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The Annual Sowerby Lecture in Philosophy and Medicine

26 Nov, 15 | by cquigley


“If I had to live like you, I think I’d kill myself”: Explaining the Disability Paradox

Havi Carel, Professor of Philosophy and Head of Subject, University of Bristol

Comment: Brian Hurwitz, Professor of Medicine and the Arts, King’s College London


Thursday, November 26, 2015.


Guy’s Campus, New Hunts House, Theatre 1


Free, no booking is required



“The ‘disability paradox’ identifies a significant difference in how ill and disabled people rate their wellbeing, compared with healthy people asked to imagine how happy they would be if they were unwell. Ill and disabled people’s wellbeing rating is only slightly lower than that of healthy people. However, healthy people rate their hypothetical wellbeing as much lower when asked to imagine themselves as ‘hypothetical patients’. There are three possible explanations: either patients misreport their wellbeing due to adaptation, or healthy people mis-imagine ill-health, or both.

In this paper I examine these explanations and suggest that it is healthy people who misimagine ill-health. I also claim that it is impossible to claim that ill people are misreporting their wellbeing due to adaptaion without this having general consequences for any subjective wellbeing measurements. I also claim that the phenomenon of adaptation to illness raises important questions for health economics, and that the psycho-social mechanisms involved in adaptation can be illuminated by a phenomenological analysis.”


Birkbeck Centre for Contemporary Theatre: Sheree Rose and Martin O’Brien

25 Nov, 15 | by cquigley


Love is Still Possible in this Junkie World?
A conversation between Sheree Rose and Martin O’Brien on sexuality, love death, pain and art.  

Birkbeck Centre for Contemporary Theatre, with support from BiGS (Birkbeck Gender and Sexuality)

  • Friday 27 November, 5-6.30 pm, G10.

Sheree Rose was born in Los Angeles, CA. She obtained her Master’s degree in psychology in the late 70s, and was extremely involved in political activism and The Women’s Movement. She received a second Masters Degree in Studio Art from UCI. Rose and Bob Flanagan met at a Halloween party in 1980 and began collaborating in life and on artwork. Together they explored issues of pain/pleasure, illness and death though profound works involving sadomasochism. They performed and exhibited throughout the world over a 16-year period and became one of the most significant performance art collaborations in history. Flanagan died of cystic fibrosis in 1996. Since Flanagan’s death, Rose has exhibited new work ‘Bobaloon’ in Tokyo, Japan, as well as other works at The Tate in London. She created a performance piece entitled ‘Nailed Again’ at Arizona State University and Galapagos in New York. Rose continues to explore and collaborate with performance artists, particularly with the UK based artist Martin O’Brien with whom she has made several pieces of work in London and LA. Martin O’Brien has been commissioned and funded by the Live Art Development Agency, Arts Council England, Arts Catalyst, Midlands Art Centre, and the British Council. He has presented work throughout the UK, Europe and the USA. He has often collaborated with the legendary performance artist Sheree Rose. He was artist in residence at ONE National Gay and Lesbian Archives, LA, in 2015. He curated the groundbreaking symposium ‘Illness and the Enduring Body’ in 2012. Martin received a PhD from the University of Reading and his work has received critical attention in publications such as Contemporary Theatre Review and the book ‘Access All Areas: Live Art and Disability’. He co-edited, with Gianna Bouchard, a new edition of the journal Performance Research ‘On Medicine’. He is a lecturer at Queen Mary’s University of London and a Fellow of Birkbeck Centre for Contemporary Theatre.

The Reading Room: A review of ‘Memoirs of a woman doctor’

11 Nov, 15 | by cquigley



©D. Carpenter-Latiri portrait of Nawal El-Saadawi UK 2015

©D. Carpenter-Latiri portrait of Nawal El-Saadawi UK 2015


El-Saadawi, N. (2000). Memoirs of a woman doctor. London: Saqi Books.

Reviewed by Dr Dora Carpenter-Latiri, Senior Lecturer, College of Arts & Humanities, University of Brighton

Nawal El-Saadawi, the famous Egyptian feminist activist, trained and practised as a medical doctor, a psychiatrist and a surgeon. She is also a prolific writer and has written more than 50 books, several of which have been translated into English. Her writings – essays and fiction – address issues of gender and class in Egypt and the Arab world. She is a vocal campaigner against male and female genital circumcision (from 1979 to 1980 she was the United Nations Advisor for the Women’s Programme in Africa and the Middle East), against religious patriarchy and against political Islam. She has also campaigned for education, women’s rights and freedom of expression and was jailed under Sadat. Her life was threatened by the Islamists and she had to flee Egypt. She has been back in Egypt since 1996. Since the Arab Spring she has been campaigning against political Islam and against the counter-revolution.

El-Saadawi was born in 1931 in Kafr Tahla, a small village in Egypt, the second of nine children. She won a scholarship to study medicine, graduated from the University of Cairo in 1955, and specialised in psychiatry.

Memoirs of a woman doctor (2000) was first published in its translated version in English in 1988. The Arabic original version first appeared in a serialised form in the Egyptian magazine Ruz al-Yusuf in 1957. The book was El-Saadawi’s first novel. In a preface to the English edition, she mentions that the book was censored both in the serialised and in the full book versions, but as she ‘was young and inexperienced and eager to see the book in print’ she ‘allowed it to be published with deletions’.

The text is a first person narrative that reads like an autobiography. The author states that ‘although many of the heroine’s characteristics fit those of an Egyptian woman such as myself, active in the medical field in those years, the work is still fiction’.

The narrative is very informative of the medical practices of the time in Egypt and could read like an anthropological text with surprising details (for example there were no regulations for access to the blood bank). In the passage below, the ‘companion’ is a musician with whom the narrator falls in love after a bitter divorce. The divorce was the narrator’s decision after her husband asked her to choose between him and her practice; this ‘companion’ character reconciles her with her femininity and her desire for a male companion that would support her:

‘A thin young man lay on a dirty mattress on the floor. Beside him was a little pool of blood. I sounded his chest, realizing he was desperately ill with pulmonary tuberculosis and that life depended on a blood transfusion. I looked round and found my companion standing beside me. He said instantly, ‘Do you need anything?’ ‘A bottle of blood straightaway from the emergency services.’ (p.97)

The narrative is chronological and describes the narrator’s awareness of the lower and unfair status ascribed to girls and women. The first period is described alongside associated feelings of shame and self-hatred:

‘I hated being female. I felt as if I was in chains – chains forged from my own blood tying me to the bed so that I couldn’t run and jump, chains of shame and humiliation’ (p.12)

The narrator’s family wants to get her married but she is determined that she will study and become a doctor:

‘Put on your cream dress and go and say hello to your father’s guest in the sitting room.

I caught a whiff of conspiracy in the air.’ (p.15)

‘I hated my femininity, resented my nature and knew nothing about my body. (…) I was going to show my mother that I was more intelligent than my brother, than the man she wanted me to wear the cream dress for, than any man (…)’ (p.22).

‘Medicine was a terrifying thing. It inspired respect, even veneration, in my mother and brother and father. I would become a doctor then, study medicine, wear shiny steel-rimmed spectacles, make my eyes move at an amazing speed behind them, and make my fingers strong and pointed to hold the dreadful long sharp needle. I’d make my mother tremble with fright and look at me reverently; I’d make my brother terrified and my father beg me for help’ (p.23).

The narrative moves on to the years of studying medicine when the young student is the only woman in the dissection room and she has to hide her fears and to proceed ‘steadily and unflinchingly’ (p.25). The passages dealing with the dissection allow the narrator to explore the vanity of the male body, the absurdity of the alleged superiority of men in Egyptian society, the equality and frailty of men and women before death and a celebration of life:

‘I was delighted by this new world which placed men, women and the animals side by side, and by science which seemed a mighty, just and omniscient god; so I placed my trust in it and embraced its teachings.’ (p. 32). ‘Ah, how simple life is when one takes it as it comes!’ (p.28)

The narrator also explores the ethics of practising medicine and she describes her transformation from a rich, successful but hard doctor into one who is caring and dedicated. This epiphany comes when she acknowledges the ‘emptiness’ of her life to be followed with her encounter with the character of the musician, who – in connecting the practice of medicine with art – answers her quest for meaning in her life and supportive, loving companionship:

‘My surgery filled up with men, women and children and my coffers with money and gold. (…) I felt a chilling cold as though I was sitting on a snowy mountain top.’ (p.82)

‘Why had I bounded up the ladder of my profession instead of drinking from the cup of life sip by sip (…)?’ (p.83).

‘Being a doctor meant giving health to all who needed it, without restrictions or conditions, and success was to give what I had to others’ (p. 100).

‘For the first time in my life I felt that I needed someone else, something I hadn’t felt even about my mother. I buried my head in his chest and wept tears of quiet relief.’ (p.100-101)

Reading Nawal El-Saadawi’s first novel today, almost 60 years after its publication, gives us an insight into her extraordinary journey and her loyalty to herself. Although simple in its semi-autobiographical structure, the rhythm is powerful and the issues of class and gender are – alas – still relevant in a world where patriarchy, poverty and lack of education are widespread. The issue of FGM, which made El-Saadawi famous in the West through her subsequent essays and her action as a doctor and a feminist, is not mentioned in the book and might have been part of the material destroyed by the Egyptian censor and thus lost. Paradoxically, this adds to the power of the short text as the whole context in which the practice takes place gets more attention and allows the reader an insight into gender discrimination and social inequalities, which are prevalent not only in Egypt.

Khalid Ali: Ageing (dis)gracefully from Camden pavements to Swiss resorts

10 Nov, 15 | by Ayesha Ahmad

Review of “The lady in the van” directed by Nicholas Hytner, UK release 13th November 2015, and “Youth” directed by Paolo Sorrentino, UK release January 2016

“The lady in the van” and “Youth” that recently premièred at the London Film Festival (LFF) in October 2015 are two great films about “senior citizens” in two completely different settings. “The lady in the van” is based on Alan Bennett’s (the famous English writer, interactions with Miss shepherd in Camden Town in the late 70’s, while “Youth” is a fictional story of three mature artists set in a Swiss Alps resort. In the first instance, the viewer might not immediately see the connection between the two films; however upon closer inspection, one can appreciate that both films explore the trials and tribulations of old age in two distinct socioeconomic backgrounds with striking similarities in their points of view.


Call for Papers – special issue of the Journal of Bioethical Inquiry

4 Nov, 15 | by cquigley


The editors of a forthcoming (2017) special issue of the Journal of Bioethical Inquiry on “Investigating public trust in expert knowledge: ethics, narrative and engagement” are currently inviting submission of papers.

The special issue will be the first of its kind to examine the ethics of public trust in expert knowledge systems in emergent and complex global societies. Through an interdisciplinary approach, it will draw from contributions in bioethics, the social sciences and the medical humanities.

Guest Editors: Silvia Camporesi (King’s College London), Mark Davis (Monash University), Maria Vaccarella (University of Bristol)

Trust pervades personal, social and political life. Basic trust is seen as the foundation of self, trust figures in the everyday reciprocity of social relations, and governmentality is imbued with questions of trust and distrust. Trust in expert knowledge (i.e. willingness to believe, endorse and enact expert advice) has emerged as a problem for governments seeking to engage and influence publics on matters as wide-ranging as public policy on the environment and economic development, biopolitics, and wellbeing over the life course. The knowledge systems which support climate change policy have been criticized and even refuted, leading to public policy challenges for action on climate. The uptake of vaccines in populations appears to be eroding and scientific/ethical controversies have marked the field. The emerging ‘superbugs’ crisis requires that publics engage with the idea that antimicrobials are no longer available to the extent they once were. Biotechnological interventions in reproductive life and health are subject to changed expectations for expert and consumer rights and responsibilities. The recent explosion of the CRISPR genome editing debate has brought with it socio-technical expectations (e.g. CRISPR technologies as a panacea for a world rid of diseases from birth, and some say even of ageing), together with fears of eugenics and a return to the discourse of designer babies, which now seem a possibility. Public life is marked also by the questions of trust, knowledge and ethics implicated in end-of-life decision making, related controversy over physician-assisted suicide and other questions of life’s limits. Against this backdrop of troubled trust, expert knowledge and changing bio/ thanopolitics, how can governments engage publics? How do public communications take effect? How do experts and publics narrate trust? What are the ethical ramifications of efforts to garner, sustain or regain public trust? As some have argued, are we already post-trust and therefore in alternative modes of public engagement with the idea of collective life?


Contributions are solicited from the above disciplines that look at the role of narratives in the construction and deconstruction of public trust in expert knowledge and at ethical or unethical ways of engaging with the publics on a variety of topics, including but not limited to:

  • sustainability and climate change
  • public policy and economic development
  • vaccination and other biotechnologies
  • emerging infectious diseases, including superbugs
  • reproductive health
  • provider-consumer relations in health care and beyond
  • genetics, including genome editing technologies (e.g. CRISPR/Cas9)
  • race
  • end-of-life decision making


We seek contributions that apply narrative approaches to bioethics, sociology, and medical humanities.

The special issue will consist of 8-10 contributions that employ a variety of methodological approaches for a recommended length of 7,000-7,500 words each.

Instructions for authors for submission to JBI can be found here:

Abstract Submission and Timeline

Extended abstract of 750 words should be submitted to Dr Silvia Camporesi by January 25, 2016. Please clearly state in your abstract the methodology you are employing in your paper, and how your contribution addresses the topic of the special issue ‘‘Investigating public trust in expert knowledge: ethics, narrative and engagement’.

A decision on the abstract will be notified by Feb 15, 2016.

Full papers are expected by May 1, 2016.

Reviewed papers will be returned to authors by August 1, 2016.

Revised papers are expected by October 1, 2016.

The special issue is expected to appear in print in June 2017.

For inquiries contact Dr Silvia Camporesi:


The Reading Room: A review of ‘A Doctor’s Dictionary’

30 Oct, 15 | by cquigley


Iain Bamforth A Doctor’s Dictionary: Writings on Culture & Medicine

2015 Manchester: Carcanet ISBN: 978 1 784100 56 8


Reviewed by Professor Alan Bleakley

Emeritus Professor of Medical Education and Medical Humanities

Plymouth Peninsula School of Medicine, Plymouth University UK


Iain Bamforth, by his own admission, is a writer who practices medicine. Indeed, while he appears to gorge on writers, essayists and philosophers, he gives medical education short shrift:

“doctors undergo a crammed, often dogmatic training in thrall to clinical ‘bosses’, which tends to hinder critical thinking. Then one fine day they wake up to find themselves as soteriological salesman in the Valley of the Shadow of Death. And they hate to lose face by admitting they don’t know.”

While many doctors I know would cringe in self-recognition at this description they would also think ‘hang on a minute, there’s more to medical education than this’ (simultaneously reaching for their dictionaries to check on ‘soteriogical’). ‘Country’ doctors come off worse, where “Doctor-baiting has long been a clandestinely popular activity in country regions. … my grandmother in Glasgow used to say ‘that’s but ae doctor’s opinion’” for in “country areas, where people have long memories, it is still remembered that doctors themselves were once a source of plague.” Bamforth should know – he worked for a year as a country GP in Scotland and has extensive experience working in a number of areas of medicine, including a long stint in his current practice as a GP in Strasbourg with “twenty-two different nationalities”. Bamforth can afford to be self-effacing about his medical career, for he is first and foremost a talented and dedicated writer, and a jobbing translator on the side. In this collection, he brings a literary sensibility to bear on the, often uncomfortable, recognition that much of medicine is an art rather than a science requiring high tolerance of ambiguity and recognition of personal limits to knowledge and ability. Medicine is a performance whose script has been crafted historically and culturally.


A Doctor’s Dictionary: Writings on Culture & Medicine is a collection of 26 essays and book reviews previously published in medical and literary journals, many of which were gathered together to form the core of the author’s manuscript Medicine and Imagination, submitted to Glasgow University (where Bamforth originally studied medicine) for the degree of Doctor of Letters by publication. The collection represents two decades’ worth of industrial strength and erudite commentary. The essay titles follow the letters of the alphabet in order, from ‘Anecdote’ to ‘(meta-) Zoology’, via ‘Depression’, ‘Happiness’, ‘Posture’, and ‘Vertigo’ amongst others. The title ‘A Doctor’s Dictionary’ refers to this conceit of an abecedarium. These single word titles serve less as signposts than welcome glades amongst thick forest, for Bamforth’s prose is baroque and relentless, providing little respite for readers who crave more minimalist approaches to the essay. Those who know the author’s poetry – he has published five collections – might not expect such convolutions and digressions within the essay form. His poetry is leaner than his prose. Certainly, he is not a writer who wears his learning lightly.


Where Bamforth provides no connecting thread from one essay to another this collection is more lucky dip than pearls on a string. And sometimes – despite the promise of the subtitle ‘Writings on Culture & Medicine’ – the links with medicine are tentative. A more honest subtitle would have been ‘Writings on Culture & on Medicine’. For example, a riveting essay ‘Emergent properties’ – relating to Joseph Needham’s masterwork Science and Civilisation in China – is linked to medicine only by the fact that Needham was a developmental biologist and his father was a Harley Street doctor specialising in anaesthetics. Further, it is not until you read the Endnotes that you find out this essay is in fact a 2009 ‘review’ of Simon Winchester’s biography of Joseph Needham. The reader is left not knowing how much is Bamforth’s original insight and how much is gleaned from Winchester’s biography.


A book review of Ziyad Marar’s (2003) The Happiness Paradox and Carl Elliott’s (2003) Better Than Well (first published in a literary and not a medical journal) contains a few lines on the treatment of depression – otherwise there is again no developed linking of culture with medicine. This leads me to ask just what audience the publishers have in mind for this book. Doctors in general are pragmatic and resist complex ideas (Bamforth quotes from a Robert Lowell poem referring to doctors: “We are not deep in ideas, imagination or enthusiasm – how can we help you?”), so I suspect that the primary audience for this book will be humanities scholars working within the health/medical humanities, although, in an ideal world, medical schools would adopt texts such as Bamforth’s to support the teaching of so-called ‘communication skills’ and ‘professionalism’ and to encourage the kind of liberal education that gives insight into the human condition.


Bamforth’s book has its weak spots. A review of Carl Elliott’s Prozac as a Way of Life (under ‘D’ for ‘Depression’) tells us little new where the author notes that depression is a cultural disorder and that many mental health symptoms are manufactured to sell drugs that supposedly treat such symptoms. While we are introduced to a stream of writers who have formed high culture, there is little reference to either popular culture or everyday people, in particular Bamforth’s patients. Are some of these not also extraordinary? Do any of them inspire, or is that just for high art?


But mainly, Bamforth offers us industrial strength prose. ‘Galen’ is a model of the essay form – pithy, humorous and insightful. Informed by his long experience of practicing medicine in Strasbourg, Bamforth dwells on the ‘folk illness’ of a crise de foi – a crisis of the liver. The essay is a generous meditation on a French national trait – the liver as embodied metaphor. Bamforth’s most recent (2015) essay ‘Tell Me About Teeth’ (under ‘M’ for Mouth) is a very funny meditation on the American obsession with good teeth (equating with good character). Bamforth takes up Elias Canetti’s challenge to ‘write about teeth’ and produces the best line of the book: ‘How can you believe the soul is a butterfly when the human breath is so foetid?’ There is cheek in the essay – Bamford, a doctor, looks down on dentists who cannot have a proper conversation with their patients “with a drainage pipe, cotton wool and gloved fingers in the mouth”.


Bamforth’s conversation with his readers, however, is more like the reality of doctors’ ‘conversations’ with their patients – the consultation is actually one-way traffic: Bamforth does not pose questions, he informs, and his information is more torrential downpour than light drizzle. Read psychoanalytically, Bamforth’s rather suffocating attention to detail might be seen as a desire to impress and to control. There is a clue in the Endnotes to this collection of essays, where referring to the essay on teeth, Bamforth notes that while many writers earn their living as doctors, the same cannot be said of dentists. Reading this, I immediately thought of the Egyptian dentist and novelist Alaa El Aswany’s The Yacoubian Building that I read a few years ago. I was interested in this novel because at the medical school where I used to work we had long established a medical humanities programme, and had just implemented a ‘dental humanities’ programme in the dental school. Aswany was recommended reading. I was pleased to see that Bamforth could afford an error, a relief from his parade of learning. But then I read the after-note to these essays, where Bamforth apologises to the reader for an oversight – dentists do indeed write novels, amongst them Alaa El Aswany’s The Yacoubian Building. The rent in the fabric of the essay is neatly repaired without losing face.


But Bamforth should not be worried about the occasional slip – after all, it is in such minor imperfections that humanity shows through (Nietzsche’s Human, All Too Human) and this is, paradoxically (and properly), how he describes the work of doctors. Little ‘holes-in-the-day’ or ‘holidays’ (as the late poet Peter Redgrove described unconscious slippage) allow both writer and reader a mini-break away from the relentless search for perfection. Indeed, such a hole-in-the-day does appear in Bamforth’s collection and is not retrospectively repaired in his Endnotes. It is an omission that also provides an insight into limitations to the author’s writing style.


While the psychoanalyst Jacques Lacan is referred to (on p.71), he is not included in the index of names that stretches to an eye watering close to 400 entries (with only a dozen women amongst them). Oddly, the publishers have not included an index of topics – a major omission in a book of this kind that is to be dipped in to and not read cover to cover. I pick up on Lacan because it was this psychoanalyst who famously suggested that the unconscious is structured like a language and shapes experience through metaphor and metonymy. Metaphor (the substitution of one word for another for effect: ‘time is money’), suggests Lacan, serves to repress (often in the form of denial). Metonymy functions to combine, where one word or phrase leads by association to another (such as ‘wand-sceptre-king-ruler’) and is then a form of displacement (often in the form of scapegoating). Bamforth’s writing is characterized by a particular use of displacement and contiguity as a rhetorical strategy. Let me give some examples.


There is a rather irritating ‘rock hopping’ technique, where reference to one author or thinker jumps quickly to another. The essay on ‘Happiness’ referred to above – a review of Ziyad Marar’s and Carl Elliott’s books – is only seven pages long yet manages to reference Freud, Plotinus, Nietzsche, Bentham, de la Rochefoucauld, Auden, La Mettrie, Diderot, Holbach, St-Just, Stendhal, Dr Johnson, Rousseau, Robert Burns, Tom Wolfe, Dostoevsky, Veblen, Wittgenstein, Theodor Fontane, de Sade, Montaigne, Aristotle, Erving Goffman, Robert Reich, Georg Christoph Lichtenberg, Alexander Pope and Jane Austen. Bamforth’s technique is not to simply list authors – that would be too crude. Rather, he metonymically links them. But these linkages are often arbitrary.


The essay ‘Ethics’ is actually about insomnia. Bamforth reminds us that the sleep state is ethically neutral. An anecdote about Vladimir Nabokov is neatly linked to one about the Romanian philosopher and writer E.M. Cioran. Both were insomniacs – so far, so good. But then, linking Kafka, W.H. Auden, Nietzsche, Freud and James Joyce, we are brought to a discussion of the merits of The Epic of Gilgamesh – a paragraph tells us how Rilke and Elias Canetti were both bowled over by Gilgamesh. But what has this got to do with sleep deprivation and what medicine and science might do about it as well as what literature has to say about it? What about sleep deprivation in junior doctors – a well-known source of medical error – rather than passing reference to Gilgamesh? Digressions and diversions are symptoms of the abuse of metonymy. A discussion of Proust and sleep leads into a section on the Irish writer Flann O’Brien with the link “Proust was unfamiliar with rural Ireland though”. The link is forced – a lazy metonymy. Here, Bamforth’s Baroque style reminds me of billiard balls flying haphazardly around the baize, or a pinball machine.


The essays contaminated by this rhetorical style tend to be lacking in narrative and resort rather to lists of events. Where narrative is strong – for example in Bamforth’s marvellous essay on ‘integrity’ – the writing seems to me to be so much stronger and engaging. Here, Bamforth turns a review of Emmanuel Carrère’s novel The Adversary into a meditation on lost identities that confounds notions of moral integrity. The essay is subtitled ‘An Empty Plot’ and this is a double-play on the fact that Carrère writes a novel about a French doctor whose whole life was literally an enacted fiction and then hollow. Jean-Claude Romand was (supposedly) a doctor living in France on the border with Switzerland and working as a researcher at the World Health Organization. In short, he turns out to be a fraud – he never completed his medical degree and lived a life of duplicity in which he pretended to have a prestigious job, convincing everyone, including his family and even a best friend Luc Ladmiral, a general practitioner working in a nearby town. Romand systematically embezzled money to maintain the lifestyle of a successful profession where his profession was in fact mute. At the point of his ruse being uncovered, he murdered his wife and two children. Carrère visited Romand in prison to piece together the story. Here, Bamforth returns us to a fundamental discomfort within medicine where doctors walk into roles prepared for them historically and culturally, and this may jar with their non-medical identities. Where then, to find solace or a moral compass? Bamforth’s suggestion is that such touchstones for reality can paradoxically be found in well-wrought fiction.


Readers of Medical Humanities will warm to Bamforth’s topics, but not necessarily to his style. A good editor would have rejected the rather forced abecedary structure of this collection to provide an alternative framework for linking otherwise disparate essays, prefaced by a different kind of Introduction illuminating Bamforth’s thought process and style of engagement. The book reviews sit rather awkwardly amongst the essays. The metonymic name-game could have been tempered. An index of topics would have helped the reader to better navigate around what is important writing in the field of the medical humanities. Finally, there are a couple of cheeky gestures: Bamforth is multilingual (he works as a translator into English from German and French), but it is rather high-handed to preface the book with a quote from the German poet Friedrich Hölderlin that is given in German with no English translation. Later, in an essay on ‘Posture’, a “famous couplet” from Ovid is given in Latin but again not translated. ‘Famous’ perhaps for Bamforth, but he is expecting high standards from his readership. The essays then expose the reader’s ignorance rather than engage her interests, and do not educate as much as lecture. It is a shame that the style sometimes taints the content in what is unquestionably an impressive collection.




The Reading Room: A review of ‘The Spanish Flu…’

21 Oct, 15 | by cquigley


The Spanish Flu: Narrative and Cultural Identity in Spain, 1918

Ryan A. Davis. Published by Palgrave MacMillan, 2013. Hardcover, 255 pages. ISBN 978-1-137-33920-1


This book is unusual in that it deals with a subject that is scarcely found among international literature in the English language, the great influenza pandemic of 1918, or Spanish Flu, so-named perhaps inappropriately after the country. Davis’s work is also uncommon in terms of its cultural historical design, as the author has chosen to look at the epidemic as a discourse made from “the collection of news stories, reports, origin, facts and figures about the epidemic”, the Spanish Flu discourse – SFD hereafter – that he dissects through text analysis. It is true that this pandemic has minimal presence in art, either visual or written, as the author correctly maintains, and that the most common historical studies to date on that episode come from the field of social history, strongly linked to demographical data and to social epidemiology, in essence those which prioritized the material changes brought about by the epidemic. Davis chooses a different path, looking at the collective experience of influenza in 1918 Spain as a cultural trauma, as much as it dealt with a threat to the [hegemonic] cultural identity of the nation that he found articulated in SFD. It is also quite an ambitious endeavour, as the author seeks to evidence “the crucial role narratives play in the human condition”. This particular narrative is well constructed, fluent and clear. Reading Davis’s book is a rewarding, and intriguing, experience.

The Introduction is densely written and painstakingly explanatory in terms of the author’s sources of inspiration. No fewer than 126 footnotes illustrate his task, footnotes that not only account for bibliographical identification but which in many cases include lengthy informative paragraphs. There is where Davis identifies his main primary sources and gives a succinct account of the principal concepts that frame his work. Chapters 1-3 contain a chronological presentation of the appearance and evolution of the two waves – Spring and Autumn – of the 1918 Flu on Spanish soil, an elaboration of the measures taken at the time, as well as reflections on public opinion as well as those of experts. The author follows the birth and development of SFD, coupled to epidemiological differences between the two waves. The first wave appeared in the capital and extended to the periphery, and appeared to be relatively milder despite high levels of morbidity. The second wave, on the other hand, was a comparatively malignant variant judging from the number of deaths associated with it. It appeared first at the French border and in the provinces. Differences between the waves added to the general confusion about the disease. The SFD privileges the collective experience over the individual one (in fact, the use of the scant private sources preserved from Spain is merely ornamental), which is structured as a plot, with a beginning and an ending (p.30-33). This main argument persists throughout the book, within a variety of contexts, including biological, social and cultural. The author displays an impressive ingenuity, and expertise, sharing and discussing these various themes, supported by a comprehensive bibliography.

A “Tale of two States”, the title of the third chapter, correctly introduces one of the inner conflicts that Davis finds in SFD: the confrontation between “epidemic” and “healthy” as the story of “two Spains”, which reflected the struggle for modernization that pervaded fin-de-siècle Spain following the end of its colonies, lost in war to the USA. This is a conflict well known to Spanish scholars, the seedbed of most social, economic and political developments in the history of 20th century Spain, and as such it has been visited many times throughout the last 40 years. Davis’s work delivers a new dimension to this issue, primarily due to its particular focus on the cultural representations of the experience of the disease, which are elaborated in the following two chapters.

In chapter four, “Figuring out the Epidemic”, an accurate path through popular drama, zarzuela (the Spanish type of musical operetta) and certain pictorial representations or cartoons within SFD take readers to Don Juan, an icon for the Flu epidemic under the guise of a “Naples soldier” – the name journalists gave to the illness – taken from a character from the zarzuela “La canción del olvido”, which Davis suggests provided a template for making sense of the epidemic (p.123). Chapter five, “Visualizing the Spanish Flu Nation”, begins with a scrupulous analysis of cartoons published at the time on the subject of the epidemic, introduced by a useful reflection on the importance of cartoonists of the era, underlining the contrast between surface and depth peculiar to this art form and hence suited to expressing the ambiguity of the disease (p.139). Davis follows this with a description and analysis of images gathered by two groups, those that depict the monster of the flu (as a bisexual creature) and those, which represent Spaniards as potential sufferers (overwhelmingly as a white middle aged man of means). The text, framed within representations of epidemics – bisexuality and monsters – is particularly rich in terms of identifying social and cultural associations: the role of women, the fears of the well-to-do in a rapidly changing environment, the newly evolving sports of football, and traditional bullfighting. It is in these final two chapters of the book that the author is at his best, sharing his understanding as he combines elements of a diverse nature within a wealth of metaphors and analogies.

The conclusion comments briefly on the unnoticed third wave of the pandemic, in early 1919, overshadowed by political happenings of the time, including Post-War Peace Treaty discussions and new awakenings of political tensions between central and peripheral Spain. Davis proceeds to focus on the final metaphor in Metchnikoff’s immunity theory. To the author, who has previously made extensive use of another biology-related analogy (membrane = border), the immunity theory metaphor serves to encompass the entirety of the entity of the Spanish Flu in so far as it includes an embodied identity, an external threat and a menace of destruction of identity. The plot that can be followed within the SFD comprises two components, a heroic and a sacrificial one, following Paul Hogan’s terminology (2009) on the role of universal narrative prototypes in emplotting nationalism. Much remains unexplained about the epidemic. It was associated with extraordinarily high mortality rates, and reasons for differences between the first and the second wave in terms of geographic spread remain unclear to the medical world. In addition, disputes over etiology remain unresolved. A contradictory discourse, the SFD, did not serve to alleviate the confusion surrounding the epidemic, as it simultaneously appeared to both soothe and incite fear, as well as on the one hand defending the values upheld by modernity while on the other hand resorting to old paradigms.

We thus find contradictory messages everywhere. It is hardly unsurprising that the author’s final call is to pay more attention to the stories that we tell. I have but one objection: the focus of the SFD, linked to mostly Madrid-based literature and newspapers, and thus largely a product of the learned classes, which is indeed acknowledged by the author, should have included some degree of scepticism on its explanatory power and collective relevance.

As we approach the centenary anniversary of the great Influenza epidemic of 1918-1919, one of the greatest single killers in modern history, it is likely that the output of studies on the subject will increase exponentially, adding to renewed medical interest in viruses as respiratory pathogens responsible for outbreaks such as the 2002-2003 SARS and the 2009 H1N1 Influenza pandemics, as well as new insights resulting from ongoing research worldwide. When the horizon of the history of Influenza has been enlarged by these new developments, the contribution of cultural studies such as Davis’s will continue to take us closer to a fuller understanding of epidemics and pandemics in general.

Esteban Rodríguez-Ocaña

Dpt. History of Science. University of Granada, Spain

The Reading Room: A review of ‘Medical Humanities & Medical Education: How the Medical Humanities can Shape Better Doctors’

14 Oct, 15 | by cquigley



Medical Humanities & Medical Education: How the Medical Humanities can Shape Better Doctors

by Alan Bleakley. Published by Routledge, 2015.

Reviewed by Dr Claire Elliott

How can medical education be changed to produce better, kinder medical students? How can they develop more astute clinical skills and improved awareness of the ethical and professional aspects of caring for and treating patients? In this book, Alan Bleakley argues for the democratisation of medical education – with integration of medical humanities as a core discipline – to help effect this change. He argues powerfully for a ‘critical medical humanities’ to be integrated into the medical curriculum in order to challenge the existing culture of medicine, which he feels breeds what he calls ‘insensibility’ and ‘insensitivity’.

Bleakley describes insensibility as the dullness to perception or blunting of close observation by clinicians. He feels that, for example, the decrease in physical observation and clinical examination in the consultation causes the loss of sensibility. He notes that there is a trend for medical students and doctors to request more investigations such as laboratory tests, x-rays and scans and subsequently their skills for ‘hands on’ examination of patients decrease. Indeed, the longer you are at medical school, the greater the lack of sensibility. He distinguishes this from insensitivity, which he describes as a way in which medicine (as currently taught and practiced) can lead to a lack of awareness or ability to be open to the experiences of peers and patients. Clinicians witness suffering all the time, but Bleakley notices that our current practice of medicine enables or encourages us not to see it.

Bleakley gives us a comprehensive view of the origins and growth of medical humanities in North America, UK and internationally. He observes that we have moved on from the exciting first wave of a new discipline to a more discerning and sophisticated second wave. He provides a full and detailed discussion of the choice of the name ‘medical humanities’, suggesting perhaps that it should be called ‘health humanities’. He argues for a critical medical humanities to reshape clinical thinking and practice to help students improve their tolerance of ambiguity. Bleakley argues persuasively that we need a new approach to medical education to help lessen the burnout, cynicism and high suicide rates that are prevalent amongst doctors. He believes that medical humanities helps stop medical students becoming inured to their patients and can help redistribute the power of noticing by experts to all of those involved in patient care. A key part of his argument is his suggestion that medical educators can challenge existing ways of teaching and practice by seeing the work of radical performance artists such as Bob Flanagan. Flanagan, who had cystic fibrosis, made a film, Sick: The Life and Death of Bob Flanagan, Supermasochist, in which he mixed his relationship with terminal illness and his sexual pleasure from being dominated by his partner.

The need for empathy in medicine is frequently encouraged, yet Bleakley discusses some of the problems with teaching it, as it can be superficial or even disingenuous. It may be that reading fiction can help with this. However, by taking us back to Homer’s Iliad, he (with Dr Robert Marshall who co-authored this section) explores how the powerful emotions of this epic story with its tales of war and killing, the heroic and the temporary nature of life on earth, can engage us emotionally in a more genuine way than teaching empathy through communication skills.

In focussing towards goals and making diagnoses, clinicians often do not see or hear what does not fit with their models of disease. In this way, we cannot see the individuality of the patient or where he or she does not fit in with our expected patterns. This tunnel vision approach is limiting for both doctors and patients. Bleakley suggests that creativity can be gleaned from learning to experience (in contrast to learning from, or through experience). This can allow the flourishing of imagination and new ways of experiencing medicine. Bleakley explores and describes a variety of types of creativity, including collaborations between jazz musicians and surgeons to matching volunteers with chronic illness in the community with second year medical students. Bleakley (who plays the saxophone) illustrates that improvisation and creativity, as used in playing jazz, can directly contrast with the reductive, pragmatic and minimalist approach to learning medicine.

Bleakley tells us about ways in which artists and doctors can work together to enhance observational skills. This can improve the noticing that is needed for clinical acumen and for sensitivity to patients’ needs. He emphasizes the need for awareness of all the senses to improve clinical acumen and decision-making. He describes examples of where clinicians are encouraged to observe, listen, smell, and touch (skills encouraged by William Osler), and this have been shown to improve their abilities. Bleakley also examines the role of close listening to the patients’ story in his exploration of narrative in medicine. He challenges the term ‘history taking’ and suggests that ‘receiving’ would be a better term as it suggests less of a power imbalance between patient and doctor. He explores the ways in which studying narrative can help clinicians, yet also suggests ways in which it can limit expression or cause harm.

Within the context of the medicalisation of normal life, Bleakley considers the ‘normality’ of taking prescription drugs. He investigates how the powerful (such as pharmaceutical companies) create an ‘insensibility’ in the general population of the potential dangers of taking medication for conditions that could be considered within the range of normal behaviour (such as ADHD, psychological problems). He cites a variety of novels where this medicine-taking activity is integral to the life of the characters.

Finally, Bleakley considers one of the common questions from within and outside medical humanities. He asks if the impact can or should be evaluated. He proposes that there are more important issues than measurement of impact: to be a critical contrast to the science based curriculum, to help clinicians be more humane and socially aware, to reconsider the meaning of wellbeing and health, and to educate for the tolerance of ambiguity.

This book is not an anti-doctor polemic, though it does challenge the existing structures and methods in medical education and clinical practice. By proposing a new and critical medical humanities, it suggests ways in which we can subvert the status quo and produce a more observant, imaginative, kinder and resilient medical student who works within an environment where the power is more equally distributed amongst the patients, and all of those who work within health care.

Screening Room: Khalid Ali – Patients’, doctors’ and nurses’ stories at the London Film Festival (7-18 October 2015)

6 Oct, 15 | by Ayesha Ahmad

‘The Good, The Bad, and The Ugly’

Patients’, doctors’ and nurses’ stories at the London Film Festival (7-18 October 2015)

October is the time of the year when the London Film Festival (LFF) brings the best of British and World cinema to film lovers in London. Screening 238 fiction and documentary feature films, the LFF offers a lot of entertainment as well as food for thought for patients, doctors, nurses, other healthcare professionals, humanitarians and ethicists.

Films such as “Mediterranea” (Italy, France, USA 2015) explores the plight of African immigrants in Europe, “He named me Malala” (USA, 2015) chronicles the brave fight of Malala Yousafzai against the Taliban regime campaigning for women education, and “3000 nights” (Palestine, France, Jordan, Lebanon, United Arab Emirates, Qatar, 2015) portrays the hardships endured by Palestinian political prisoners in Israeli jails.

“Fifty” (Nigeria, 2015) manages to go behind operating theatres and lecture halls into the personal life of an eminent obstetrics consultant by exposing her personal life, and how a successful professional career can mask an unhappy existence. The opposing ethical dilemmas of “pro-life” and “pro-choice” in teen-age pregnancy are explored in “Flapping in the middle of nowhere” (Vietnam, France, Germany, Norway, 2014).

Mental illness and depression following bereavement is the theme explored in “The wait” (Italy, 2015), while eating disorders are subject to cinematic interpretation in “My skinny sister” (Sweden, German, 2015).

Terminal illness and cancer form the background of patients’ stories in “Truman” (Spain, Argentina, 2015), “James White” (USA, 2015), and “Chronic” (Mexico, France, 2015).

The intriguing world of comatose patients and how carers, families, doctors and nurses communicate with patients and in some instances abuse them is the subject of “Cemetery of Splendour” (Thailand, UK, France, 2015), and “Madonna” (South Korea, 2015).

There is also an old classic “The raging moon” (UK, 1971) which was one of the early films that featured young disabled people as leading characters in a mainstream film.

“Chemsex” (UK, 2015) a documentary film delves into the underworld of drug use in HIV positive men in London, while drug addiction amongst teen-agers in Algeria is the set for “Madame Courage” (Algeria, France, 2015).

The ugly side of corruption in medical insurance companies is explored in “A monster with a thousand heads” (Mexico, 2015), and the rarely seen world of mortuary workers is seen in “The corpse of Anna Fritz” (Spain, 2015).

Whether you are a patient, or a healthcare professional, you will be spoilt for choice from the stories unfolding on the screen at the LFF.

Review by Dr Khalid Ali, “Screening room” editor

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Screening Room: Vivek Santayana ‘The Messenger’ directed by David Blair (2015)

4 Oct, 15 | by Ayesha Ahmad

The Messenger follows Jack (Robert Sheehan), the titular protagonist, who delivers messages from the ghosts of the recently-deceased to their bereaved loved ones. Only he can see those ghosts. Following the murder of a prominent war correspondent Mark (Alex Wyndham), Mark’s ghost tasks Jack with giving his wife an important message.

Despite a premise that is reminiscent of M Night Shyamalan’s 1999 film The Sixth Sense (including an ironical  reference of some characters being able to ‘see dead people’), and despite The Messenger being advertised as a supernatural horror film, what actually unfolds is a sophisticated study of the experience of schizophrenia, its misunderstanding by society, and the associated prevalent stigma.

Instead of dwelling on the supernatural, the film’s central focus is portraying Jack’s personal experience, his family and social background and behavioural motivations.

Jack suffers from auditory and visual hallucinations for which he is medicated and undergoing psychotherapy. It is ambiguous at first whether or not the people with whom he communicates are indeed ghosts or just hallucinations. The film follows Jack’s perspective quite closely, committing to the idea of ghosts, but nevertheless challenges this perspective by emphasising its conflicting nature with the lived reality of people around Jack.

Interestingly it is not so much the possible presence of the supernatural that is central to the film’s plot as much as Jack’s turbulent relationship with his family and exploration of his tragic past. There are strong indications that following a traumatic experience as a child, Jack started seeing and hearing dead people. The story unfolds through the therapeutic encounters with his psychiatrist (Joley Richardson) as the two of them work together to uncover the trauma that is at the heart of Jack’s condition.

The imagery that represents Jack’s dialogue with his psychiatrist is particularly evocative. He is depicted as walking (or sometimes running) through a deserted field, shouting over the deafening wind, while his psychiatrist’s questions are voiced over. As an image, this conveys his despair, isolation, confusion and frustration at being unable to make sense of his experience.

It also signifies his attempts to run away from traumatic memories striving to reach a coherent understanding of his self. This depiction of Jack’s underlying mental illness is particularly sympathetic to the pain that he suffers in confronting his past, and it portrays the chaotic nature of his struggle to overcome the constant hallucinations.

Many of Jack’s relationships suffer because of his affliction; he is abandoned by his mother and remanded into a psychiatric institution, he is estranged from his sister, he confronts the police and the families of those who recently died. He has no friends; his sole company are the dead people whose messages he carries. His isolation and insecurity make him increasingly paranoid. His “supernatural” experiences are radically at odds with the reality of those around him; nobody close to him understands his agony or shows him any sympathy. His immediate family cannot cope, and his only support comes in the form of his psychiatrist.

Ultimately, the film makes an important point about empathy. In one of their sessions, Jack’s psychiatrist insists on maintaining a crucial distinction: she reassures him that she does not think that he is lying, but genuinely believes instead that “he thinks what he sees and hears is true”. This emphasis on a relative truth shows her appreciation of the authenticity of “his account of reality”.

It is this empathy that allows them to uncover the underlying cause of Jack’s pain and gradually work towards its resolution. Similarly, his relationship with his sister changes profoundly as she gradually begins to understand his condition, and they both begin a slow process of healing.

Far from being a horror film or a thriller, The Messenger is a sensitive and astute exploration of schizophrenia from a patient’s perspective. It is especially compelling in the case it makes for empathising with patients and trying to understand how fraught their experience of reality is. The film categorisation into these genres does a great disservice to the film, especially considering it is quite sparing in its use of thriller and horror tropes. It is far more provocative when seen as a humane film about mental illness and a patient’s struggle to overcome it.

Review by: Vivek Santayana, postgraduate student at the English Literature Department at the University of Edinburgh

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