Medical Humanities

    Medical Humanities

    Anna McFarlane

    The medical humanities were developed as a means of using the tools offered by several fields in the humanities – law, history, and literature among others – to improve or interrogate experiences of healthcare and patienthood. Humanities training for doctors, particularly, has been valued in that it encourages medics to listen to their patients closely and to consider what is being communicated by certain uses of language in a process described as “narrative medicine”.[1] Claims for narrative medicine focus on the importance of communication between doctor and patient, and the improvements in communication that humanities training can elicit. It is claimed that this encourages medics to think about the patient as a three-dimensional human being, and to approach healthcare as a holistic enterprise, working with the patient to defeat death and disease. However, this approach finds the humanities important primarily due to their instrumental use-value in creating better physicians (physicians who can more humanely apply medical technology to the body of the patient), and communication is recognised primarily as verbal, with some body language. Thus, a posthumanist approach might seek to reveal and critique the liberal humanist assumptions that underlie such a position, complicate the concept of communication and acknowledge the implication of individuals in wider systems, while also engaging with recent developments in biotechnology in a nuanced way that recognises continuities between the body and technology.

    A posthumanist perspective offers something to the medical humanities, in that the figure of the ‘human’ has been a staple since the field’s inception. Medics are encouraged to care more deeply and considerately for patients by seeing beyond the sick role to a human identity worthy of individual care and attention. Critiquing the medical humanities from a posthumanist perspective encourages us to re-evaluate the importance of the figure of the ‘human’ in eliciting empathy, and being worthy of care. This re-evaluation might draw on the concept of community to consider quality of life as aligned with the integration of human and non-human others as well as the environment. This would mark a departure from the conception of the human as an individuated subject who is ‘broken’ by sickness and can be restored to the ‘wholeness’ of health, or of the doctor who must add the humanism of arts and interpretation to his repertoire of mere biotechnological mechanics. These liberal humanist assumptions inadvertently re-inscribe the material and spiritual duality of the patient at the expense of recognising the interconnectedness of human and non-human being. In a 2008 paper, Jeffrey Bishop argues that attention should be paid to the medical humanities approach which can be used to reinforce an unhelpful dualism that aligns medicine with pragmatic action and a mechanical view of the body, while the humanities are aligned with the soul or consciousness and valued only for their usefulness in helping the doctor successfully treat the body.[2] Separating the material from the spiritual in this way, and looking to the humanities as a tool for achieving the goals of medicine, means that the metaphysics of medicine and its possible unintended consequences remain invisible and therefore unchallenged. Bishop argues that,

    “the medical humanities and narrative medicine are just the latest, and a more palatable means of control, of acknowledging the narrative overlay, the mythic cover, in order to master the material beneath. Thus, the narrative overlay becomes the tool by which the doctor can sway a patient, to make him or her feel better, to create a therapeutic relationship; indeed, narrative sensibility becomes a therapy itself. The usefulness of humanism is precisely about efficient control of the bodies – the animality – of the body politic, even while humanism thinks of itself as being about emancipating and liberating”.[3]

    Such criticisms of the humanism of the medical humanities demand the development of a medical posthumanism that critiques humanist assumptions, values and practices in environments where power and control must be viewed with caution, if not suspicion.

    The need for a medical posthumanism builds with the increasing availability of complex biotechnologies. Interventions like sub-dermal regulators (currently in use for diabetic patients), pacemakers, and life-prolonging techniques call out for ethical consideration. The dividing line between healthcare, which seeks to return patients to health and independence where possible, and enhancement, which offers abilities beyond those that can be achieved without biotechnological intervention, is often no longer clear. Such a development means that medicine begins to actively direct capabilities, regulating human dependence on, and entanglement with, medical technologies. This demands critical and political engagement with the medical domain, something that the medical humanities field has responded to with the development of a ‘critical medical humanities’, which has begun to suggest some of the issues that a medical posthumanism might take up. Early signs of this project can be seen in a special issue of the journal BMJ Medical Humanities in 2015 whose editorial, by William Viney, Felicity Callard, and Angela Woods, argues that the limitations and drawbacks of the medical humanities must be considered: “We are thinking, for example, of the frequency with which some of those aforementioned areas of focus have been enabled by particular – humanist – models of the self, of the ill and suffering body, and of modes of intervention and care”.[4] While the authors describe their movement towards a critical medical humanities as a second wave, reacting to the first wave of medical humanities which focused on pedagogical concerns in medicine, the position taken here also points to the value of a medical posthumanism.

    From these beginnings, the project of formulating a critical medical humanities was developed in the recent Edinburgh Companion to the Critical Medical Humanities (2016) which recognises the overlap with posthumanism. Here, Luna Dolezal outlines the ways in which the human has already become somewhat malleable through the use of cosmetic and gender reassignment surgeries.[5] Dolezal points out that transhumanists and posthumanists have argued for ‘morphological freedom’ to be treated as a human right, allowing humans to be able to experiment with new biotechnologies for self-actualisation and to experience ‘posthumanity’. However, she argues that this view of the body as a piece of property in need of renovation is tied up with neoliberal concepts of ownership and individuality, rather than looking to a truly post-humanist model of embodiment.[6]

    Also investigating some aspects of what posthumanism might do for the medical humanities is a recent special issue of BMJ Medical Humanities on ‘Science Fiction and the Medical Humanities’ whose editorial makes the case for the ways in which science fiction impacts the technoscientific imaginary – the conception of technological possibility shared by communities, making scientific development a priority and an expectation.[7] The issue covers future bioethics, disability studies, prosthetics, and ectogenesis as possibilities for the future of medicine that already demand a re-evaluation of what it means to be a human subjected to or practising medicine, even when the possibilities discussed remain hypothetical.

    By using medicine as a locus for humanities enquiries, medical humanities can be a space for questioning the ways in which biology and society mutually construct the subject – pertinent conversations for those involved in thinking through the possibilities of a critical posthumanism. While posthumanist discourse has begun to enter the medical humanities, particularly through the critical wave in the field, an explicit focus on posthumanism might sharpen and radicalise the points being made. Such a position encourages discussions of how humanity might change with technology over time, particularly when the fields of futurology, bioethics, or speculative fiction are engaged while, at the same time, prompting us to consider the ways in which the concept of humanity has already been shaped by medical, technological intervention and humanist assumptions.

     

    – Glasgow University, 2017

    Keywords: medical humanities; disability studies; medicine; science fiction

     

    [1] Rita Charon, Narrative Medicine: Honoring the Stories of Illness (Oxford: Oxford University Press, 2008).

    [2] Bishop, Jeffrey P., ‘Rejecting Medical Humanism: Medical Humanities and the Metaphysics of Medicine’, Journal of Medical Humanities, 29 (2008), 15-25.

    [3] Bishop, p. 22.

    [4] William Viney, Felicity Callard, Angela Woods, ‘Critical medical humanities: embracing entanglement, taking risks’, BMJ Medical Humanities, 41 (2015), 2-7.

    [5] Luna Dolezal, ‘Morphological Freedom and Medicine: Constructing the Posthuman Body’, in The Edinburgh Companion to the Critical Medical Humanities, ed. by Anne Whitehead and Angela Woods (Edinburgh: Edinburgh University Press, 2016), pp. 310-324.

    [6] Dolezal, p. 315.

    [7] Gavin Miller and Anna McFarlane (eds), Special Issue: Science Fiction and the Medical Humanities, BMJ Medical Humanities, 42 (2016).