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Global Humanities: On Being Invisible

8 Dec, 16 | by cquigley

 

Ines Ongenda – A Personal Reflection

 

In September 2015 I started a Master of Science in Global Health and Development at a leading UK institution. My background was in biological sciences and I was your typical aspiring medical doctor who had a strong interest in global health and wanted to explore and learn more about the field and whether I could fit in there.

Two weeks in and I wanted to quit the programme. I felt inadequate, ignorant and with nothing to bring to the table. Nothing to say. Nothing to share. Nothing to give. I was embraced by a group of African students who were all brilliant and experienced. Those were individuals who not only walk the talk but were grasping this opportunity with both hands. It was humbling. Not only because it was my first time studying with so many people from my continent but also with many from different countries within it. They were my rock and nudged me to stay and to make the most of this opportunity. I am not sure I did, but I recently completed my degree.

At the time, when I looked around me, the cohort was incredibly diverse: people with different nationalities, different languages, different religions, and different professionals at different stages in their careers etc., but very few felt like frauds. From those I approached, there was excitement and awe, people being inspired by their fellow students, people eager to grasp that different perspectives and people eager to share their own, to confront their ideas.

I looked at other students who “only” held bachelor degrees and came straight from those undergraduate studies, like I did. I talked to them to understand their position and very few echoes my sentiments. At that time, I did not think much of it. I felt like a fraud, I did not want to talk during lectures or tutorials. I wanted to be one with the walls and be invisible. It was something that had always been true in my upbringing as a daughter of a Congolese (DRC) father and a Burundian mother. I was taught to not make waves. I was told to always be very discrete. This was in sharp contrast to those from other nationalities. Most Americans students were bold and outspoken, happy to share their opinion, unapologetic in their way of presenting themselves and their ideas. The first few weeks, they truly dominated the narrative.

Only recently have I been interested in asking myself: why? Why is it that my upbringing does not foster that confidence? Why is it that the cultures I grew up in do not reward that free spiritedness I encountered in my Americans counterpart? I specifically do not want to make a generalisation to the entire continent. As we were often joking with other members of the diaspora, Africa is a continent not a country, there is no one Africa. My experience as a half Congolese, half Burundian former political refugee partly raised in France is of course different from that of a Yoruba from Nigeria.

To answer those questions, one of the components could be religion, or should I say superstition. In my culture, one does not make himself known/seen too much because one must fear jealousy, and gossip. One does not want his life spread out in front of others and risk spoiling it. What is the link with Global Health? I was not supposed to share my opinion as it might attract ridicule. What if people questioned my legitimacy? After all, I was just at 24-year-old who flew from genocide in Burundi as a small child. What does she know? What is her authority in these matters? This crucial idea of legitimacy. This idea that only people with a vast amount of experience, people who are legitimate due to their achievements, can speak out loud. The idea that only the one who “knows” can talk probably hindered my ability to learn. This led me to dismiss my own opinions, my own ideas. I took it as a given that they knew what was right and that I was as a result wrong in my own thoughts and views. My opinion was not valid because I did not have that a true global health background.

As the year progressed and I was ready to work on my thesis, I truly went against a wall. Every idea that I dismissed where the ones that my supervisor nudged me to stick with. Any opinions, any criticism that I had, I had to develop and research. It started to weigh on me that I was the only mixed Congolese and Burundian of my program. I was the only one able to share my perspective and to tell my story. I was the only ‘me’.

Global Health Humanities to me is about my coming into my own truth. It is about respecting my origins and looking at them as an asset and not as a point to dismiss because it is not the ‘right’ background. Global Health Humanities is about exploring my own humanity, my own identity in order to better raise my voice, and thus carry the torch for sharing this story, ultimately our story. Global Health Humanities represents a window that will serve to ensure that we no longer need to be ‘mindful’ of other cultures, but can instead truly integrate those cultures and facilitate an authentic sharing of stories.

This process is ongoing, and progress is being made – there are increasing opportunities for sharing stories through art (from writers to musicians and filmmakers), through the businesses that are being created from fashion brands to travel companies to magazines and healthcare startups), and through research.

Africa is rising.

Film review: Mannequin

7 Dec, 16 | by cquigley

image1

 

The Banality of Evil – Review of Mannequin, Egypt, 2015, directed by Dr Mina Elnaggar

 

Reviewed by Professor Robert Abrams, Weill Cornell Medical College, New York

 

Mannequin is a short, terrifying film with ambitions as large as its 7-minute running time is brief. The action starts immediately: An unnamed man who must have his wife’s dress retailored as a birthday gift has evidently placed an advert for a seamstress. When Mofida, the young woman who has responded to his advert, arrives at his home, he starts behaving oddly. The mood turns voyeuristic and sinister when he begins to make demands of her, including that she must wear and model the dress. The viewer now senses that Mofida might be used as an alter ego for the man’s wife, an inert substitute, as if she were indeed a lifeless mannequin. We watch with fascination and fear as an ordinary transaction changes over to the deceitful entrapment of an innocent woman.

Several questions are raised: What circumstances could justify the evil intentions this man appears to harbor? What internal conflict he is attempting to resolve?
The film can be viewed below.

 

Now that some details have been clarified, there is more to consider. We know that there are truths that are so unbearable that outright denial must be marshalled, and often that denial is framed in a uniquely personal way. This man’s wife has presumably been unfaithful, a circumstance he re-enacts by dousing Mofida with men’s cologne when she has put on the dress. Why someone who has been (or believes that he has been) betrayed by his wife chooses a particular style or format of disavowing is the province of psychoanalysis, not elucidated here.

But this is also where Mannequin reaches for a deeper understanding of the nature of vengeance. Although the implications are not immediately apparent, in only a few minutes it becomes clear that this film is depicting a perversion of anger and grief. The director, Mina Elnaggar, seems to grasp that narcissistic rage arises from a perceived threat to the narcissist’s self-worth. In the mainstream psychiatric view, a person with pathological narcissism might experience infidelity as a grave threat to his integrity, reacting with extreme anger or devaluation of the unfaithful partner as a way of avoiding emotional pain (Pincus AL, Lukowitsky MR. Pathological Narcissism and Narcissistic Personality Disorder. Annual Review of Clinical Psychology. April 2010. 6:421-446). Here, in a variant of pathological narcissism, the cuckolded man further engages in a kind of “undoing”, a defensive revision of reality wherein it is no longer his wife who has wronged him, but a randomly found young woman; and while his victim might pay dearly for him being betrayed, the man seeks to avoid suffering himself. Also, in this delusional world, violence against others is acceptable if they are viewed as dehumanized mannequins; but if the mannequins resist, they just might have to be rendered lifeless again.

One of the defining characteristics of adulthood is the ability to distinguish between fantasy and reality. In essence, fantasy is the notion that one can control the world, with no restrictions placed on one’s libidinal urges, but this happens only in psychosis, pathological narcissism, sociopathy, or films.

In Mannequin, the protagonist is in a desperate flight from the immutable reality of whatever his wife has done that has been so damaging to his core identity. What the film does show, as a kind of reward to the viewers for tolerating the convoluted thoughts and images, is that unprocessed narcissistic rage is a zero-sum game, a desperate, losing position that can only enfeeble, rather than strengthen or vindicate the self. The elaborate avoidance of pain leads only to more pain for all concerned.

Mannequin provides a thought-provoking inquiry into a very dark domain. Its central character seizes control over the life of his victim as he cruelly manipulates her, but in fact it is he who is being controlled by unconscious motivations of which he is unlikely to be aware.  From there, it is not a great leap to recognize that vengeance born of narcissistic injury can become murderous, but will still be impotent, whether on an individual or a global scale.  If this man’s denial or undoing—call it what you will– had been satisfying, he would not need to repeat it, a point that is eerily hinted at in the film.  Mannequin, despite its short span and familiar, ordinary setting, manages nothing less than to shock the viewer to a deeper appreciation of the underpinnings of human violence.
Address for correspondence: rabrams@med.cornell.edu

 

 

Interview with Dr Mina Elnaggar- actor, film director and producer

 

image1

 

Can you introduce yourself to the readers?

I am a clinical nutrition specialist, but before that I used to work in the forensic department at MUST University. I worked in several theatre performances inside and outside of Egypt, such as ‘No time for art’ directed by Laila Soliman; in addition to the ‘Cairo trilogy’ with the BBC radio 3 directed by John Dryden; plus some interesting roles in TV and film in Egypt.

What was the reason behind your choice of a mentally-disturbed person as a main character and what were your cinematic influences?

I was always passionate about theatre and cinema since childhood, but I never studied either in an academic format. Most of my studies were independent self-driven attempts. I was fortunate to attend several theatre/ film workshops where I gathered loads of useful information. I am a big fan of Daoud Abdel Sayed (https://en.wikipedia.org/wiki/Daoud_Abdel_Sayed). His 1991 film ‘Kit Kat’ (https://en.wikipedia.org/wiki/Al-Kit_Kat) was one of the films that left a big impression on me as well as ‘The Land of Fear’ (http://www.imdb.com/title/tt0233234/plotsummary?ref_=tt_ov_pl). But my real influence was theatre. That was my real source of inspiration in making my own films. For example breaking the fourth wall was one of the tools I applied in ‘Mannequin’ to engage the viewers – whether to empathize with the victim or be a silent witness.

How did your film work support your interaction with patients?

Working with film and acting has several psychological aspects that runs fluidly back and forth; as an actor I have to dig deep and uncover my personal truths and convictions, and in doing that I was able to widen my perspective. In return, I was able to deal more flexibility with patients and understand their urges and needs. Honestly I believe that every person (doctor or otherwise) should have a go at acting because it makes you better understand yourself. Acting helps you to identify your own personal journeys in a civilized manner.

Films take you to different realities and help you plunge into different worlds. A film can also help release the pressure of everyday life stressors.

Which films do you encourage your students/ patients to watch and why?

I tell them to watch any types of films and not just art films; I also encourage them to go to performances, theatre, galleries, and any place that provides a form of art to exercise their creative muscles

 

 

Book Review: A Smell of Burning

6 Dec, 16 | by cquigley

 

a-smell-of-burning-jacket

 

A Smell of Burning

By Colin Grant

London: Jonathan Cape, 2016

 

Reviewed by Dr Maria Vaccarella, University of Bristol

 

Colin Grant’s A Smell of Burning conveys a powerful message: being diagnosed with epilepsy means being associated with an intricate and captivating cultural history. Patients and families are connected to centuries of prejudice, transcendental explanations, scientific, as well as social, experiments, and works of art. Grant wrote this book as an elegy to his younger brother Christopher, who died of SUDEP (Sudden Unexpected Death in Epilepsy) in 2008; he, thus, joined David B. and William Fiennes, who in Epileptic (1996 – 2003) and The Music Room (2009) respectively, explore the impact of epilepsy in their brothers and in their families at large. It is, indeed, endearing to find resonances between these accounts, despite their different familial backgrounds and the different medical support available in each case. When Grant admits in his introduction that he “often wandered where Christopher went in those moments” (p. X), we are reminded of the many, imaginative spatial metaphors, beautifully rendered in the woodcut style of David B.’s drawings: for example, the original French title of his graphic memoir, L’Ascension du Haut Mal, reconfigures epilepsy as a disproportionately high mountain the two brothers attempt to climb throughout the book. But time is equally important in grasping the multifaceted concept of epilepsy: Grant learns in medical school that “the answer to your patient’s present condition lies in the past” (p. 2), which gives way to his retracing of the past of epilepsy in the book, interwoven with recollections of his brother, in a blending of medical history and biography, reminiscent of the more conscious pastiche technique used by Fiennes in The Music Room. Grant’s medical training, in actual fact, adds some intriguing nuancing to this shared plotline, as for example when he confesses his fascination, mixed with revulsion, in witnessing one of his patients having a tonic clonic seizure.

The interplay of spatial and temporal dimensions in making sense of epilepsy, despite its inherent ineffability, provides the basis for a secret language between the two brothers: coded expressions, such as “you had a visitor” (p. 68) or being “not in Kansas anymore” (p. 157), are genuinely tender glimpses into the reality of living with epilepsy. These enlightening, heartfelt snapshots into Christopher’s life are, unfortunately, almost obfuscated by the plethora of wide-ranging vignettes of famous people associated with epilepsy, from Julius Caesar to Neil Young. The limits of retrospective diagnosis and the problems of glorifying rhetorical catalogues of outstanding patients are well-known: it is, then, uplifting to learn that Christopher himself “was not comforted by the roll call of famous historical figures that were thought to have had epilepsy” (p. 22), though the permanence of these tropes in the book remains disorienting.

The tension between a more public, maybe even political, facet of epilepsy and its more intimate manifestations is palpable throughout the text: Grant moves among milestones in the history of epilepsy understanding and treatment, in search of an overarching meaning, which could probably give him (and his readers) a privileged access into Christopher’s brain and mind, into his mysterious unconscious peregrinations, as well as into his more conscious decisions, such as, for example, his intermittent adherence to his anti-epileptic drug regime. Each chapter in the book relies on these connections between the macro and micro dimensions of epilepsy, sometimes resulting in a slightly skewed perspective: by means of an example, Grant’s reading of “the fragility of Myshkin’s epileptic body to mirror the underlying fissures of Russian society” (p. 56) paradoxically detracts from Dostoevsky’s pioneering subjective contribution to the narrative use of epilepsy.

There are, indeed, a few underdeveloped points in A Smell of Burning that call for a more conscientious elaboration. Seizures are constantly described with reference to the old-fashioned vocabulary of grand mal and petit mal, possibly in the attempt to conjure up well-known social perceptions of epilepsy; yet, the downside of preventing the circulation of the more up-to-date and sophisticated medical terminology is not contemplated. Along similar lines, Grant brings in the testimony of writer M., who defines himself as “epileptic” (p. 204 and 210) to signify how pervasive and disempowering his condition is. Accordingly, Grant describes people with epilepsy as “epileptics” throughout his book, but never discusses in detail why some patients may feel uncomfortable with this label. A good example of this different view comes from Lily O’Connor, the protagonist of the 2014 film Electricity, which Grant briefly mentions as a recent creative attempt to represent epilepsy, for instance, through “swirling spectral lights” (p. 59). Yet, it is arguably in Ray Robinson’s 2006 experimental novel by the same title, on which the film is based, that we can find extensive discussion of discriminating labelling, as well as ground-breaking visual renditions of seizures on the page, thanks to the use of jumbled typeface or blank pages.

Unsurprisingly, it is Christopher himself, who provides the most compelling attempts to comprehend epilepsy in A Smell of Burning. When he calls his seizures “thingamajigs” (p. 160), he perfectly captures their uncertain nature, as well as maybe his own difficulty in absorbing obscure medical terminology. Similarly, in a very imaginative way, he introduces his GP to the Native American concept of Konyaanisqatsi (p. 165), life out of balance, to explain how his drugs made him feel in disharmony with nature. Christopher learned this concept from Godfrey Reggio’s experimental 1982 film on contemporary American landscapes and was planning to create his own filmic response to it, perhaps an analogous timelapse footage of the wanderings of an “epileptic mind” (p. 203). We are sadly never going to watch this promising film project, but thanks to A Smell of Burning we are encouraged to put into question our own perceptions of what constitutes balance and harmony, in our brains, our minds, and the world around us.

Poetry Book Review: Owen Lewis’s Best Man

30 Nov, 16 | by cquigley

best-man-frcov-copy

 

Best Man by Owen Lewis. Dos Madres press, 2015

 

Reviewed by Wendy French.

 

Best Man has just been awarded first prize in the Jean Pedrick Chapbook prize from the New England Poetry Club. When you read the poems you can certainly understand why Lewis’s work has received this recognition.

Edward Hirsch’s epigraph features at the beginning of the collection and is entirely apt for all that follows:

Look closely and you will see

Almost everyone carrying bags

Of cement on their shoulders.

 

How universally true this is. Although our bags of cement may be entirely different from the ones that Lewis carries, they are nevertheless present. It is for this very reason that Best Man can speak to each and all its readers.

The poems focus on anger, regret, failure and love. They are about all that it is to be human, and specifically to love a brother in a hopeless situation.

In the collection, each of the poems stands alone, but together they tell a story of dependency, support, and of the fight against a battle with drugs and addiction. The story needed to be told. I read the book as a single unit from beginning to end, as the poems together record a  young man’s life and were written from the standpoint of despair. Once I started reading, I felt compelled to finish. Lewis truly captures the pain and anger that he, an older brother, felt towards his sibling who was, as well as destroying his own life, destroying that of his parents, his grandmother, indeed his entire family. I was totally engrossed in the unfolding narrative and desperate to find out how it would all end. In each of the poems there is a level of intensity that drives the words forward and into the next poem.

The collection opens with Post-script, Unwritten Letter where Lewis looks back over childhood and the familiar games that children play:

‘… like the children we were

digging through the backyard soil, determined to get to China,

                                                                               The spot under the swings

 

where our feet whisked the ground before each pendulum soar…’

 

These lines determine the relationship between two boys. The poem ends:

‘Wherever you’ve been you’ll have something to tell me. I expected

                                                                                              to know more.’

I had to re-read these lines as that situation, where we have lost friends and want to know more of their lives, is so familiar. Tragically for Lewis, the loss is that of his brother, whose full story will never be known. How did this fall into addiction begin?

This was a brave book to write and it took Lewis thirty years to be able to tackle the content. Lewis is not afraid to be truthful:

I am still mad at you.

Every week another call

 

from a burnt-out Bronx

neighbourhood,  or Brooklyn…

 

…our grandmother told me you were ok.

She cooked you a pair of fried eggs. 

 

The very fact of a grandmother feeding her grandson, hoping that this might bring him back to his senses, reveals a family pulling together and trying to overcome the situation. When you care for a loved one, you believe that food conquers distress. We all at times clutch at straws.

Lewis comes from a Jewish background and it is not until the fifth poem, Once, that we learn that his brother Jason had been adopted. Born to an Italian mother, Jason is brought into the Lewis household by Lewis’s grandmother.

 

…Once upon a time, it’s true,

the mother and brother, a pair,

looking out, a long wait

for the new baby to get there…

 

I’m your brother, and, so I’m…

 

Too long upon this time.

 

The poems are dark yet also uplifting because of their honesty. Lewis never tries to excuse his brother or to make excuses for himself in how he responds to addiction. This collection gives readers permission to confront their own demons and to write about them. No one is going to judge us or our reactions. Lewis has shown us how to do it. He has not abandoned his brother but is still talking to him after thirty years. Jason still has a prominent place in Lewis’s life and he listens to what his brother may be saying to him from beyond the grave. Lewis is working through his own feelings and is trying to make sense of his inexplicable loss. He never once blames his brother as an adopted force that came into the family, but fully accepts that Jason is his brother, and that he died at the age of twenty three.

The poems are beautifully constructed and restrained. They explore the chaos that addiction can bring to a family. Jason’s girlfriend, also hooked on heroine, is behind some of the late night frantic phone calls that Jason makes to Lewis. I have the feeling that Lewis helped to sort out the chaos that still existed in his mind about his brother’s death by writing this elegy. It seems that Lewis’s second marriage to Susan was the catalyst for this collection. He wanted to introduce Susan to Jason, and vice versa. In the poem Introducing, Lewis writes:

 

Under the chuppah

The rabbi will call: Yaacov ben Simcha…

 

You’ll ride on my shoulder –

 

Best man!

 

These poems are compassionate:

 

And what of the family’s soul,

Mother, as if you already knew

his disquieted soul won’t find peace…

 

ruthless:

 

Your breath is foul from rotten

meat. Your nostrils flare me

fresh in the cave of your furry hug.

 

 

nostalgic:

 

Remember how each year

we’d come back, have to learn

the beach all over again?

 

confused:

 

… you don’t know how

you passed a bill to the cashier

or how she passed you change

and why she is smiling or how

your hand cold lift the cup…

 

angry:

 

Okay brother,

Give me what you got.

A kick to the solar plexus.

 

full of searching:

 

This morning, the hour of haze,

a blackbird called through my window

with some urgency. (I think it was you.)

 

This fine collection would be very helpful for any family involved with a loved one going down the addiction route. The poems are energetic and the energy released will speak to many who are trying to understand this destructive path. The poems could act as a personal counsellor by offering the different stages of grief. Each reader can digest the content at his or her own individual pace.

The book would also be a useful teaching tool in the narrative medicine field as it demonstrates how personal stories paint a lucid and detailed understanding of the subject.

But first and foremost it is a book of poems that Owen Lewis has dedicated to his younger brother who died at the age of twenty three while hooked on drugs. The poems reflect a tragic story of a young life wasted.

Best Man should be widely read as these fine poems hit hard upon the dormant tragedy in all of us that perhaps looms around the corner. Lewis’s work depicts an unsettled world that is within each of us. From the outset, we realise that we are not in for an easy read.

A finely produced book, Best Man has an arresting cover depicting youth, confusion, and the beauty of snowdrops that appear in a touching poem, Thaw.

I hope that for Owen Lewis the thaw has begun with the publication of this work.

 

Wendy French

wendyfrench.co.uk

 

Wendy French, Thinks Itself A Hawk, poems from UCH Macmillan Cancer Centre. Hippocrates press, 2016

Symposium – Retroviral Cultures: AIDS, Twenty Years On

23 Nov, 16 | by cquigley

 

1 December 2016, 2.00 PM – 6.00 PM

Andrew Blades, Maria Vaccarella, Corinne Squire, MK Czerwiec

Old Council Chamber, Wills Memorial Building

 

2016 marks the twentieth anniversary of the 11th International AIDS Conference in Vancouver, at which Taiwanese American researcher David Ho and his team revealed new antiretroviral combination therapies to the world. Before long, Andrew Sullivan was (in)famously writing in the New York Times of the ‘end’ of AIDS.

Twenty years on, the global AIDS pandemic continues, and in the USA there are still 1.2 million people living with HIV. Cultural representations of HIV/AIDS in America – literature, film, television, art – no longer portray AIDS as a death sentence or as a ‘rupture in meaning’ (Edmund White); depending on access to healthcare and education, HIV is primarily a manageable long-term health condition. At the same time, Richard Canning has pondered that the representation of HIV-positive people in American culture has ‘diminished sharply’ since the 1990s.

Our symposium will ask how American approaches to and representations of HIV/AIDS have changed since 1996, and how they might compare, interact with, or challenge those from elsewhere around the world.

Programme:

2:00 Welcome notes (Andrew Blades and Maria Vaccarella)

2:10 Corinne Squire (Professor of Social Sciences and Co-Director, Centre for Narrative Research, University of East London, UK), Looking Forward, Looking Backward, Looking Sideways: Representing HIV in the Time of Treatment Expansion (Chair: Andrew Blades)

3:25 Comfort break

3:30 Andrew Blades, Maria Vaccarella, ARVs in Text and Context (Chair: Theo Savvas)

4:15 Tea/coffee break

4:30 MK Czerwiec (Feinberg School of Medicine, Northwestern University, Chicago, IL, USA, and author of Taking Turns), Making Medicine Graphic: AIDS Comics as Activism, Support, and Remembering (Chair: Maria Vaccarella)

5:45 Concluding remarks (Andrew Blades and Maria Vaccarella)

All welcome! Please register to attend on Eventbrite.

Organisers: Dr Andrew Blades and Dr Maria Vaccarella (English)

This symposium is generously funded by a United States Embassy/ British Association for American Studies Small Grant.

http://www.bristol.ac.uk/arts/events/2016/december/retroviral-cultures-aids-twenty-years-on.html

 

Science Fiction Book Review: Spaceship Medic

23 Nov, 16 | by cquigley

 

The theme for the next issue of Medical Humanities is Science Fiction. There are many online articles already available on the theme (see Related Reading below).

 

A Spaceship in Trouble: Reflections on Harry Harrison’s Spaceship Medic.

Puffin books, 1976

Kindle version currently available

 

Reviewed by Matthew Castleden

 

Lieutenant Donald Chase, a young medical officer serving on the interplanetary passenger liner Johannes Kepler, is relaxing on a bunk in the sick bay— with a textbook describing the effects of low gravity on bone deterioration— when he feels an impact shudder through the fabric of the ship, followed immediately by a cacophony of alarms. A meteorite has blasted through the bridge and killed all of the vessel’s senior officers, leaving Chase, as the highest-ranking remaining member of the crew, as captain. He must overcome a series of seemingly insurmountable crises— including massive solar flares, mutiny, and a mysterious epidemic— that threaten the survival of everyone on board. Drawing on a broad knowledge of astronomy, physics, and chemistry, whilst utilising a newly qualified doctor’s grasp of his own craft, and showing an impressive capacity for logical reasoning and quick decision-making, Chase struggles against the odds to bring his ship safely to— where else— Mars.

The late Harry Harrison (1925-2012) clearly wrote the novella Spaceship Medic with children, and more specifically boys, as his target readership. Published in 1970, the story must have appeared dated even then. The linear narrative describes a strong male character problem-solving his way through a series of ‘hard’ science challenges, in a hierarchical space setting that any reader familiar with ‘Golden Age’ science fiction from the 1940s and 1950s would immediately recognise.

Of course, none of this mattered to one young reader who stumbled upon the story one sunny afternoon sometime in the late 1980s. He picked up a well-thumbed Puffin edition of Spaceship Medic in his school library and was instantly hooked. Perhaps he linked the simple heroism described in the book to his sketchy knowledge of his grandfather’s experiences as a newly qualified medical officer serving on board a Royal Navy frigate in the North Atlantic convoys. It certainly brought the boy’s nascent interests in science, medicine, and storytelling together into one irresistible package. And it undoubtedly contributed to the development of two significant lifelong interests: medicine and science fiction.

It is a gripping tale. The thrills of a taut, tight plot are spilled with sparse, unpretentious language and near-faultless manipulation of dramatic tension. Much of the science, particularly with respect to orbital mechanics and spacecraft design, holds up well and the extrapolations remain plausible. The overall plot direction holds no big surprises: with the exception of one character, we are left in little doubt as to who are the good guys, and who the bad (and they are all guys). In many respects it is simple, straightforward science fiction: a tale of Boy’s Own derring-do in space, with the only obvious quirk being the professional background of the protagonist.

Re-reading the book nearly thirty years later, Spaceship Medic is both less and more than I remember it from that afternoon in the school library. It is short— easily demolished in a couple of hours, then as now— and the limitations of its language, structure and broader social and cultural perspective are sometimes painfully apparent. Yet there is more going on than the direct language, simple narrative form and Golden Age trappings might suggest, and much in the portrayal of the protagonist that remains relevant to the practice of medicine in the present day.

There is certainly more to the young Doctor Chase than first meets the eye. He spends most of his time competently dealing with one disaster after another, yet is constantly assailed by doubts regarding his capacity to succeed in his new role and, on occasion, sinks into ‘black depression’ when considering his situation. Chase’s predicament appears to be an exaggerated version of the insecurity —sometimes manifesting as fully-fledged ‘impostor syndrome’— that many doctors experience at various times in their career: often in its early stages, when starting new jobs or ‘acting up’ in a more senior role. Unexpectedly assuming command of a stricken spacecraft tumbling through the uncaring vacuum of space may not be too dissimilar, in terms of its emotional and psychological impact, from enduring a busy and chaotic acute hospital medical on-call shift for the first time as a junior doctor.

It is significant that we first meet the young medic reading a textbook. Circumstances may force Harrison’s reluctant protagonist into an active role, but he is first introduced to the reader as a thinking man. The tension between contemplation and action is a common thread running through much of Harry Harrison’s work: many of his protagonists are compelled to negotiate the difficult path between thinking and doing, which is, of course, a familiar one to most doctors.

Chase’s insecurity is unjustified; he overcomes his fears and delivers excellent outcomes to the population under his care, and does so in a manner that may seem familiar to modern medical readers. Despite working within the hierarchical environment of a spaceship the young doctor’s approach to problem solving is essentially collaborative, and he relies extensively on the knowledge and experience of the other members of his team. An early scene in which he evaluates the key skills and strengths of his remaining crew and delegates accordingly reads like an illustrative case study for a contemporary leadership and team-building exercise.

The story also prompts broader consideration of the scope of health and healthcare. We can see how the death of the Johannes Kepler’s senior officers allows the reach of Chase’s medical practice to suddenly expand to encompass the functional health and pathophysiology of the entire ship, not just the physical health of its human passengers and crew. Through Chase’s medical eyes, we start to view the spaceship as a body; a holistic socio-technical system comprising both physical hardware, and the lives and interactions of the people it carries. It is hard to read the story as an adult without constructing extended spaceship analogies: spaceship as hospital; spaceship as a microcosm of society; perhaps even ‘Spaceship Earth’.

Harrison’s choice of profession for his protagonist provides is itself telling— as is that of his mutinous antagonist, one of the ship’s passengers named General Briggs. Briggs is pompous, hidebound, and has an overinflated opinion of his own self-worth: an embodiment of Harrison’s distrust of the military dating from his time in the US Army. Harrison’s portrayal of Chase establishes the medical profession as an alternative, non-military ideal for young men: one that showcases qualities such as determination, hard work, and self-sacrifice without the need for violence or killing.

Spaceship Medic therefore sits squarely within the pacifist school of medical science fiction. Like James White’s Sector General series of novels, it paints a refreshingly positive picture of medicine within its fictional future. Although the world it describes is, in many respects, similar to the old-fashioned medicine of the nineteenth and early twentieth centuries— male-dominated, hierarchical, and heroic— elements of Harrison’s essentially liberal worldview are also evident, and there is much in his portrayal of Lieutenant Donald Chase that a contemporary doctor would recognise. In short, it is a curious and compelling mixture: while its dated setting and structure may reflect the Golden Age of science fiction, there are signs of a more open, experimental and progressive ‘New Wave’ sensibility lurking beneath.

But first and foremost it is a ripping yarn. The story was written to inspire interest in science in young people by engendering a sense of fun and excitement. As Harrison wrote: “Science, and the facts of science, can be fun – because real things make a real world.” [a]

For one once young reader, it was and is an astounding success. Thank you, Harry Harrison.

 

[a] https://harryharrison.wordpress.com/2008/01/21/lets-start-with-a-spaceship-in-trouble/

 

Related Reading – check out these Science Fiction titles online first at Medical Humanities:

Doctors in space (ships): biomedical uncertainties and medical authority in imagined futures http://bmj.co/2eOU0K0

The medical science fiction of James White: Inside and Outside Sector General http://bmj.co/2eiM5kA

Human life as digitised data assemblage: health, wealth and biopower in Gary Shteyngart’s Super Sad True Love Story http://bmj.co/2eOQijk

Zombie Tapeworms in Late Capitalism: Accelerating Clinical and Reproductive Labor in Mira Grant’s Parasitology Trilogy http://bmj.co/2eUKenw

Rewinding Frankenstein and the Body-Machine: Organ Transplantation in the Dystopian Young Adult Fiction Series Unwind – Original Article http://bmj.co/2fnd0ji

Towards A Structure of Feeling: Abjection and Allegories of Disease in Science Fiction ‘Mutation’ Films http://bmj.co/2eUMdbA

Book review: Is Literature Healthy?

22 Nov, 16 | by cquigley

9780198724698

 

 

Is Literature Healthy?

by Josie Billington. Published by Oxford University Press, 2016.

 

Reviewed by Dr Neil Vickers

 

Many years ago, I blagged a ticket to an invitation-only symposium on the subject of medicine and narrative, held under the auspices of what was then the Arts and Humanities Research Board. The premise of the meeting was that humanities academics were sitting on a goldmine – something called narrative – but were too high-minded or obtuse to rate it at its true worth. There were a few big names in attendance but the star turn was a researcher from the hospital soap, Holby City. Here was someone who knew how to link medicine and narrative in a way millions approved of, on an almost weekly basis. We were also invited to read Jed Mercurio’s novel, Bodies, which was being adapted for television but hadn’t yet been broadcast. The organisers hoped that by studying ‘hard-hitting’ narratives of healthcare from a variety of disciplinary perspectives, we might stumble upon facts concerning medicine, or healthcare, that had eluded observation by other means. It was never explained why narrative would be better at picking these things up than other kinds of investigation. It was assumed that narrative was a good in its own right and that we would all find ways of making common cause through it. Needless to say, we didn’t. It was clear that narrative was as vexed a term as ‘literature’ and even though we were focusing on fictional texts some of those present – including your reviewer – felt that what would be found would depend on the quality of the sources. Rubbish in, rubbish out. The idea that narrative, merely by being narrative, would yield up untold secrets was a piece of magical thinking.

Josie Billington’s Is Literature Healthy, is, among other things, a compendium of everything I wish I’d said that day. Billington is a literary scholar who works at Liverpool University’s Centre for Research into Reading, Literature and Society (CRILS). Her book is a plea for literary reading but she starts from a premise that is seldom aired at meetings of literary scholars or medical humanists: that our culture has lost its literary edge. We no longer have an adequate metric for valuing literature because we have forgotten what makes literary experience distinctive. We think it has to do with narrative. For Billington, the problem isn’t that literature is missing from medical syllabuses or even university literature departments (though even there, it is missing). It is missing from life.

Chapter 1, ‘Healthy and Unhealthy Thoughts’, introduces the reader to the ideas of the British psychoanalyst Wilfred Ruprecht Bion (1897-1979), as set out in four fiendishly difficult works published between 1962 and 1970. Bion believed we have an inherited propensity to distance ourselves from meaning because it disturbs our mental balance. To become attuned to meaning we have to be willing to acknowledge the extent of what we do not know. We have to acknowledge our dependence on others. We also have to submit to experiences whose outcomes may be very threatening. Bion traces the development of our capacity to bear meaning to early infancy. If our anxieties have been ‘contained’ by a mother, say, we can set aside some of their physical impact and face them as mental entities. In this form they are not necessarily rational. They may appear as shards of thought disconnected from the rest of what goes on in our mind or as dream images; or they may exist as unconscious phantasies. Bion gives the name ‘alpha function’ to the process by which the psychobiological sources of anxiety are converted into forms of mental life of this way. He thought it was a lifelong process. Now most humanists, like most scientists, treat this zone of our lives with polite disdain. But Billington argues—very persuasively, in my view—that literary reading is profoundly enmeshed with alpha function. When a piece of literature moves us deeply, it is because it resonates with something in our history that carried a great weight of anxiety when we experienced it the first time around. The work of reading allows us to continue the processes by which we came to terms with it or failed to do so. If we feel more alive, it is because the most primitive stakes in our existence have been thrown into relief. An analogy from biology suggests itself. It used to be thought that DNA that didn’t code for a protein – i.e., at least 95 per cent of human DNA – was ‘junk’. We now know that so-called junk DNA provides the instruction manual for turning genes on and off.

It requires something like Bion’s alpha function to follow a character like Dorothea Brooke or Anna Karenina through their confusion. We must attune ourselves to their mental states, make these our own, before we can do anything with them. Literary reading begins when we strive to catch the primitive edge of experience which is a literary text’s true growing point. In Billington’s words, ‘the experience must not be used—only let be, in its words… a book can have thoughts that humans cannot have’ (44). In a reading designed to be provocative to medical humanists of Tolstoy’s The Death of Ivan Ilyich, Billington praises not the butler’s assistant Gerassim’s empathic witnessing of his master’s sufferings (the standard Med Hums reading), but Tolstoy’s depiction of what it is like to live completely beyond the reach of human care. I loved it.

The second chapter, ‘Telling a New Story’, does three things. It offers a broadly-brushed but incisive critique of narrative medicine. It explains why literature is not coterminous with narrative. And finally, with an eye to Billington’s own practice at CRILS, it explains why healthcare interventions that seek to use literature must go beyond narrative. Billington is fully alive to the humanistic aspirations underpinning narrative-based medicine. In particular she recognizes and approves of its concern to treat ‘the whole person’ and to vouchsafe patients a voice in any therapeutic process. But in cases of depression, for example, she thinks the whole person is absent to himself or herself. To be depressed often means not to have a story. The hero of this chapter is another psychoanalyst, Michael Balint (1896-1970), Sándor Ferenczi’s great pupil and literary executor. Balint is remembered in this country as the founder of ‘Balint groups’ which were designed to help GPs listen psychoanalytically to their patients’ complaints. Billington appears to think that the best kind of general practice will do just this. A good doctor, like a good literary reader, will know how to bear with his patient’s confusion and not substitute his own understanding for it prematurely. The limits of narrative-based medicine stem from its obsession with immediately-measurable variables and its conviction that story per se is empowering. It will often be easy for a clinician to give a narrative shape to their own or other people’s lives. It will not always go very deep. At this point, Billington appeals to what was once a commonplace of literary criticism. At the heart of poetic experience is something that lies beyond words. By virtue of its preoccupation with the ineffable parts of human experience, the parts whose importance we barely know how to articulate, the zone of Bion’s alpha function, the nineteenth-century realist novel is in fact a mode of poetry. It is only superficially a narrative form. Its power to move us is patterned after our experiences of poetry and the chapter concludes with a description of participants in reading groups run by Billington finding their own deepest selves mirrored in verse by, among others, Ben Jonson and Elizabeth Barrett Browning.

The third chapter, ‘Reading in Practice’ describes Billington’s work with her colleagues at CRILS and The Reader using reading aloud as a therapeutic intervention with patients with depression and chronic pain. The meetings were video-recorded and individual reactions noted. Billington is at pains to say that this intervention has nothing to do with bibliotherapy, where readings are often matched to conditions. The assumption is that the sufferer will be ‘found’ by the text ‘in a deep sense and at a deep level’ (105). It is his or her ‘inner life’ that she and her colleagues wish to engage. They believe it has a therapeutic effect arising from the ‘something deeper’ that literary reading provides. I think the time has come to test this claim experimentally. The final chapter puts forward an exemplary reading of John Berger’s masterpiece, A Fortunate Man, though, pace Billington, I think that book owes more to Marx than to Balint.

Underpinning this entire book is a compelling theory of literary reading which could be made more explicit. If I had to summarise it, it would go something like this. The reader of a great literary work such as Middlemarch gets to experience the process of containing the vicissitudes of Dorothea’s fate by rehearsing George Eliot’s words as if they were his or her own, allowing them ‘to be’, without attempting to put a construction on them, and simultaneously of being contained by the total process of getting through the book. It is this doubleness at the heart of literary experience that makes perseverance so rewarding. It is only superficially the same as telling a story or piecing one together. It is being acted upon by means of a story. A Kleinian, such as Bion once was, might see it as a benign species of projective identification. But all sorts of lexicons can capture it.

The medical humanities have become more complex and more theoretically savvy over the years. But we desperately need more books like Billington’s that address us quietly and clearly, about something very basic. Literature and the literary have lost their cachet in our field. If you want to know why it should be restored, read this book. The case could not be better made.

Global Humanities: Writing as a form of protest

15 Nov, 16 | by cquigley

Ayesha Ahmad

 

‘Daughters of Rabia’ is a social media blog with over 50,000 viewers a week. The blog is a dashboard containing narratives of different forms – poems, essays, and short stories – from women, and sometimes men, in Afghanistan about the challenges they face often in the shadows of being silenced and shielded from the view of the rest of the world.

Each word is an act of protest; an echo of resistance and a triumph of knowledge that although voices may be quiet, the mind is alive and speaking out against injustice and violence towards the body as well as towards the spirit of humanity.

The question I ask here, then, is why is writing as a form of protest remaining such a strong tradition in our global culture?

The below image details an inscription, or rather, the signature of a determined artist to finish their poem once the war ends.

14947951_10153900696187624_3109917954384490624_n-1

“When this war ends, I will return to my poem”

I think that our stories are our hope. If we can create our words during a time of destruction or decay or death either in terms of an ill society or an ill body, then there is a pathway to a legacy.

Should we make a parallel between words dying or our bodies dying and the words we convey during illness, perhaps there is a sense that words signal our breath; the stories that become of our words are the times that our hearts have beaten through our tales; our traumas.

It would be hopeful for medical and health professionals to relate to the initiative of writing as a form of protest. Sometimes silence reaches the most deep of wounds, and when such silence emerges as a voice, there is a power, a blood in the veins of all the intricate ways in which we, and our sufferings, are connected.

Daughters of Rabia (Persian): in English, Free Women Writers: http://www.freewomenwriters.org/afghan-women-write-threats/

 

Art review: chronic conditions and the digital age

9 Nov, 16 | by cquigley

Changing Lanes: Art in long term conditions in the digital age – new ways to adapt

By Shanali Perera

Rheumatic and musculoskeletal diseases are the largest growing burden of long term disability in the UK, affecting over 10 million adults. The concept of empowering patients to better engage with self-management of their long-term conditions is changing the world at an ever-increasing pace. Incorporating creativity can enhance interpersonal well-being.

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Through my artwork, I aim to reflect my personal experience to raise awareness on ‘Creative empowerment – exploring the healing power of art’. Personal insights as a medic and a patient into integrating creativity, healing & health on the use of creative expression as a tool to face some of the physical limitations & challenges imposed by chronic illnesses. I am keen to tell others of my experiences as they may benefit from incorporating art or similar creative expressions into their own healing. Why not challenge illness dominance? I do so by using digital art.

I am currently a patient under the care of Rheumatology services at the Manchester Royal Infirmary, treated for vasculitis. I used digital applications for artwork to cope with pain, illness experience, adjust to living with vasculitis; to communicate with health providers, family and friends. Prior to ill health retirement, I was a Rheumatology specialist trainee and this journey has indeed been a transformative experience both personally and professionally.

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Copyright © 2016 Shanali Perera

Eight years of numerous A&E and hospital admissions, multiple consultations from various disciplines have given me some valuable insights into a patient’s journey. Chronic diseases can turn one’s life upside down, gradually changing the landscape of daily living. Art can be a refuge for coping with the dynamic shifts in daily routine – accepting role limitations, altering perceptions and regaining some level of control. Creativity gives something to take control of and construct a positive identity. I like to highlight the potential benefits I felt by facilitating self-expression through creativity. Art was a tool for positive reinforcement and reflective thinking for me. I found expression through Art not only represents symbolic aspects of coping but also demonstrates the many facets of emotions and degrees of pain I feel at various points, as a visual narrative. This form of non-verbal communication is effective in helping family, friends and health team gain new insights into often under estimated, emotional/spiritual elements factored into the illness experience. Seeing beyond the illness – creative expression helping to redefine self-identity. I managed to achieve a semblance of normality by starting to set more realistic goals and standards for me around my limitations. From my experience, adapting to find ways around limitations plays a key role in rebuilding confidence and progressing forward. I feel that accepting the shift in roles, reshaping and reinventing one’s self is an essential part to living with a long-term illness.

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People with certain disorders not only have to deal with the general disability of the chronic illness, but also the physical limitation of expressing the “art” that is in their mind. On repeated use my hands become numb and painful, pain radiating to my shoulders. I found the use of digital medium my adaptation as it enabled me to use light touch with minimal effort and alternate hands. Less pain and fatigue became apparent in my hands and arms compared to using a paintbrush on canvas or charcoal on paper. For me, artistic expression was a means of self-exploration to convey how I was feeling. This really helped me to keep the fun side alive and regain a degree of control. This newfound freedom to explore myself through the world of colours and inner creative space, gave rise to my present work.

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Copyright © 2016 Shanali Perera

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Copyright © 2016 Shanali Perera

I think art certainly can be used to explore and represent one’s individual journey -The way chronic illnesses are constantly changing shape, defining and re-defining itself. I feel that this aspect to self-care isn’t advocated to its full potential in people with long-term physical illnesses. There is a lot of scope to develop this further as a holistic approach to care given the wealth of studies illustrating the beneficial effects of integrating creativity and healing in long-term conditions. Present day represents the Digital age where Digital technology in healthcare is continually changing the world at anever-increasing pace. The use of digital medium/applications for creativity, especially for people with limited functional capacity/pain can be a constructive as well as an enjoyable pursuit to explore one’s creative side to cope with day-to-day struggles. Why not put this into wider use in the context of self-management of chronic illness? Let’s take a closer look at our creative space.

Be Visible! Be Heard! See yourself through art.

Correspondence to:

shanaliperera@gmail.com

Film Review: Doctor Strange

7 Nov, 16 | by cquigley

The theme for the next issue of Medical Humanities is Science Fiction. There are many online articles already available on the theme (see Related Reading below). The blog will feature a series of reviews and original pieces on Medical Humanities and Science Fiction over the next weeks.

 

picture1

A Superhero inside you…

 

Review of Doctor Strange, USA, 2016, directed by Scott Derrickson, in UK cinemas now.

Reviewed by Dr Khalid Ali, Screening room editor.

 

Can a blockbuster film telling the story of a Marvel Superhero ask serious existential questions about mortality in a character-study narrative in addition to providing edge-of-the-seat popcorn entertainment? Doctor Strange, the 14th film from the Marvels Cinematic Universe (MCU), responds to that question with an emphatic Yes, and makes the viewer eager to see part 2 in the not so distant future. Dr Stephen Strange, played with abundant charm and wit by Benedict Cumberbatch, is an egotistical, highly driven brain surgeon who is called upon to operate in the most complicated life threatening neurosurgical emergencies. An unexpected turn of fate in the form of a car accident causes serious damage to his hands, preventing him from operating. A series of surgical interventions fail to restore his hand function. His quest for super-natural recovery takes him on a journey of self-discovery around the world, and an ultimate Superhero transformation.

The key to Doctor Strange’s redemption as a human being comes with a hefty prize; he must choose between saving his career as a surgeon and ‘saving the entire universe’. Even though he is an accomplished surgeon, Doctor Strange still needs a mentor in the form of ‘The Ancient One’, played impeccably by Tilda Swinton, to help him unravel the mysteries of the universe. The values of apprenticeship, such as listening and following advice are extremely challenging to a highly qualified surgeon who is used to the rules of strict mentorship and to being obeyed. Through the journey of the reluctant student and his benevolent master, serious questions about the sanctity and purpose of life, the nature of religion, and philosophy are posed.

In spite of the fact that the theme of ‘One chosen man saving humanity’ has been explored before in films like The Matrix, Superman and Spiderman, Doctor Strange still manages to look and feel original with mind-blowing time and space bending special effects. The co-existence of kind and caring traits alongside an evil personality in one doctor have formed the backstory of Dr Jekyll and Mr Hyde, and Mary Shelly’s Frankenstein. However, Doctor Strange takes the theme of good vs. evil to a whole new level by expanding the personal struggle to explore the basic nature of human existence – our purpose in life, spirituality and faith, and man’s everlasting quest for eternity.

Several scenes will be familiar to an audience with a healthcare professional background: Cardio-Pulmonary Resuscitation (CPR) features twice, in one scene graphic details of how to perform peri-cardiocentesis (evacuation of blood from around the heart) are shown, and in another highly imaginative scene, the dying patient being resuscitated leads the CPR procedure. In addition to the physical dimension of the CPR act, a parallel exploration of who determines a patient’s best interests when it comes to making the ultimate ‘Do not Attempt Resuscitation’ (DNAR) decision. The scene of a key figure dying, and using their power to stretch time to enjoy a few more seconds of living, is a powerful metaphor for the value of life of patients in their terminal stages. It is also a call for doctors to truly appreciate the significance of their irreversible judgement when they stamp that DNAR order. An inherent ethical and moral dilemma faces Dr Strange when he is about to kill for the first time; he questions his convictions as a ‘doctor sworn to save lives’ who is about to take away forever a human life.

Are doctors so different from Superheroes? Both save lives and care for humanity. They might wear different uniforms; doctors mostly wear white coats, while Superheroes wear trademark costumes like Doctor Strange with his ‘Cloak of levitation’. The story of Doctor Strange reminds us that doctors are as vulnerable as most other human beings, and are prone to accidents, personal and professional setbacks and tragedies. A redeeming fact though remains in that both doctors and Superheroes still have the power to overcome adversary, and save themselves and potentially others. One life saved is as worthy and as valuable as saving millions of lives. So if you happen to be a doctor, search for the Superhero inside of you.

 

Film trailer

Film poster and trailer are included with permission from Disney Entertainment, UK.

 

Address for correspondence: Dr Khalid Ali, Khalid.ali@bsuh.nhs.uk

 

Related Reading – check out these Science Fiction titles online first at Medical Humanities:

Doctors in space (ships): biomedical uncertainties and medical authority in imagined futures http://bmj.co/2eOU0K0

The medical science fiction of James White: Inside and Outside Sector General http://bmj.co/2eiM5kA

Human life as digitised data assemblage: health, wealth and biopower in Gary Shteyngart’s Super Sad True Love Story http://bmj.co/2eOQijk

Zombie Tapeworms in Late Capitalism: Accelerating Clinical and Reproductive Labor in Mira Grant’s Parasitology Trilogy http://bmj.co/2eUKenw

Rewinding Frankenstein and the Body-Machine: Organ Transplantation in the Dystopian Young Adult Fiction Series Unwind – Original Article http://bmj.co/2fnd0ji

Towards A Structure of Feeling: Abjection and Allegories of Disease in Science Fiction ‘Mutation’ Films http://bmj.co/2eUMdbA

 

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