I think.  First, while I tend to agree that a history of professions and institutions is not equivalent to a history of patients, I would also suggest that a social history of those professions and institutions necessarily informs a history of patients insofar as the former is a primary, albeit not the only factor in the construction of patient experiences.  The nature of patient experiences would naturally seem to depend a great deal on the medical professions and institutions that inform the relevant culture(s).  No?

Second, Wiltshire's argument raises some fascinating questions for me on the relationship between personal narratives (whether pathographies or broader narratives of health care experiences) and the history of medicine.  If the "true" history of medicine is really a study of the history of patient narratives, than I must admit I do not see a drastic difference between the history of medicine and the ethnographies of medical anthropology.

On that note, Day notes that another speaker, Sander Gilman, took issue with Wiltshire's assessment, noting that "narratives don't necessarily reflect patient reality, they are are patients' encounters with 'the system' and are no more 'true' than other types of narrative."  I tend to agree more with this claim than with Wiltshire's.  Indeed, I am uncertain what the notion of a "true" history of medicine actually entails, let alone whether patient narratives are more "true" than representations of medical professions and institutions (which themselves must be explained in terms of the people, context, and practices that animate them, I submit).

Thoughts?

Aesthetic Model of Literature & Medicine

Today's installment of the Lexicon will explore the aesthetic model in literature & medicine ("L&M").  L&M as a formal scholarly pursuit has only existed since the early-mid 1970s at the earliest, but I tend to think it has contributed richly to the analysis of biomedicine from a humanistic perspective.  Dr. Rita Charon, one of the leaders of the L&M movement, maintains an excellent web resource on all matters L&M at the web site for Columbia University's Program in Narrative Medicine.

Literature Review

I apologize for the dearth in posting for the last week.  I hope to have three posts up by the end of this week, two literature reviews and an entry into the Lexicon.  Today's review will collate articles from

J. of Religion and Health

J. of Legal Medicine

Vesalius

The purpose of this blog is to help shed some light on the nature of the medical humanities, both for its practitioners and students, and for interested laypersons.  Posts have thus far belonged to one of three general categories: the Literature Reviews, the Medical Humanities Lexicon, and Medical Humanities Happenings.  I realized, however, that I have been remiss in failing to include a category for posts relating to historical figures that are of importance to the medical humanities.

Thus, this post will represent the first effort at a "Who's Who" of persons who are relevant to the medical humanities today.  As always, the hope is that surveying, in a necessarily (and painfully) brief manner, some of the people who have shaped the dialectic of the medical humanities will also shed some light on the meanings and contours of the medical humanities as they currently flow.

The first entry in this category will be Andreas Vesalius.

New Publication

The ASBH was kind enough to send me (and all of its other members?) a gratis copy of the new book Narrative Matters: The Power of the Personal Essay in Health Policy.  The blurb on the back of the book reads as follows:

Drawn from the popular "Narrative Matters" column in the journal Health Affairs, these forty-six articles focus on such topics as the hard financial realities of medical insurance, AIDS, assisted suicide, marketing drugs, genetic engineering, organ transplants, and ethnic and racial disparities in the health care system.

The book is edited by Fitzhugh Mullan, M.D., Ellen Ficklen, and Kyna Rubin, and features a foreword by Abraham Verghese, M.D.  This looks to be a terrific read and the subtitle alone is a microcosm of the medical humanities: "the power of the personal essay in health policy."  Using the insights and theory of narrative studies to illuminate features of health policy and bioethics seems to me to be a paradigm case of medical humanities work.

Many thanks to the ASBH for providing the book.

Organ Transplantation Conference

The University Medical Center of Rotterdam, Netherlands is hosting a conference from April 1-4, 2007.  The topic is "Organ Transplantation: Ethical, Legal, and Psychological Aspects," and the conference is geared towards initiating a European Platform.  The conference website is available here, and does include a call for abstracts, with a submission deadline of Nov. 1, 2006.

Literature Review

Today's review will feature articles from the latest issues of:

Social Science & Medicine

J. of Clinical Ethics

Vesalius (the journal of the International Society for the History of Medicine)

J. of the Kennedy Institute of Ethics

Literature & Medicine

Medical Humanities Lexicon: Medicalization

Today's entry in the Lexicon will be "medicalization."  Medicalization is, I tend to think, an important concept in the medical humanities, and has particular application in all manner of fields, including anthropology, sociology, bioethics, disability studies, gerontology, etc.  Though I am not aware of the precise origin of the term, it received its most direct expression in Irvin Zola's 1972 seminal article, "Medicine as an Institution of Social Control."  (1972).  Sociology Review, 20(4):487:504.

As I understand it (and, as always, the Lexicon is irreducibly a product of my own understanding), the term "medicalization" generally refers to the encroachment of culturally (Western) biomedical concepts, terms, and values into a discursive space the boundaries of which need not necessarily be defined in biomedical contours.  This excellent web resource on medicalization defines it as an "expansion of the medical institution and reviewing deviance and the processes of human life from a medical perspective. In the process of medicalization the power of medicine extends to areas which were considered non-medical."

In studying the medical humanities, I have been chiefly struck by a sense of how entrenched medicalization is, such that it becomes difficult to even perceive its wide-ranging social effects and influences.  The study of aging, for example, has been dominated by medical views and attitudes towards aging.  Under the medical model of aging, aging is often seen as akin to a kind of deterioration, of a winding down of cellular processes, accompanied by a concomitant increase in disease, dysfunction, and disorder.  Senescence thus becomes something requiring (medical) management, and its associated breakdowns and malfunctions become forces to be resisted and, to the extent possible, overcome (by the formidable armentarium of biomedicine, chiefly).

Naturally, this is both a polemic and an oversimplified formulation, but it is not, I submit, so crude as to be wholly inaccurate.  A medicalized sense of aging is conveyed quite clearly, for example, in Michael Gazzaniga's recent book, The Ethical Brain.  The problem with the medicalization of aging or senescence is that, of course, there are myriad different ways to view aging aside from a condition of deterioriation and disease.  Indeed, one might, as gerontologists have for some time, begin by even questioning whether senescence is something that should be resisted.  Cicero refuted this conception himself in his famous essay, On Old Age.

As another example, the medicalization of old age commonly produces a conception that older persons are more likely to have rigid, ossified, thought, and are less capable of creativity (consistent with the functional deterioration model of aging).  Why? Why should one believe that older persons are generally less able to think creatively, to generate, as younger persons can? Joan Erikson argues for the concept of generativity in senescence in The Life Cycle Completed.

All of this is ripe for debate, of course, and by asking such questions, I do not pretend to answer them here.  The point is simply to offer an example of the ways in which a particular social conception results from viewing it through "medicalized" lenses, and to suggest that there are a number of social phenomena that merit analysis from gazes that are derived from non-medical milieu.  Regardless of the position one takes, awareness of the medicalization of phenomena that could theoretically be explored through values, concepts, and lenses that are not traceable to the culture of biomedicine is itself significant.  For better or worse, the medical paradigm is so conceptually dominant that it is often difficult to see the ways in which phenomena that are arguably not reducible to medical phenomena are characterized, explained, and conceived of largely in medical terms.

Literature Review

This review will collate abstracts from the following journals:

Medical Anthropology

Bulletin of the History of Medicine

Journal of Medicine & Philosophy

Medical Humanities Lexicon: Principalism

For the first installment of the Medical Humanities Lexicon, I'd like to try to illuminate a basic conception of "principalism."  Of course, any entry in the Lexicon will be nothing more than a crude sketch of the concept under examination.  However, offering a brief introduction, as well as some suggestions as to how any such concept might be relevant to the culture of biomedicine will hopefully prove a worthy endeavor.