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Empathy and Affect in Medical and Theatrical Practice: Sophocles, Beckett, Edson

19 Sep, 17 | by amcfarlane

Empathy and Affect in Medical and Theatrical Practice will be a two-day event on the 14th to the 15th of October at the University of Warwick. The event will bring together theatre practitioners, clinicians, and scholars in humanities and medical ethics with other members of the public to consider the embodiment of illness (both physical and mental) in theatre. Asking, as its starting point the following questions:

  • How does theatre elicit empathetic engagement; what different perspectives can it provide on a character or a ‘condition’; and how might this bear on encounters in medical practice?
  • How does the entire theatrical language of a play – the bodies, stage, use of space and gesture, lighting, sound, and so on – contribute to the exploration of the pathologies represented and the relationships that surround them?
  • What does theatre, including masked theatre, tell us about strategies for communication, particularly when the capacity for self-expression is impaired?
  • What might the processes of embodiment entailed in theatrical performance offer to our understanding of somatization, physical manifestations of mental distress, and the relationship between mental and physical illness?
  • How might the ethics of the consulting room be illuminated by the encounters in and complex emotional texture of these works?

Three plays from very different contexts—Sophocles’ Electra, Samuel Beckett’s Not I, and Margaret Edson’s Wit—will provide the source material to stimulate interdisciplinary discussion of these questions. These plays, and our discussions, consider complex and unexplained illness, trauma and distress, conditions that themselves affect and impair communication, life-threatening conditions and end of life care, pain and grief. We will ask what role the pre-linguistic, the bodily, and the affective have in the experiences and relationships that attend such conditions. What ethical and emotional challenges do doctors, nurses, patients, carers and families face in the particular social exchanges that medicine entails?

Those who attend will be encouraged to be active participants in discussions, stimulated by short position papers, round table discussions, and performances of excerpts from all three plays. The event is free but places will be limited. To express interest in attending please email Ania Crowther (s.m.crowther@warwick.ac.uk).

Through a Shattered Lens

18 Sep, 17 | by amcfarlane

By Rebecca Marshall

Through a Shattered Lens by Rebecca Marshall

How to tell a shattered story?

By slowly becoming everybody.

No.

By slowly becoming everything.

There will always be a line, a phrase; threads of words which hook onto you. For me, it was Arundhati Roy’s words above (in her latest novel, The Ministry of Utmost Happiness) that weaved their grip around a memory of mine. A memory, not unlike one of those beloved novels sitting on your bookshelf, that needs dusting off and revisiting from time to time. Anjum, the central character in the novel is a ‘hijra‘ (Hindu word for a transgender individual), who battles with identity, belonging and physical health; themes which resonated with this particular memory of mine. Just as Roy mystically paints the fragmented narratives of her characters, it was my experience of exploring a patient’s story – the backdrop to their clinical presentation – that laid the foundations for my decision to break away from clinical medicine into medical anthropology. And just as Roy utilises the power the narrative to understand contemporary Indian history, I found a similar magic in the patient’s narrative in terms of uncovering their medical history.

Entering my clinical years as a student in a wholly unfamiliar and daunting environment, my mind was already whirring with theory from my Global Health iBSc. Yet putting this theory into the context of patient cases, enabled me to find a different way of seeing, a different way of knowing.

I was to meet the patient from this particular memory during my fourth year of study (with a fellow medical student), on the Infectious Disease ward inside the towering block of University College Hospital, Central London. Armed with our face masks, a few sterile facts, and an encouraging nod from our Consultant, we set off to clerk our patient. Using our well-ingrained structure, our logical framework, our clear and well-circumscribed lens, we were set the task of The Structured Medical History.

Twenty-Five year-old. Male. Originally from Pakistan. Presented with weight loss, productive cough, haemoptysis. Isolation room. Structured Medical History. Okay?

Walking into an isolation room, a skeletal yet smiling young man greeted us.  As we delved into our framework for taking a history, he seemed to tick off many of the classical symptoms for tuberculosis. He described the many challenges of balancing so many different antibiotics and their side-effects. A gruelling task for most. We changed course to his social history. Alongside his studies, he was working part-time for a food-courier company. Joking together about the quality of hospital food (or lack thereof) seemed to mildly bridge the divide that our masks had created. A shift in dynamic and our patient started to show us photos on his phone of the appalling housing conditions he had been living in. Damp, mould, lack of heating. Yet he was happy in London, living with his boyfriend –it offered him a freedom. As a refugee from Pakistan, uprooted from his home, he faced unbearable levels of stigma and possible criminal prosecution for his sexuality. I sat absorbing, listening to each layer of his shattered narrative unfold.

Later that afternoon in our case tutorial, our teaching consultant summed up the case: ‘A classical presentation of an ancient disease…. with a modern twist.’

But this didn’t capture the history. Not even close. This was a narrative of a young man struggling with his identity, torn between loyalties, across geographic and moral borders. This was not a diagnosis of tuberculosis. This was a diagnosis of stigma, of social injustice, of forced migration. This was a diagnosis of an individual uprooted from his land, his family – his home. A diagnosis shaped by the insidious forces of structural violence, both in Pakistan and the UK. Yet on a human level, this was an individual’s tale of conflict.

From this point onwards, my well-circumscribed lens had been shattered. This wasn’t a disease or case that could be neatly boxed into a category; it couldn’t be narrowed down to a single choice in an MCQ question. It was complex, messy – and honest. For me, this way of looking at illness and health alike, addressed the questions that I wanted to ask. How could a patient’s own narrative shed light on understanding the cause and impact of illness? What were the wider socio-cultural forces that had shaped his disease and suffering? How do these processes in different cultures and in different communities interact? And how do we begin to navigate these differences across amorphous global and ethico-legal boundaries?

As I continued with my clinical studies, it became evident that medicine needs to be viewed itself as a culture: a culture with its own language, traditions and social behaviours.  As a rite of passage, a medical student is taught the structure (almost a formula) for taking a patient’s ‘history’. Through this well-circumscribed lens, we should be able to decipher a patient’s presentation with clarity and focus. During this process, the medical discourse meets the patient’s discourse, an interface – a meeting of cultures. The so called ‘doctor-patient interaction’. It was fascinating, as a student, to observe the myriad of possibilities and interactions that took place across this interface. Some full of hope and alleviation of suffering, others riddled with uncertainty, conflict and miscommunications.

Walking into our patient’s negative-pressure isolation room that day on the Infectious Disease Ward, fully masked and gowned, it was hard not to feel the presence of this interface and the creation of the ‘Other’.  Yet these invisible forces that have such an impact on patient care and on clinical decision making, remain neglected and under-researched.

I wanted to keep looking through the shattered lens, to keep listening, examining the multifaceted influences on the human condition. And for me, medical anthropology and the tools of ethnography handed me the opportunity to pursue this.

The late Oliver Sacks, in his novel An Anthropologist on Mars, echoes the importance of the narrative in understanding the world of medicine – as he states, ‘the study of disease, for the physician, demands the study of identity, the inner worlds that patients, under the spur of illness, create. This very much shadows Foucault’s advice to see the pathological world with the eyes of the patient.

I was movingly reminded of this sentiment in Roy’s words, how to tell a shattered story….by slowly becoming everything’, just as I was when listening to the experiences, socio-cultural and biological forces that had shaped our patient’s diagnosis that day.

Conference Report: Empathies

14 Sep, 17 | by amcfarlane

‘Empathies: 11th Conference of the European Society for Literature and the Arts’, Basel University, 20-25th June 2017

By Anna McFarlane

The ESLA conferences have been growing for a number of years, working alongside their sister organisation in America, the Society for Literature and the Arts to promote interdisciplinary communication through wide-ranging conferences that take one term as a starting point, deconstructing and recontructing it across disciplines and through varied media. The organising team for this year’s conference was headed up by Manuela Rossini, a posthumanism scholar with a deep interest in the medical humanities, and an advocate for Basel, her home city, which provided a beautiful sunny backdrop for the conference with plenty of opportunities to swim in the Rhine. Her stewardship showed a programme that engaged with its subject deeply, firstly through the varied keynote speakers; neuroscientist Jean Decety, bioethicist and disabilities scholar Jackie Leach Scully, and philosopher Jesse Prinz, each of whom offered a very different epistemology for what ’empathy’ means, and whether it can be considered a basis for ethical behaviour, both in medicine and throughout society. Across the conference, much attention was paid to the arguments made in Paul Bloom’s book Against Empathy: The Case for Rational Compassion and other critical engagements with empathy, such as invited speaker Carolyn Pedwell’s Affective Relations: The Transnational Politics of Empathy.

As well as exploring empathy through the body of the conference, Basel University offered a number of workshops for early career researchers, one of which focused on medical humanities specifically and included guest speakers Anne Hudson Jones (co-founder of the journal Literature and Medicine), Seamus O’Mahony (medical doctor and author of The Way We Die Now), Ivan Callus (professor of literature and cultural studies at the University of Malta), and Marion Coutts (author of the memoir The Iceberg which tells the story of her husband’s death from a brain tumour). The workshops were not the only extras on offer; a series of entertainments were integrated into the conference programme, including a reading from the English poet and philosopher Denise Riley.

‘Empathies’ was a dense and fascinating discussion that ranged from medical humanities to theories of mind, and the ethics of artistic practice. The next ESLA conference is entitled ‘Green’ and will be held at the University of Copenhagen in June 2018.

Wellcome Trust-funded Research Posts

11 Sep, 17 | by amcfarlane

Three new research posts have been announced for the project ‘People Like You’, a 4-year Wellcome Trust-supported Collaborative Project in the Medical Humanities awarded to Professors Sophie Day (Goldsmiths, Anthropology), Celia Lury (Warwick University, Centre for Interdisciplinary Methodologies) and Helen Ward (Imperial College London, School of Public Health).

It aims to establish the cultural significance of new methods for specifying and portraying people precisely across a range of settings: health care and data science (in the Academic Health Science Centre, Imperial College London) and selected practices in digital culture. The project will develop an interdisciplinary figural analysis in collaboration with three creative practitioners (poetry, portraiture and digital media) to put the ‘person’ back into personalisation and relate people to the data collected from them and on their behalf. The project will assess whether personalising practices are influencing concepts of the person with consequences for individual and collective health.

The project is seeking research assistants at Imperial, working on data science, at Goldsmiths to work on personalised medicine and at Warwick to work on personalisation in digital culture. The closing date for all three positions is the 2nd of October 2017.

Fleeing a Spider’s Web

8 Sep, 17 | by amcfarlane

Enemy, directed by Denis Villeneuve, Canada-Spain, 2013

Reviewed by Dr Franco Ferrarini, Gastroenterologist and Film Reviewer

 

Adapted from Josè Saramago’s novel The Double, Enemy is an intriguing film directed by Denis Villeneuve. The film narrative employs multiple metaphors, embedded in a dream-like environment, which may be difficult to notice or fully understand at first glance. As is usual for the novels of Saramago, the Nobel Prize laureate in literature, there can be several interpretations to his seemingly straightforward stories.

Adam Bell (Jake Gyllenhaal) is a weary and depressed history teacher whose life unfolds in a boring, predictable way. Everyday, he delivers the same lecture on the fraudulent annihilation of people’s identity brought about by totalitarian regimes. To emphasize this message, Villeneuve employs recurring images of big, uniform skyscrapers and cars stuck in traffic jams on a background of a characterless skyline, enticing the viewer to think about the loss of individuality in western societies. Adam meets his girlfriend Mary (Melanie Laurent) everyday at the same time, and they make love in a rather mechanical way.  All of a sudden Adam’s life is turned upside down by the appearance of Anthony Claire (Jake Gyllenhaal again), an actor physically identical to him; they even have a similar scar on their chest. However, Anthony is a determined and assertive family man married to pregnant Helen (Sarah Gadon). A love-hate relationship develops between Adam and Anthony which culminates with them swapping partners. Only tragedy can happen when the rules of the game are broken; the film ends with a sensational scene, one of the most astounding in the history of cinema.

Many questions arise in the viewer’s mind during and after watching this thought-provoking film.

Could Adam be affected by schizophrenic psychosis? This does not seem the case, since his partner Mary, as well as Anthony, both recognize the physical existence of two human beings.

Could Adam and Anthony be twins? This is a tougher question to answer; when Adam asks his mother (Isabella Rossellini) if he has a twin brother, she strongly denies, but later refers to Anthony as ‘a class C actor’ proving that she is aware of his existence.

Could Adam and Anthony be Siamese twins who inherited a scar after surgical cleavage?

From a psychoanalytical viewpoint Anthony could be interpreted as Adam’s Double, his Doppelgänger. The notion of the ‘Doppelgänger’ was described by Otto Rank in 1914, as the shadow of a person who bears all the evil of someone’s personality, just like Mr Hyde in Robert Louis Stevenson’s novel.

The mysterious aura of Adam and Anthony’s story continues with unexplained scenes of spiders crawling throughout the film, a detail that was absent from Saramago’s novel. Big, hairy, scary spiders randomly appear, either explicitly at the beginning and at the end of the film and in Adam’s dreams, or implicitly as the web-like scribbles on the blackboard, and the tramway wires criss-crossing in the sky. What do these ‘spiders’ symbolise? Could they be a metaphor for dictatorships, with their web-like structure designed to control everything and everybody? This sounds like a reasonable explanation but there is probably more: spiders in Greco-Roman mythology derive from Arachne, a maiden who challenged the Goddess Athena in a weaving contest. Arachne won the contest but, frightened by Athena’s rage, hung herself. She was then transformed by Athena into a spider, and condemned to weave for eternity. Spiders are frightening animals but Arachne’s myth identifies them also as a sign of femininity; Villeneuve seems to share this view, since spiders and female characters are often associated in his film. This ambivalence could be explained in a psychoanalytical fashion according to the theories of Carl Jung’s archetypes of the Great Mother as opposed to the Terrible Mother. The ‘feminine interpretation’ is supported by the names of the women: Mary, like the mother of Jesus Christ, could stand for the Great Mother, whereas Helen, like Helen of Troy, the cause of the Trojan war described in Homer’s Iliad, could stand for the Terrible Mother. Revisiting the significance of names again, Adam was the first man created by God. According to the Bible, God then created woman by extracting a rib from Adam, which brings us back to the scar in Adam’s and Anthony’s chests.

Is it possible to find a unifying message in all of the aforementioned speculations? Here is my personal interpretation: Every individual carries an evil Double (the ‘enemy’ of the film’s title), which may bring about dreadful consequences both at an individual level and at a society level. At an individual level, the Double exerts its effects on men through their traditional leading role in war and conflict, and in women, through the exploitation of their roles as the Terrible Mother. At a social level, the Double is totalitarianism with its annihilation of individuality and its tragic consequences of mass destruction, genocide, and so forth.

Enemy is a multi-layered film, hence my explanation may not be welcomed by everyone. Hopefully it might induce readers to watch the film once or twice to appreciate its remarkable artistry, and perhaps discover more theories about its meaning.

Conference Reports: Accounts of Illness in Historical and Modern Texts

7 Sep, 17 | by amcfarlane

‘Accounts of Illness in Historical and Modern Texts: Exploring Methods in Medical Humanities Research Across the Disciplines’, University of Oxford, 27th June 2017

By Anna McFarlane

The ‘Accounts of Illness’ conference was organised by Professor Katherine Southwood of Oxford University as a means of understanding the different methodologies used across the disciplines that intersect in the field of the medical humanities. Dr Southwood hosted the conference through the Oxford Research Centre in the Medical Humanities (TORCH) to enrich her own research in the field of theology, particularly working on the Book of Job as an illness narrative from the Bible.

Dr Jeff Aronson opened the day with a digital humanities approach in a paper entitled ‘Autopathography: A Patient’s Tale’, building on work he has been doing for a number of years identifying and cataloguing death narratives. Dr Catherine Kelsey also argued for the importance of illness narratives, taking a Foucauldian approach to draw attention to the pulmonary illnesses suffered by ex-miners in the UK, while I took the opportunity to share the findings of the Science Fiction and the Medical Humanities project at the University of Glasgow while opening a conversation based on my upcoming research on science fiction as a means of discussing the monstrous aspect of pregnancy. Historical approaches came from Professor Elizabeth Hsu and Dr Hannah Newton who discussed the difficulties in interpreting the symptoms and emotions associated with illness in Ancient China and early-modern England respectively. Dr Therese Feiler provided a quick history of medicine in critical theory, and accounts of illness narratives in contemporary literature came from Professor Olivia Vázquez-Medina and Dr Lisa Mullen, who spoke on Jenny Diski’s memoirs.

Drawing together scholars from Oxford University alongside others from across the UK, this one-day conference showcased the very different work in the medical humanities happening in university departments, stimulating some fascinating conversations about methodologies in the field and what its future direction might be with particular notice in question and answer sessions focusing on the ways in which funders might be shaping research priorities and what illness narratives can do for patients, doctors, and the wider public.

Book Review: The Cognitive Humanities

5 Sep, 17 | by amcfarlane

Garratt, Peter., editor. The Cognitive Humanities: Embodied Mind in Literature and Culture edited by Peter Garratt, London: Palgrave, 2016. xvii + 259 pages, £66.99.

Reviewed by David Rodriguez, Stony Brook University

It is a difficult task to collect work in a coherent introductory volume for a field as diverse, divisive, and multi-disciplinary as the cognitive humanities. Peter Garratt’s The Cognitive Humanities: Embodied Mind in Literature and Culture humbly follows the bulky Oxford Handbook of Cognitive Literary Studies edited by Lisa Zunshine in 2015. But the present collection aims to represent the prevalence of more radical elements of cognitive science and philosophy of mind than the latter. This means that in lieu of critical essays applying concepts from cognition to narrative theory, work in neuroaesthetics, or mapping continuity with experimental psychology, Cognitive Humanities strongly asserts that neither cognitivism nor neurophysiology are productive focuses for humanists interested in the interdisciplinary study of mind and text.

Garratt succinctly argues for the unique value of the field in his introduction (in what is actually a defense of the humanities, in general): ‘an important feature of the cognitive humanities will be looking beyond the horizons of debates already configured and regulated from within the cognitive sciences, creating new terms of reference for different types of conversations that have begun to happen and can continue liberally unfolding, as opposed to adding to what goes on already’ (4). This statement of intent attempts to directly link literary critics, cultural theorists, and theater arts scholars with the philosophers to whom they are indebted for the boosted interest in study of second generation cognitive science in the first place. Previously, in Strange Tools, philosopher Alva Noë made a similar claim about his own discipline: ‘Art has value, then, exactly as philosophy has value. Not because it produces knowledge in the way that science does. But precisely because it is the domain in which we grapple with what we already know (or think we know). It is the domain in which we try to get clear about the ways we think and respond and assign value’ (203). One wonders if the disparity between Garratt’s restatement of the function of the liberal arts and Noë’s bold claim that philosophy is art doesn’t put an undue burden on the cognitive humanities to prove itself to be more than just noise. Though this burden may reflect the experience of many working in the cognitive humanities, it suggests an image of lone exploration rather than creative production.

The most valuable essays in Cognitive Humanities do not just create new terms, but challenge the efficacy of terms and types in the first place. In ‘The Opacity of Fictional Minds’ literary theorist Marco Bernini digs into a central debate in narrative theory without burying the reader in disciplinary squabbles. Through a detailed reading of The Awakening by Kate Chopin, he inverts the now commonplace idea that fiction’s value rests in its ability to give us ‘impossible’ access to another’s cognition. Bernini points out that there is an assumption here that betrays everyday experience of mind: it is not just other minds that appear ‘opaque’ in our daily lives, but rather it is mostly the workings of our own minds that seem opaque and inaccessible, to ourselves. Thus fiction’s relationship with mindreading has less to do with the easy transparency of fictional minds represented in some literary characters and more to do with the ‘impossible’ access to others’ experiences of their own opaque mind; ‘only fiction gives access to multiple internal opacities and to the interpretative nature of cognition” (51). Bernini is able to limberly negate prior theorizations of fictional minds as well as provide a meaningful thesis for theory of mind. These results are the kind of feedback loop between disciplines that interdisciplinary work strives for.

This interaction between a scholar nominally ‘outside’ developing a meaningful theory to those ‘inside’ a field such as the cognitive sciences also conveniently mirrors the conceptual grounding of ‘4E cognition.’ The alternative theorization of cognition that Garratt defends with this collection is the idea that the mind is embodied, embedded, extended, and enacted—and defined—through encounter with the environment. It appears that the “E” that Cognitive Humanities is most interested in is the extended mind, with most essays referencing its primary philosopher, Andy Clark. Garratt introduces the collection with a new interpretation of Clark and David Chalmers’s famous thought experiment that compares two subjects who navigate from two separate locations to the Museum of Modern Art in New York City using different strategies—Inga uses memory and Otto uses personal notes. Clark and Chalmers flatten these two strategies into an example of cognition functioning similarly both ‘inside’ and ‘outside’ the mind: we recruit tools such as notebooks, maps, and writing to complete a feedback loop between our minds, bodies, and the environment. Here we have evidence of the extended mind, but Garratt wonders why ‘attention falls on Otto’s extended mind only before he enters MoMA’s stylish glass frontage […]. What would happen if we could follow Otto and Inga into the museum, as it were, and consider how the extended mind story might play out there?’ (4).

In her chapter, ‘Bayesian Bodies: The Predictive Dimension of Embodied Cognition and Culture,’ Karin Kukkonen takes us ‘into the museum,’ as it were, by tweaking Clark’s own model of predictive processing to describe the cognitive function of probability in literary reading experience. Kukkonen develops a textured look at the encounter between real-world predictions (developed through experience) and storyworld-specific predictions (modeled through familiarity with genre, character development) that suggests the general usefulness of narrative as a site to develop theoretical tools for future empirical work. In this way, Kukkonen’s theoretically rigorous chapter presents the cognitive humanities—like Garratt—as a bridge for cognitive scientists to dip into the kind of thinking humanists are trained to do. With a philosophical background in Clark and a theoretical structure in Kukkonen, the logical next step is further empirical testing of the ‘extended mind’ hypothesis.

A standout essay in the collection may not be an empirical test, but another, practical pathway for this disciplinary work to play out if cognitive scientists appear uninterested in developments by literary critics. Nicola Shaughnessy and Melissa Trimingham report on their Imagining Autism project at the University of Kent in ‘Autism in the Wild: Bridging the Gap Between Experiment and Experience.’ Their application of concepts from 4E cognition is much different from the call for future interaction with empirical work in Kukkonen or Bernini: ‘It is important to stress that the utilisation of macro-theory […] is an integral part of the continuing spiral of iterative advances in our understanding’ (195). This ‘understanding’ is given specific definition here—not just general humanist value—as they work with children with autism to create playful performances that support creative engagement with the environment. A definition of mind that is inclusive of the outside world is an opportunity to directly address the diagnostic criteria of autism, which is based on a non-typical range of linguistic, social, and affective abilities. By creating a therapy/performance environment from which Shaughnessy and Trimingham transcribe and close-read the behavior of their subjects, there is a short-circuit in the lag between theory and practice while also potentially treating and encouraging certain behaviors in their subjects. This is a unique scenario where the theory does not need to reach an interdisciplinary audience, because the need for meaningful application or testing is fulfilled by a strong belief in the theory itself: a unique approach, indeed reaching the equivalence between theory and practice/philosophy and art proposed by Noë.

The other essays in the collection are potentially equally interesting to specialists, though the organization seems somewhat haphazard. Chapters by Paavolainen, Anderson, and Seymour develop further theories of performance in the context of the cognitive sciences; Paavolainen inserts an interesting critique of deconstruction—a critical field almost altogether ignored by the cognitive humanities. The collection concludes with a survey by Matt Hayler proposing what the cognitive humanities can offer new digital work, particularly as it interfaces with emerging medical humanities research on biohacking, body modification, and posthumanism. Hayler, like Shaugnessy and Trimingham, has something other than academics on his mind. In order for the humanities to stay relevant, for Hayler, the bubble must be popped that creates the apparent wall between academic research on mind and the public’s increasing hunger to understand the mind. He is frustrated with the present circumstances, and indeed convincingly lays out how ‘these are not niche issues, but it is niche research’ (219). While Hayler’s statement is not necessarily a critique of a collection such as The Cognitive Humanities, it is a definite projection of a reader who is not just interested in the humanistic value of the issues within—or, one who has already integrated an understanding of the embodied mind—and desires to see the field evolve into a form accessible to a wider audience. The present collection does not precisely fill that desire, but it adds to the strong group of collections on cognition in the humanities that hope to prepare this future.

Congratulations to Film Correspondent Khalid Ali

1 Sep, 17 | by amcfarlane

It gives us great pleasure to offer our congratulations to our film and media correspondent, Dr Khalid Ali, who has been selected as a Film Fellow by the Global Health Film Initiative. It is an intense programme in filmmaking for doctors and involves working with a professional production company, and the CEO of the Global Health Film Initiative, and a trustee of Medical Aid Films, Gerri McHugh.

Only nine doctors from the UK were selected to be trained, and the outcome will be three short films which will premier in the Barbican as part of the Global Health Film Festival in December. Well done, Khalid!

Primum Non Nocere: An Artist’s Perspective into the World of Medicine

31 Aug, 17 | by amcfarlane

This guest blog post comes from Emma Barnard, a London based visual artist specialising in lens-based media and interdisciplinary practice and research within Fine Art and Medicine. Her solo retrospective exhibition Primum Non Nocere, focuses on the patient experience. The show has its private viewing on the 15th September 18.00-21.00, and then runs from the 16th September to the 7th October at Berlin’s Blue Art Gallery.

‘Without your medical file you don’t exist within this environment’. I will never forget those words, spoken to me by an ENT Consultant at what was the beginning of several years research as an artist into patient experience. This led me to the writings of French philosopher Michel Foucault and his book The Birth of the Clinic. It is said that Foucault coined the term ‘medical gaze’ to denote the dehumanizing medical separation of the patient’s body from the patient’s person or identity. Already at one of the most vulnerable times in their life, the patient can sometimes be viewed by their consultant as their diagnosis rather than as a person.

Mis(recognition) CType Photographic Print, 2013

We’ve all heard the stories. As a further education lecturer, I remember after a particular class in which I happened to mention that my work as an artist involved coming into contact with patients, some of whom had been given a cancer diagnosis, a learner approached me and told me that he was diagnosed with cancer several years ago. The diagnosis, he said, was delivered so badly that he was left without hope. On his return home he gathered his family together and prepared them for the worst. When he attended subsequent treatment he was advised that they were hopeful of a recovery. He looked haunted when he told me his story, tormented for years by the delivery of that diagnosis. Another time, a healthcare professional told me that after her diagnosis she walked outside, fell back against the wall, and collapsed sobbing as a result of what she’d just heard. At that point, I was horrified to hear, she told me that she thought that she would rather die than go through with the advised treatment.

I felt led to do my small part as an artist in offering patients a voice. After observing the consultation I invite the patient into another consulting room and discuss how it feels to be them: right here, right now. I’ve now spoken to hundreds of patients from various departments. Every single person has answered that question differently, often surprising the consultant when they are shown the patients’ drawing afterwards. During the consultation process patients’ show little emotion; it’s quite difficult to read how they really feel about the impact of the words spoken during the clinical encounter.

So many different patient stories flood my mind as I write this. The reality of cancer was brought home to me fairly early on as I witnessed a patient who was without their larynx and therefore communicated through writing to ask the doctor how long he had to live, he needed to get ‘his house in order’. It was difficult for me to remain unmoved as I sat and watched this scenario play out in front of his wife and grandchild. I still have that writing as a powerful testament. In our current climate, with the richness of many different languages being spoken and the issues that this situation may pose when there is no one to translate, how much more difficult must it be when a person is unable to use the ‘voice’ that they are born with?

Patients facing life-threatening illnesses are heroic; they have allowed me to witness the brutality of a treatment that is intended to cure them, from surgery, through to radiotherapy, chemotherapy and subsequent complications that may arise from being the recipient of these. I am constantly humbled by their generosity in allowing me an insight into their world, but also their sheer courage when faced with a diagnosis that rocks their very existence.

Out of hundreds of images I choose to show Martin’s. I know he will not mind me mentioning his name as, like many others, he is supportive of the work and keen for its exposure to a bigger audience. His writing cuts to the heart of what many cancer patients face when presented with their diagnosis.

This work has now grown to encompass the surgeon’s view, the patient pathway, the surgeon/patient dynamic, and to include the experience of being a doctor in a busy outpatient clinic. The following images contain snapshots of the doctors’ experience in clinic between patients.

As an artist working collaboratively with doctors I feel privileged to have been given a fascinating insight into the field of medicine and I have a huge amount of respect for them, the work that they do and the immense pressure that they are under. They have incredible workloads, are overbooked in clinic, coping with funding cuts whilst often dealing with potential projections from patients of being ‘miracle workers’ and ‘life-savers’. I’ve seen the exhaustion, the despair, heard about the strikes, and know that currently many doctors are leaving the NHS to go abroad – consequently, there are not enough doctors to cover the workload. In their 2002 presidential address, neurosurgeons Stan and Raina Pelofsky write: 

Martin Heidegger and Jean-Paul Sartre suggested that alienation occurs when we divide the world into two distinct parts: the ‘true’ world of science is on one side, and the ‘flawed’ world of human perception is on the other. It’s as if we try to strip ourselves of human values in order to understand this perfect scientific world, and we begin to substitute science for meaning. But science alone is empty, and it threatens to separate us from our human connections…we neurosurgeons may become separated from our patients through our use of new technologies, by the hassles of our professional lives, or by lack of time. This in turn makes us isolated.

We might think to ourselves: We are the doctors – they are the patients. They are sick – we are healthy. We are objective and scientific; they are objective and emotional. This is a form of alienation and we have to understand it if we are to find ways to soothe it and become connected to our patients and to the essence of medicine.

 

‘Profecta est Tableau Latin – Duo’, 2014, Giclee print on Hahnemühle Pearl

This solo exhibition will allow me an incredible opportunity to showcase the perspectives that I have witnessed over several years as an artist working within medicine. I am selecting from hundreds of never-before-published images taken over the years. Primum Non Nocere will provide an insight into patient experience and the surgeon and patient dynamic, and it will expound on the air of mystery surrounding the surgeon’s practice, the immense pressure that they are under, and the harm that this may cause them.

Primum Non Nocere

Private view: 15th Sept 18.00 – 21.00

Exhibition dates: 16th Sept  –  7th Oct

Book Review: Caring Architecture

29 Aug, 17 | by amcfarlane

Caring Architecture: Institutions and Relational Practices by Catharina Nord and Ebba Högström, Newcastle Upon Tyne: Cambridge Scholars Publishers, 2017, 220 pages, £61.99.

Reviewed by Cristin Sarg (University of Glasgow)

Caring Architecture: Institutions and Relational Practices is an edited collection by Catharina Nord and Ebba Högström that had its genesis in a session of the 2014 Royal Geographical Society – Institute of British Geographers (RGS-IBG) Annual International Conference that was held in London. With this in mind, it is no surprise that the papers that comprise this volume approach medical humanities from a human geography perspective, examining institutional spaces in both historical and contemporary contexts.

The overarching aim of this book is ‘to elucidate how architectural space in institutions is involved in processes of complex ordering – the kind of ordering which destabilises order, as it were – thereby hopefully contributing a more detailed and nuanced image of what it is that is happening in institutional care today’ (10). Chapters 1, 2, 3 and 6 examine various contemporary institutional spaces such as hospitals, residential facilities and assisted living for the elderly in Sweden. The first chapter by Erling Björgvinsson and Gunnar Sandin focuses on the experience of hospital patients and ‘spatial manoeuvring and norms that emerge when [these] patients negotiate and align [themselves] with the hospital’s culture’ (15). Therefore, they argue that ‘the appearance of vagueness [within these spaces] must inevitably arise, but that there are different types of vagueness.’ (34)

In the second chapter, Susanne Severinsson examines the fluctuating and stabilising aspects of an art studio/room and materiality within the context of a residential care facility for troubled teenagers, arguing that a lack of ‘structure’ within these spaces, as viewed through several lenses, such as art lessons, psychotherapy, amusement, and imprisonment, make it possible to capture mobility and flow and provide an example of a ‘paradoxical space’. Then in Chapter 3, Catherina Nord explores the essential goals of assisted living – autonomy, privacy and dignity – through an examination of its historical and architectural roots with the support of the Deleuzian/Guattarian concept of stratum. Nord argues that ‘residents’ privacy, autonomy, and dignity are negotiated in refreshingly de-territorialising processes in which architectural space is at stake.’ (80) In Chapter 6, Morgan Andersson also focuses on an assisted living facility. Andersson argues that, despite spatial limitations, the usability of the facility is in continual negotiation, conceived, perceived and lived between the environment and users in the performance of spaces, artefacts and residents.

In contrast, Chapters 4, 5 and 7 take a historical turn in their examination of asylums or mental hospitals in Scotland and mental health clinics in Sweden. Chapter 4 by Kim Ross examines the engineering of affective atmospheres within the interior of nineteenth-century Scottish asylum spaces. Ross argues that the moral, medical and hygienic discourses of the period had a profound influence on the arrangement and use of both internal and external spaces of these asylums, with the hope that these engineered spaces would affect the behaviour of these patients. In Chapter 5, Cheryl McGeachan examines the work of Scottish psychiatrist R.D. Laing who became well known for his humanist approaches to psychiatric care and was a prominent figure within the anti-psychiatry movement. The main thrust of this chapter is the complex network between spaces of care, the psychiatric encounter and the worlds of individuals experiencing mental ill health from which new subjectivities emerge, in addition to illustrating the impact Laing’s experience with the patients of the ‘rumpus room’ had on his ‘(re)configuration of psychiatric practice and the space of mental care.’ (126) Finally, in Chapter 7, Ebba Högström examines the difficulties of translating specific spatial experiences into general design recommendations through an exploration of the organisation, design, experiences and representations of Saltsjöbaden Mental Health Centre, which opened in 1975 as part of the decentralisation movement in Sweden. Högström concludes that any guidelines that are established as a result of this experiment are only stable for a short time and that ‘this way of thinking entails broader (re)presentational repertories for architects and other spatial agents working in the care industry, particularly when translating immaterialities and materialities into guidelines for future caring architecture.’ (162)

The strength and weakness of this collection is its temporal scope, in that the topics that are discussed within stretch from the Victorian period until relatively recently, which can be somewhat jarring when the collection is read from cover to cover. Since most readers will focus on the sections that are most relevant to their research, this weakness becomes less prominent. Overall it illustrates that mores – moral, medical, and political – evolve and change over time as regards all types of institutional provisions, encompassing the physical and psychological needs of patients/residents and staff. Simply put, there are more points of convergence than would be expected on the surface.

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