11 Mar, 14 | by BMJ
Widening the Lens | Medical Humanities
Author, Historian and Adventurer at the Intersection (http://brandyschillace.com)
Recently, I read and reviewed Identity and Difference: John Locke and the Invention of Consciousness by Etienne Balibar. One of the points brought up in the lengthy introduction by Stella Sanford is that the reception of the work in its first edition was hindered by transcontinental miscommunication. It is a point worth considering. Our cultural context deeply influences the way we perceive everything from philosophy to art—and so it should not be surprising that this same cultural frame of reference has impacted what we mean by medical humanities. It can even influence what “counts” in the discipline (and this notwithstanding our frequent disagreements about humanities themselves!)
In the US context, the medical humanities are often subsumed under medical education or bioethics initiatives. At the Cleveland Clinic Lerner College where I help to develop year two curriculum, medical humanities consists in history, ethics, literature and arts with the purpose of integrating “the human dimension into healthcare, medical education and research.” The New York University School of Medicine defines medical humanities in a similar fashion, as “an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.” In both of these statements and countless others in the United States, a key focus is upon the humanities utility to the practice of medicine. It enriches the human perspective, but with only a few exceptions, the medical lens is still primary. This differs from perspectives in the UK where, for instance, the Centre of Medical Humanities at Durham considers medical humanities to be a field of enquiry where the humanities lens is brought to bear on the enterprise of medicine. The BMJ’s medical humanities are similarly situated, seeking to enhance the discussion of medicine in a forum that welcomes critical exploration in which the humanities are frequently privileged and primary. On one hand, these two perspectives do not seem divergent. And yet, small differences do matter. We seek inclusivity—and medical humanities is a necessarily broad field—but certain perspectives still fall between stools.
Despite our aims at diversity, one aspect of the medical humanities easily overlooked is the one nearest to us—the same that influenced the reception of Locke and of Barber’s work about him—our cultural context. Nothing is so blinding as the screen of self; we cannot get outside our own heads to see with other eyes. Those most adept at translation are those most immersed in multiple worlds, which is why I so deeply value medical anthropology and social medicine as critical lenses. This is also why I value the historical perspective—anything that unmoors us so that we may look back at a distance and see more of the picture. To Victorians, animal magnetism, mesmerism, mediums, paramnesia, proamnesia and displaced memory were all more or less soundly scientific. Further into our history we find alchemists, and long before that, Greek philosophers experimenting with elements supposedly ruled by planets and by the gods. How much of what we believe today will be cast out in the future? And might not some of that past knowledge be resurrected? An oncologist friend of mine recently pointed out that humoural theory has begun to have a certain valence once again—“progress” is rarely linear, after all.
I will examine a case from the US context, and from my work at Culture, Medicine, and Psychiatry, an international journal of cross-cultural health research. Devon Hinton, of Harvard, works a great deal with Cambodians suffering PTSD after the Pol Pot period. What he discovered was that this group possesses a unique “bereavement ontology,” in which dreams of the dead play a crucial role. In another work by Hinton a few years earlier, he similarly looked at somatic distress, and here, too, the findings were unique.
The Cambodians believe in a wind-like substance called khyâl; this “wind” is greatly feared and considered pathogenic; it may “surge upward in the body” to cause bodily catastrophes: neck soreness, rupture of vessels, dizziness and weakness. The psychiatrists understood these as post traumatic symptoms, but that does not make the khyâl less real, or the dreams of the dead less important. Cambodians frequently resort to coining and cupping as treatment—and just because therapists also want to use biomedical methods of treatment does not negate the positive benefits of these traditional healings. Their experiences are not less “true” because they are conceived of along different lines, because scientific and medical truth are relative to context and experience. Seeing the relevance of other cultures’ beliefs and practices is valuable to remembering that the truth we cling to is largely a product of our cultural underpinnings. Does coining work? Ask the Cambodians before you say no. It’s working for them.
How does this relate to the medical humanities? The connection I draw between medical anthropology and our shared discipline is bridged, in part, by social medicine. As yet one more useful lens, social medicine studies intersections of medicine and society, the ethical and social contexts of medicine’s larger enterprise. Taking these perspectives together, we may be able to re-see ourselves, stepping away long enough to recognize that health is intimately bound up with the human, knit together as close as the bodies that contain us. The useful distance of history and place should also force us to recognize that there is room enough for medical understanding and for personal truth. Lastly, the social dimension should remind us that there are consequences to all we do—including the boxes we draw around ourselves and others. Will that make us too broad? I can imagine the question being asked, but for me the answer is necessarily yes. In fact, medical humanities ought not only to be broad, it ought to facilitate breadth. Only in so doing will we remove obstacles and be truly interdisciplinary—and in fact international—in scope.
As with so many things, we always see more when we widen the lens.
 Martin Kohn, Director. Medical Humanities/ Information Page. Cleveland Clinic Lerner College. http://my.clevelandclinic.org/about-cleveland-clinic/ethics-humanities-care/medical-humanities.aspx
 Felice Aull. “Mission Statement” Medical Humanities New York University School of Medicine
 Devon Hinton, et al. “Normal Grief and Complicated Bereavement among Traumatized Cambodian Refugees: Cultural Context and the Central Role of Dreams of the Dead.” CMP (2013) Volume 37(3):427-464
 Devon Hinton, et al. PTSD and Key Somatic Complaints and Cultural Syndromes among Rural Cambodians:
The Results of a Needs Assessment Survey.” Medical Anthropology Quarterly (2012) 26(3):383-407