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Culture

Global Humanities – Finding New Narratives

19 Sep, 16 | by cquigley

 

Conflict, Culture, and the Clinic: Finding new narratives

Ayesha Ahmad

 

In a recent publication “Syria Speaks”, the book volume is a collection of various forms of narrative that have been born in conflict. In reflection, there is a line that says: “War ignites people’s anger, and acts against culture, which is the work of the mind and the imagination”.

I find this interesting because culture becomes a force, a current of an ocean that is our imagination—our creativity, whereas war personifies all ways of life ending—killing, being killed, dying, and seeing others die.

Conflict is not culture. Rather, conflict unearths the skeleton of our human condition at the same time as burying the flesh from the bodies that are returned to the ground.

The ground, or land, is the bedrock of a conflict. The soil is separated and territories are disputed. The fragmentation of the land is a replica of the falling down of humanity. Pieces of the land are fenced away, boundaries that keep people apart from their footsteps.

I recall a passage in a story of four seasons in an Afghan village, recounting the lives of women weaving carpets; their hands moving in ways their grandmothers patterned the stories of their lives into colors and shapes.

The book, The World is a Carpet by Anna Badkhen, features a character called Amanullah. I was captured by the description of Amanullah walking “the trail by heart, steering from a memory that wasn’t even his own but had double-helixed down the bloodstream of generations of men who had travelled this footpath for millennia. A memory that was the very essence of peregrination, a flawless distillation of our ancestral restlessness”.

Our lives mirror our memories, and we carry our cultures; sometimes as treasures and sometimes as burdens.

I wonder about medicine. I wonder about a horizon where those walking from ancient paths like Amanullah entered new landscapes. I wonder about the doctor who encounters the Amanullah’s reaching Europe as refugees; what is the body when the body is without land?

If culture is our embodiment of the soil of our cradle, then medicine must confront culture in the clinical setting, as a form of sight, of hearing, of tasting, of feeling and of expression.

Our “travelling cultures” (Ahmad, 2014) must not be forgotten. In the examination of the toll of such journeys, medicine is challenged with new boundaries of healing and of humanity.

The question that emerges and I leave open for thought is “can doctors find a new narrative for culture in the clinic that inherently holds hope for the suffering?”

 

Reference

Ahmad, A. (2014), Do Motives Matter in Male Circumcision? ‘Conscientious Objection’ Against the Circumcision of a Muslim Child with a Blood Disorder. Bioethics, 28: 67–75.

Book review: Social Class in the 21st Century

15 Jun, 16 | by cquigley

 

9780241004227

Mike Savage, Social Class in the 21st Century, Pelican, 2015

 

Reviewed by Jacob King, Medical Student.

 

You may have heard about the Great British Class Survey, you may have even completed the Great British Class survey (GBCS) or tried their online Class Calculator. In 2015 Mike Savage and colleagues summarised the findings of this great exploration into British society in their book Social Class in the 21st Century. Launched by the BBC in 2011, over 161,000 people (p.409) replied to a survey assessing an extensive range of factors regarding the lives of anyone living in Britain who volunteered to be heard: your income, your savings, the value of a home you may own, whether you went to university/which university? Who do you socialise with? Do you know a cleaner, a doctor, a student, travel agent, what about an aristocrat or noble? What did your parents do for work? Where are you from? What class do you think you belong to?

It’s almost hard to believe that anyone would divulge all this information, and yet a second wave of data collection has since yielded an additional 164,000 respondents, and millions more have tried the abridged Class Calculator online. Social Class in the 21st Century is an Aladdin’s cave of data for the socially curious, for those interested in what makes British society tick, for the man who wants to know what others presuppose of him, not just the class conscious Hyacinth Buckets of the world (though I am certain she would eagerly paw through its pages of charts too). Through the wealth of collected data, and extensive interviewing, the results of the GBCS made revolutionary revisions to the historic models of class, and what, if anything, could justify these. The book in its whole therefore relates to the analysis of their investigations, the establishing of new class identities and explanations of what qualifies membership to these groups, but importantly, it examines the relationship between each of these factors, and the political ramifications the results may hold for society.

While the authors ultimately conclude that the concept of social class has significant flaws, unfairly stereotyping the bottom of society and justifying the position of those at the top, their work identifies three key qualities which influence social standing. They term these economic capital, cultural capital and social capital. (p.46)

Economic capital: The value of your home, whether you rent, your household income, what savings do you have.

Cultural capital: The type and range of interests you pursue: from visiting stately homes to attending rave parties.

Social capital: The kinds of people, and the range of the kinds of people you know: have you an aristocrat friend, has one of your friends never worked?

On the back of this, the authors develop a new model for class structure based on typical and common groupings of traits expressed through these forms of capital. (p.169) With the greatest showing of each of these traits, the ‘Elite’ class characterises those financially well off with high scores for social capital, consumption of ‘highbrow’ cultures (opera and classical music, for example) and relatively high consumption of emerging culture (social media use, listening to hip hop/rap music). At the other end of the grouping the authors describe the precariously placed ‘Precariat’, who often demonstrate very low household income, low social contact scores, very low levels of the consumption of highbrow culture and low levels of emerging culture. The model is completed with five intermediate groupings: established middle class, technical middle class, new affluent workers, traditional working class, and emerging service workers, each with a different pattern of capital forms.

Throughout the book, the authors consider whether class is useful as a stratification tool. In practice, only one-third of people in the UK believe themselves to belong to a class. (p.367) Interestingly, those with higher economic, cultural and social capital reservoirs are more likely to believe that they belong to a class, and are more accurately able to identify which grouping they may fall into. (p.369) On the other hand, 75% of those with lower levels of capital do not believe that they are part of a social class. But despite popular rejection of class titles, the authors describe evidence of lines being drawn between groups, and argue that the labels are perpetuated “even if only to prompt negative reactions to them”. Key examples include the relationships between the traditional working classes and the ‘benefit scroungers’ below, or the technical middle classes and the ‘posh snobs’ above. Commonly, a person’s job, the way they speak, and even, as evidenced by inflammatory comments made by journalist Katie Hopkins on ITV’s This Morning in 2015, what you name your children indicates social class, and where these lines are drawn. (p. 363)

But, what do these models of class, concepts of capital forms, rejections of a class hierarchy but lines being drawn all the same, mean for our lives? While this book is certainly not a medical text, the conclusions may have significant impact on the state of medicine. In one aspect, doctors as a profession have been widely drawn upon for examples of why capital reserves matter.

We are all aware of the gender pay gap, the concept that women are paid less than men for equivalent work. The GBCS highlights the importance of the ‘social background pay gap’, especially among professionals. The results demonstrate that while many other professional groups experience wild differences in their future income depending on their background, doctors are more or less immune to this phenomenon. Doctors beginning their lives in the most elite upbringings only earn around £5,000 more per year than a doctor from a background where their parents did manual work or did not work (£80,226 versus £74,915). (p. 202) Compare this to lawyers (£86,363 versus £65,583) or company CEOs (101,052 versus £83,467). There is not enough room in the book to speculate on why this is the case, but perhaps an industry monopoly, and concrete training programs could offer explanation for why strong social networks, varied interests and comfortable finances do not impact on doctor’s career progression notably. The implications of this exploration of social class have significant (at least proven financial) impacts on the future lives of individuals.

We are treated to a handy metaphor for social mobility. When climbing the mountain that is the social/economic ladder, those who start off near the top of the mountain do not have to climb as far. They have the resources, experience and ability of those around them to support the short climb to the top. Those who start off at the bottom have significantly further to climb, and lack the experience or resources with which to climb. To emphasise the point, Social Class in the 21st Century also takes us through how whether we go to independent or comprehensive school, which university we go to, which course we do, and where we live significantly predicts future social standing.

Reading this book – especially the targeted interviews which provide delightful insight into the very real lives of the anonymous subjects – one leaps to think of people in our own lives, maybe a patient, or family member or friend. You think about their start in life, what jobs they have taken, how much their house may be worth, what are their interests, how does all this link? Aside from the direct implications that this work reveals for the medical community, doctors and patients, and broad examples of health experiences, this work is not a traditional medical piece. Yet, the profound impact that sociological relations have, not just on the day-to-day observable doctor-patient relationship or even medico-sociological phenomenon: access to health, quality of life, health behaviours, attitudes to health and others, but also in shaping everything else in between. The structure of society is linked so fantastically to health, wellbeing and illness, through education, employment, family ties, that the direct health implications that result from disruption in any one of these, could be considered a precursor for the occurrence of poor health and the ultimate success of outcomes.

I relay the conclusions of Prof. Mike Savage and others; despite the quirks and quandaries a sociology study’s methodology faces, the importance of this understanding and how it shapes every aspect of a life is important to appreciate. From our medically tainted view of this book, we can only conclude that our status as doctors fundamentally and inescapably plies us with a high degree of social, cultural and economic capital. Our patients more often than not will not be similar. It is our job then to ensure that social status, presuppositions of ‘our kind’ is in no way a detriment to the clinical relationship. Perhaps more importantly, on a political note, appreciating capital in our patients and the overwhelming effect our early years circumstances has on our social networks, on our interests, our finances, and how this frames all of our interactions is vital to understanding the context of a patient’s life.

Social Class in the 21st Century is a book with beautifully broad scoping commentary, revealing a glimpse into the nature of society, and opening significantly more questions than attempts were ever made to provide answers.

 

Other articles that may be of interest:

Daniel Holman and Erica Borgstrom. Applying social theory to understand health-related behaviours. Med Humanities 2016;42:2 143145 

John Harley Warner. The humanising power of medical history: responses to biomedicine in the 20th century United States. Med Humanities 2011;37:2 9196 

Claire Hooker and Estelle Noonan. Medical humanities as expressive of Western culture. Med Humanities 2011;37:2 7984 

Kenneth M Boyd. Disease, illness, sickness, health, healing and wholeness: exploring some elusive concept. Med Humanities 2000;26:1 917 

 

The Reading Room: ‘Deaf Gain’

8 Apr, 16 | by cquigley

 

Deaf Gain: Raising the Stakes for Human Diversity

H-Dirksen L. Bauman and Joseph J. Murray, Editors

University of Minnesota Press, 2014

 

Reviewed by Dr Paul Dakin, GP Trainer in North London with research interest in the representation of d/Deaf people

 Deaf

This book challenges the commonly held notion that deafness is an existence marked primarily by loss of hearing and a condition that needs to be treated or corrected. Deaf Gain proposes an alternative in which deafness is seen as an evolutionary divergence carrying specific advantages for both non-hearing and hearing communities. Claiming that “Deaf Gain can change the ways in which we appreciate the gifts of all humans” (xxxii), the book argues for a shift in the dominant hearing world view from a perception of what is missing towards a positive recognition of the contributions and advances derived from the experiences of Deaf individuals and Deaf culture.

The basic concept of Deaf Gain was originally formulated in a series of presentations organised by two of the editors, Baumann and Murray, in 2009. These presentations took place at Gallaudet, the world’s only Deaf University, situated in Washington DC.

The 500 page volume was generated out of the resulting discussions and seminars and represents the work of 45 authors mainly based at Gallaudet. The 27 chapters that constitute Deaf Gain are not too long, and are on the whole easy to read, informative, and well researched. The book is arranged in sections that consider applications of the underlying concept around specific themes such as philosophical, language, sensory, social and creative.

The overwhelming approach is positive, optimistic, and even heroic. The concept of Deaf Gain turns on its head the usual idea that deafness should be defined through narratives of suffering and isolation. “The Deaf community has gone to great efforts to deabnormalize deafness. To combat the abnormalizing notion of seclusion due to deafness, we get Deaf cultures. To combat the abnormalizing characterisation of deafness as hearing loss, we get Deaf Gain” (p33).

This may well be true for a minority of people who are non-hearing. The book is written mainly, though not exclusively, from the perspective of the American Deaf Community, most of whom would be deafened at or near birth, and whose first language would be American Sign Language (ASL). Their experience would resonate with other signing communities, such as British Sign Language (BSL) in the UK, although it is not as large, active, or vocal as its counterpart in the USA.

But it should be remembered that the vast majority of individuals who experience deafness are not born Deaf or become deafened at a young age. They actually lose hearing in later life, perceive their experience in terms of communication difficulties with the majority community to which they have always belonged, often feel isolated, and would most certainly characterise deafness as a process of loss.

Claims are made early on concerning the evolutionary advantages of deafness on the basis of the persistence of the deaf gene. Again this is less likely to apply to the majority of people who become deafened later in life. I’m not convinced that just because a gene persists this inevitably means it has enhanced evolutionary potential. For instance, the cystic fibrosis gene is not rare, but its evolutionary rewards, if any, remain unclear. Parallels are also made between the advantages of deafness and those of bipolar disease and Huntington’s chorea, a suggestion that seems rather self-defeating, as I have never come across individuals with these conditions who celebrate such devastating diseases.

Other potential benefits of deafness are more readily and obviously explained. Evidence is given to show that Deaf people have better visual acuity, pay more attention to facial features and to peripheral vision, enjoy greater manual dexterity and enhanced tactile senses, and have improved spatial memory compared to their hearing counterparts. It could be argued that this is not a genetic facility at all but an increased functionality due to loss – an example of when one sense is absent, the brain develops others to compensate. People who have severe visual impairment are traditionally believed to have developed greater abilities to hear and to sense movement, and to even display ‘second sight’. Many people have folk beliefs about the loss of sight leading to enhancement of other senses or even ‘supernatural’ ones. This ‘benefit’ or ‘privilege’ isn’t conferred to those who have lost their hearing but perhaps should be.

An appeal is made to historical records showing how much deafness and Deaf people have contributed to our understanding of the development of language and have pushed forward inventions such as Morse code and the telephone. Deaf people are revealed to be quick learners and good employees, with large companies such as Firestone and Goodyear actively recruiting staff from within the Deaf community. Instances are given of societies around the world in which both hearing and non-hearing people use sign language, with a resulting increase in social cohesion.

The information presented from neuroanatomical studies is fascinating. There is evidence for the gestural origin of language. When children acquire language, spoken or signed, they do so in a similar way. The brain learns communication using similar processes regardless of whether it is visual or auditory, although the right hemisphere is more active with signing. Teaching a hearing baby simple signing conveys advantages in visual processing, language acquisition, vocabulary, and reading.

Creative gains include the notion of Deaf Space in which architecture takes ‘possession of space’ for Deaf people by emphasising vision and touch as the primary means of spatial awareness and orientation. These benefits are available for all, and include emphasis upon exciting features such as building around a common collective space, an emphasis on the placement of light and mirrors, and soft intersections that have destination points within immediate view.

In summary, the book proposes that the world as a whole benefits from the attributes, abilities, perspectives and contributions that arise from deafness, Deaf individuals, and Deaf culture. The concept of Deaf Gain promotes deafness as a positive for the entire community, hearing and non-hearing, not as a genetic or disease abnormality but as “a biological variety in the human race, like skin color or gender” (p287).

I enjoyed reading Deaf Gain, and recommend it as a resource. Although I have reservations about some of its assertions, it catalogues a wide body of evidence and presents well-argued opinion. It is an excellent addition to the understanding of deafness and to the promotion of Deaf culture.

Ayesha Ahmad: Introduction to Global Humanities—Through Creation, Violence Will Die

15 Mar, 16 | by Ayesha Ahmad

Against the backdrop of violence, I have been examining through my research the qualities of our human condition that perpetuate both our survival and our spirit.

As an introduction to an ongoing series on Global Humanities, I will be discussing ways we can counter the dominant narrative of violence.

Our globalised world, or rather, the collective ‘Other’, is met through encounters from suffering—the patients that enter our clinical settings, the individuals that sacrifice their lives to reach the shores of safety, and the images that we only ever see from afar of stories that breathe suffering.

more…

Widening the Lens: Guest Post by Brandy Schillace

11 Mar, 14 | by BMJ

Widening the Lens | Medical Humanities

Brandy Schillace

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.”[1] 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.”[2] 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.[3] 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.[4] 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.

 


[1] Martin Kohn, Director. Medical Humanities/ Information Page. Cleveland Clinic Lerner College. http://my.clevelandclinic.org/about-cleveland-clinic/ethics-humanities-care/medical-humanities.aspx

[2] Felice Aull. “Mission Statement” Medical Humanities New York University School of Medicine

[3] 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

[4] 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

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