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Richard Smith: Medicine’s need for the humanities

30 Dec, 10 | by BMJ

Richard SmithI spoke as well at the meeting on valuing the humanities at the London School of Economics (see blog below), and I argued that medicine needs the humanities badly.

The NHS and overseas aid are the only budgets that have been protected by the coalition government, and universities, particularly the teaching of humanities, have been hit especially hard. Even though “protection” for the NHS means 4% “efficiency savings” every year for four years,  those of us in health care should, I believe, speak up for other sectors. Indeed, I think that some, perhaps even many, within health care would argue that it might be better for the country to cut health care and invest more in education.

I fear—and I’ve written this before—that health systems around the world are engaged in “an unwinnable battle against death, pain, and sickness.” We will all die, and do we want in Britain to follow the US and eventually spend 16% of our GDP on health care in fending off death? As Atul Gawande, perhaps the US’s most influential doctor, has pointed out intensive care units in the US are “warehouses of the dying.” (Interestingly in this context of valuing the humanities Gawande has gained his influence not through his surgery or research but through his writing.) People have their day in intensive care as they have their day in court, and, as Gawande’s article makes clear, death is often protracted, undignified, dehumanising, and brutal in the US. A recent report in Britain—from Charles Leadbeater for Demos —has made clear that Britons are dying badly as well.

Perhaps the most urgent problem in health care is to change attitudes to dying, and here, I suggest, the humanities have far more to offer than medicine. Medicine is good on the statistics of dying and what we die of but poor on how to contemplate death. If we want to think more deeply about death then we need to study not medical textbooks but Montaigne, Seneca, Marcus Aurelius, Schopenhauer, Wittgenstein, Illich, Saramego, and Julian Barnes. Indeed, perhaps the best book written recently on death and dying by a doctor—that by Iona Heath—is composed largely of quotes by great thinkers in the humanities.

We also need philosophers to help us think deeply and correctly about assisted suicide, something that I’m sure will rise higher and higher on the agenda in the next 20 years.

More and more of life’s inevitable processes and difficulties—birth, sexuality, ageing, unhappiness, tiredness, and loneliness —are being medicalised, and we are growing the budget of health care to tackle them. But medicine cannot solve these problems, and again the humanities can help.

Jonathan Miller, who trained as a doctor but has spent his life in the arts, has talked about medicine’s need to rediscover the human side of medicine after several decades of being diverted by exciting technical possibilities.

We within health care also need the help of those in the humanities to define health. There is, it seems to me, growing interest in defining and promoting health, and we need to move beyond medicine’s de facto definition of health as “the absence of disease.” Health and the platonic idea of the good life may be close.

I believe as well that the humanities can help us with a problem as pressing as that of attitudes to death—climate change. Scientists have long identified the problem, but we have failed to act effectively– largely, I believe, through our evolutionary flaws of selfishness and lack of imagination. “I’ll let somebody else make the changes needed to reduce carbon emissions,  and I simply can’t imagine how awful the world is likely to be for my grandchildren and their children.” Imaginative works can help us, and George Monbiot, one of Britain’s leading commentators on environmental issues, has said that the greatest book written on climate change is Cormac McCarthy’s The Road. The ancients also created powerful images of the consequences of humanity over-reaching itself—read, for example, Ted Hughes’s  magnificent translation of Ovid’s Metamorphosis, particularly the poem about Phaethon, who lost control of “the chariot of the sun” and burnt the land.

Those who value the humanities are speaking up in their defence, and one of the best pieces I’ve read comes from  James Vernon, a Mancunian who is now professor of history at UC Berkeley.  In his essay, “The end of the public university in England,” he says how “The humanities…offer us the chance to think otherwise,” something I believe to be especially important for doctors. “The humanities,” he continues, “speak to different systems of value—of imagination, beauty, laughter, and wonder….Economic utility is not the measure of who we are or who we want to become.”

Medicine has increasingly recognised its need for the humanities, and courses in the humanities are springing up within medical schools and new journals are starting. But it would be fair to say that so far the humanities have been marginal within medical education. The current threat to the humanities should lead us to recognise their importance to medicine, incorporate them further into medical training and thinking, and speak up for them. Inevitably doctors arguing for the importance of the humanities will sound less self serving than humanities practitioners speaking for themselves.

G. John Kennedy

When power leads man toward arrogance, poetry reminds him of his limitations. When power narrows the areas of man’s concern, poetry reminds him of the richness and diversity of his experience. When power corrupts, poetry cleanses. For art establishes the basic human truths which must serve as the touchstones of our judgement. The artist . . . faithful to his personal vision of reality, becomes the last champion of the individual mind and sensibility against an intrusive society and an offensive state.

Richard Smith was the editor of the BMJ until 2004.

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  • Vcm

    I find the sentiment admirable but to my mind there is no shortage of literature, films or great works which elaborate the points you discuss- dying well, true health, climate change- beautifully. A large number are freely available through the internet. It is not a shortage of humanities to me, more a question of access and distribution and bringing these topics to the fore, which falls into media and distribution. I don't think bigger or smaller humanities budgets will make a difference. The best works often are written with small budgets. It is a question of application, cross-media platforms where healthcare and other skills come together to apply these thoughts.

  • http://twitter.com/psychoticyordle Mike Rees

    You've given loads of examples of why we needed humanities. I can't see one as to why we need it. The resources are already out there – spend the money making doctors read them.

  • http://twitter.com/PostFilm Dr Ian McCormick

    I share VCM's points below, and having enjoyed a long and privileged career in the literary arts I'm now thinking and feeling that the long under-resourced field of community arts is where resources would be best focused. That positions demands having a recogbition of the creativity of ordinary people, as well as their capacity to respond to others' creative work.

  • Matthew_bushell

    Both VCM and Dr Ian McCormick have identified a significant application for the humanities (Community Arts) which is, certainly within my society, already seems to be on peoples minds and agenda's, especially where concepts of Wellbeing (which is, if I'm not wrong, advocating an improvement of personal, social and cultural consciousness in order to enhance functionality and efficiency of modern societies on all levels and across all sections) and are concerned – through community engagement it is possible to resurrect ancient and historic wisdoms which themselves offer people practical insight into what it is to be human but in a way that enables, through application, a whole host of transformations, from physical to psychological. It seems to me that there is currently a kind of adolescent, philosophical confusion about the function of knowledge – both what it should be used for and how it should be used; I have found there to be an emergence of a practical philosophy geared toward the advancement of personal and social consciousness that, when simplified, seems to contain all that is needed for the world to initiate positive and meaningful change.

    The issue of course still seems to be that the empirical method has a strangle hold on our intellectual evolution – just as theology once had – disallowing the emergence of alternative practice on the sole basis of not knowing if it is really 'trustworthy'. The sensible thing to do, for ecological purposes (as far as I can think) is to combine Scientific Reason with the more subjective and inter-subjective emotional experiences of man, in order to create a narrative for evolution that does not alienate the common man, instead actively bringing him into the very experience of evolution. I find it excruciating to read so much hopeful literature and yet see, locally, so little integral development, in the sense that I am personally, as an example, struggling to engage the attention of the academic, religious and political community with practical discussions about how best to stimulate a human advancement in thought and practice. The reality, it seems, is that the higher-communities are too busy, too indulged to let go of their most intimate passions, passions which many accept are a result of their particular lives and thus no more important or useful than the passions of a Bin Man, or Factory Machinist.

    Art has not, at the grass-roots level and within many societies, yet been understood as being a means to great ends: many powerful people fail to understand what is happening in Artistic processes, as they do in other, more common psychological processes, and yet there is good enough reason, supported by science, to accept already that through experiences, well structured experiences, people can achieve impressive insights into the nature and thus the benefit of collaboration and cooperation.

    All this said, and I think Richard Smith himself seems to be advocating a move toward an increased, intrinsic relationship between the physical Sciences and the more, shall we say (not wanting to inflame sensitivities) Metaphysical (Imaginative) Sciences, in order to serve not least an economical benefit but, dare I say it, a spiritual one? I don't want to miss the point. Should those working in the Humanities be supporting those working in Health? Of course and vice-versa and absolutely the cuts in Education has set us back – I dread to think – a very long way. Again, all that said, perhaps it is over complicating the issue by categorizing precisely who should be helping who. We should all be helping each other and I find it utterly unacceptable that there is so little interdisciplinary collaboration across the board – and especially within Universities. So something does have to change.

    I think communities (the country and the world – and I'm sure it is happening in places already) ought, through Creative Play (if you will) explore their thoughts and feelings, with the help of the Science and the Humanities (every credible, useful discipline on the planet), about what it means to be human. We need to be thinking in more ecologically interdisciplinary ways, with a will to transcend cultural habits and barriers with communication and behavior.

    Where there is the Will, there is the Way…as someone once said. Does anyone know?

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