Medical Humanities and the University Humanities Center

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Medical Humanities and the University Humanities Center

Let me begin with an anecdote.

I’ve recently been reviewing a book about stories that are told from a parental point of view--stories that are often contained within the classics of Western literature but which largely go unnoticed there or are easily forgotten, supplanted in memory by stories told from the perspective of a child (the default narrative perspective, whether occupied by a child in youth or by a grown-up son or daughter).

In reviewing this book, I was struck (as a frequently am) by the continuing relevance of the ancient Greek myths to our experience of contemporary life.

In the particular example I’m about to give, I was struck by how long human beings have been actively seeking treatment for infertility. But also, and more significantly, I was struck by how unpredictable the consequences have always been not only for the individual seeking such treatment, but for the entire social community in which such seeking occurs: by how pervasive and unexpected are the political and cultural ramifications of what seems at first to be just a simple, isolated, personal choice.

As you’ll recall--in Euripides--Medea is given political refuge in Athens, despite the fact that she has committed three acts of premeditated murder (two of her victims being, infamously, her own children). Why she goes unpunished by both gods and men has something to do with the circumstances. That is, she makes a (pre-murder) deal with King Aegeus that--in return for his granting her “unconditional right of residence” in Athens--she’ll give him “fertility drugs” ( pharmaka ) that she guarantees will work:

Aegeus has stopped in Corinth in order to “discuss the reply of the god” with the wise and “righteous” Pittheus, King of Troezen. But Medea obviates the necessity of an interpretation of the Oracle, by promising to use her pharmaceutical expertise to assist Aegeus in conceiving a child: This sort of reading—which, among other things, discloses the historical constant of child-longing and its effects on the political narrative--strikes me as possible only outside the bounds of strict disciplinary thinking: in literary studies, at least, this Euripides play is more commonly cited as evidence for the destructive force of erotic love. “Medical Humanities” is one of several attempts to solve the problem articulated in C.P. Snow’s extremely influential “two cultures” essay: a way of widening the lens beyond the scope of any individual discipline—a way of expanding our perspective so as to take in the many silos of disciplinary thought and method that are scattered across the intellectual landscape, in both the humanities and the sciences. It’s a way to bring together diverse ways of thinking, perceiving, describing, and valuing so as to open up scholarship and to problem-solve more effectively. I take this collective endeavor at making knowledge differently to be the proper remit of “medical humanities” on the university campus.

And by “university” here, I specifically mean the arts and sciences, rather than the medical school, where “medical humanities” generally entails a distinct—if overlapping--set of values, aims, and purposes. Bluntly put, the purpose of “medical humanities” in US medical schools is to revise the curriculum and training of medical students so as to make them more client-friendly, to encourage doctors to be more empathic (more responsive, more “humane”) in their interactions with their patients and in the treatments they prescribe: in other words, to train physicians to think of their patients as embodied subjects (as individuals with their own desires, histories, and self-knowledge) rather than as merely a repository of body parts or a site of disease.

***

Over the past several years, there has been a tremendous push among US academic institutions to develop an undergraduate curriculum that emphasizes the humanities aspect of the human sciences. Dozens of programs of study have been established—at both public and private universities—bearing a variety of slightly different names (“Medicine, Health, and Society”; “Medicine, Literature, and Culture;” “Medicine, Literature, and Society”; and so forth). All of these share, however, the common purpose of exploring how the disciplinary perspectives of the humanities shape our understanding of illness, health, and well-being.

The “medical humanities” undergraduate major that we’ve devised at Columbia University is offered through the Institute for Comparative Literature and Society. This new major—which is significantly comparative in nature (students must show proficiency in two languages besides English)--is not intended primarily for pre-med majors. Although it actively engages physicians and other health professionals as teachers and mentors, many of the students who take it have no intention at all of becoming doctors or health professionals themselves.

Here’s a description (drawn from the Columbia University website):

University Humanities Centers (now numbering in the hundreds around the world) are frequently key players in facilitating “medical humanities” activity on their campuses and between institutions. Although located at the hub of intellectual activity on their campuses, a university humanities center also exists outside the departmental structure that dominates most US universities, thereby largely exempting them from the narrow disciplinary perspectives and parochial loyalties of departments. They sit in the midst of their universities—but, figuratively speaking, they also sit above the fray, and there they have a panoramic view: they’re able to see how various individuals and entities (departments and initiatives) might be brought together to work cooperatively. They provide neutral territory—a space for the play of ideas—which is optimal when facilitating the growth of a program that, like “medical humanities,” not only crosses academic departments, disciplines, and schools, but often makes common cause with individuals, institutions, and communities outside the academy as well.

The Andrew W. Mellon Foundation (the largest non-governmental source of funding for the humanities in the United States) has recently recognized the unique value of university humanities centers in fostering “new forms of collaborative research across national, regional, and disciplinary boundaries” and in “explor[ing] the ways in which” humanities centers—working together—“can further scholarly innovation in the humanities on a global scale” [CHCI website}.

Working through the Consortium of Humanities Centers and Institutes (otherwise known as CHCI), Mellon has awarded millions of dollars in just the past three years to a project called “Integrating the Humanities across National Boundaries.” One of the first recipients was the CHCI Medical Humanities Network Program:

In conclusion, let me draw attention to two problems in the US (one of longstanding; the other, just now coming into being) that may be forcefully combatted by our institutionalizing medical humanities on the undergraduate level globally. And the sooner this is done, the better—since it is on the undergraduate level that any shift in perspective and attitude great enough to affect socioeconomic policy has the best chance of taking hold. That is, if we educate our future health professionals at a young-enough age, we may be able to change the way that healthcare policy and decision-making is made. It seems to me that the most serious problem we face is not how to get scientists and humanists to talk to each other (as C.P. Snow thought), but how to get them to join forces to combat the combined power of insurance and drug companies, which because they control the purse strings, dictate medical policy and practices in the United States (determining who gets treated and what kind of treatment they receive).

The first of the two major problems we face is the recent move by some universities (including my own) to invest resources in what is called “personalized” or “precision” medicine—or sometimes “personalized precision medicine.” This is how Wikipedia defines it: “Personalized medicine,” that is—capitalizing on advances in genetics, new medical technologies, and pharmaceutical research—promises its patients more customized diagnoses and targeted therapies. It also promises huge profits for insurance, drug, and medical technology companies.

I suspect that US medical schools and teaching hospitals—which are constantly competing for grant money from government, industry, and private foundations simply to survive—look to “personalized medicine” as a possible cure for their financial distress. Backed by medical R & D companies and big pharma—as well as being attractive to grant-giving institutions, which almost always favor potentially ground-breaking research over, say, a wider distribution of AZT or even malaria prevention—“personalized medicine” is likely to benefit only the super rich--as both patients and investors (including investors in so-called “Cadillac” insurance programs). It’s as though university development offices, looking for a new source of income, have hit upon a new class of donors—those extremely wealthy people who are not temperamentally inclined to be philanthropic but who are willing to invest in research that may increase their own (already extremely long) life expectancy.

The second, older, and more frequently discussed problem facing the US is an ideological one: whether healthcare should be (like elementary and secondary education) a legal right of all US citizens (if not of all US residents).

If we have any chance at all of making the legal argument that the right to healthcare is as basic a right as that to education, it will be (again) through education itself--and through the sort of cross-disciplinary studies and engaged scholarship that “medical humanities” entails.

Even though I hate to give Ronald Reagan the last word, I’ll end with some brief excerpts from a ten-minute radio “message” he gave in 1961 (that is--almost two decades before he became president, and six years before he became Governor of California)—a “message” paid for by the American Medical Association (a still quite conservative organization, though, thankfully, representing the views of fewer and fewer American physicians each year: less than 30% of American doctors currently belong to the AMA).

As you’ll hear, Reagan’s message is that “socialized medicine” is a threat not simply to capitalism (which, in this case, profits on the illness of others), but, indeed, to what he holds to be the “American” way of life. (This is an attitude still held fiercely by a small but extremely powerful segment of American society.) http://www.youtube.com/watch?v=AYrlDlrLDSQ