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medical humanities

The Reading Room: Erik Parens’ ‘Shaping Our Selves…’ reviewed

1 Dec, 15 | by cquigley


Shaping Our Selves: On Technology, Flourishing and a Habit of Thinking by Erik Parens. Oxford University Press. 2014. xi+200 pages. Hbk. ISBN: 9780190211745.

Reviewed by Nathan Emmerich, Visiting Research Fellow, Queen’s University Belfast.


On the face of it Shaping Our Selves is about the way biomedical technologies, such as neurochemical enhancements and reconstructive surgeries, can be sued to alter and mould the human body and mind. However, the author has previously addressed both of these topics. What is on offer here is, first, a consideration of the way the ethical analysis of these technologies are characterised by polarised positions and, second, an account of binocularity. This latter is a metaphor and names a habit of thinking that, if adopted more generally, purports to promote a greater degree of mutual understanding between different sides in these debates.

Parens’ strategy is to demonstrate that participants in these debates do not simply disagree but have differing intellectual orientations, or lenses, through which they consider the matters at hand. Such disagreements are, therefore, a result of a fundamental incompatibility, even incommensurability, that lies at the heart of opposed ethical perspectives. Parens proposes that if we wish to increase our understanding of the matters at hand we should attempt to consider them by thinking in a binocular, as opposed to monocular, manner. Whilst he thinks that in the final analysis, and when deciding to act, we must lapse into monocularity (p.158), he maintains that when trying to fully understand the issues we can and must oscillate between different ‘lenses’ if we want to fully comprehend the issues at hand.

The binocular metaphor works because Parens is able to divide bioethics – or, at least, the literature on the topics he discusses – into two opposing and mutually incompatible camps each of which adopts different stances on a variety of matters. The camps are those of the enthusiasts and the critics. Those who inhabit these camps have, he says, two different kinds of ethical stances, each of which is associated with two different sets of conceptual ‘lenses.’ When he suggests binocularity involves oscillating between different perspectives it is these conceptual lenses he has in mind. This endeavour can be compared to the way our vision flips between seeing a duck and a rabbit in Wittgenstein’s famous example (p.39).

Thus, the purpose of binocularity is not to help us to see further and with greater clarity or to see in greater depth, at least not insofar as seeing in greater depth means developing a more detailed appreciation for the dimensions of a ‘monocular,’ ‘singular’ or ‘unified’ ethical picture. Rather it names a habit of thinking about different, mutually incompatible approaches to ethical arguments. The aim is not to adjudicate the arguments, to effect some kind of reconciliation or to uncover some sort of ‘third way’ compromise – although, particularly when one begins to think about substantive policy, this latter may in fact result. The avowed aim is, instead, to sensitise us to our own ethical partiality and, in so doing, to encourage us to become less combative and more bipartisan in our thinking. It is Parens’ hope that we will become less rigid in maintaining our ethical stances and, in so doing, become less concerned with winning ethical arguments and more concerned with developing a greater understanding of the issues.

It is a laudable aim and Parens’ discussion contains a great deal of insight into and appreciation for the essentially political problem of engaging in contemporary ethical debate in a mutually respectful manner. Nevertheless, there are some questions to be answered. For example, Parens divides bioethicists into enthusiasts and critics, roughly those who embrace emerging biotechnologies and those who are more cautious and critical of its potential impact. The characteristic perspectives of these two groups is fleshed out by a series of conceptual binaries, one of which is the idea that enthusiasts see biotechnology as ‘value-free’ whilst critics see it as ‘value laden’ (Chap. 4). Whilst this might be true of bioethicists like Julian Savulescu and John Harris, it is not clear that this applies to others who are positioned in this camp, such as James Hughes (p.60 & 95), Andy Clark (p. 81) and Donna Haraway (p.81). Indeed it is also not clear that these latter techno-enthusiasts – and other comparable figures such as, for example, Steve Fuller – would have much sympathy for the relative simplicity of utilitarian accounts. Equally, one could suggest that utilitarian bioethicists would no doubt find Haraway’s or Fuller’s thinking needlessly complex.

One can make a similar point about those who adopt a more critical stance. In Parens view the inhabitants of this camp include outright bio-conservatives such as Leon Kass (p.51), as well as more moderate conservatives such as Dan Callahan (p.15), Michael Sandel (p.60), and Hans Jonas (p.67). However, it also includes many if not most, sociologically inclined bioethicists such as Illina Singh (p.58), Jackie Leach Scully (p.136), and Tom Shakespeare (p.136), none of whom could really be considered anything but liberal in their general outlook. Whilst one might take this as suggesting there is a distinct problem with Parens binary nomenclature, it is important to note that he rejects the idea that the enthusiasts and the critics map onto standard political divisions of progressive liberals and traditional bio-conservatives (p.52).

Given the evident and significant differences between the perspectives held by those Parens groups into enthusiast and critic, we might consider Steve Fuller’s recent suggestion that the notions of left wing and right wing are undergoing an ‘axial rotation.’ Fuller’s thinking indicates that we should reframe these basic political differences in terms of ‘up wing’ and ‘down wing.’ The latter is associated with the ‘precautionary principle,’ something often espoused by those Parens has termed critics. In contrast the ‘up wingers’ are associated with the ‘proactionary principle’ or ‘imperative,’ an idea that stems from the enthusiasts’ reaction to the precautionary principle. Whilst they come from very different perspectives, Parens (the critic) and Fuller (the enthusiast) have, it seems, independently divided the world in very similar manners, indicating that their ideas have some degree of validity.

Whilst Parens’ division of bioethicists, and those who labour in associated fields, into enthusiasts and critics stands up to scrutiny, some of the associated binaries seem less robust. For example, he holds that enthusiasts see technology as value-free whilst critics hold that it is inherently value-laden (chap. 4). However, even if these individuals are not bioethicists per se, this division can be supported when we consider enthusiasts like Haraway, Clark and Fuller. Furthermore, given the scope of this division, what might it mean to propose that we oscillate between the view that our techno-scientific achievements are value-free and the view that they are value-laden? Parens asserts that “no thoughtful person would want to choose between thinking that technology is value-free and thinking it is value-laden” (p.93). Whilst I am not a true Scotsman, I certainly aim to be a thoughtful person and, as such, I fail to see why one should not ‘choose’ or, rather, conclude that all human technology is value-laden. In my view the alternative position is fundamentally flawed.

This is not to say that I cannot appreciate the arguments, the motivations and, to a degree, the value of arguments that presume that technology is value-free. Nevertheless, I cannot take them as seriously as work conducted from what I consider to be the more defensible perspective. Given that Parens is not proposing binocularity as a ‘grand, meta-lens’ (p.9), ‘cure or solution’ (p.10), or ‘panacea’ (p.172) perhaps this is all that is required when oscillating between competing, contradictory and incommensurable points of view. If so, one could think that what Parens is proposing is a mode or style of interaction between those with differing ethical stances and perspectives. Whilst he is not suggesting we abandon the pursuit of singular or monocular ethical perspectives, arguments and accounts, he is questioning how we ought to conduct ourselves when speaking across such divisions. One might, then, take him to be offering an ethics of the public square or, to put it another way, attempting to find a common socio-political space from which we can give proper consideration to divergent but genuinely held ethical perspectives. As such ‘binocularity’ is a kind of political stance, built upon the recognition that the neutrality of liberalism is not the same as liberalism being value free (p.49).

Whilst it is not discussed, at least not in any detail, Parens’ approach can be seen as insisting on the value-laden nature of the public square, our political debates and, for that matter, our ethical discourse. One can, I think, see this as predicated on the assumption that applied or practical (bio)ethics is, in essence, a contemporary political technology, one that bolsters the apparent neutrality of liberalism. As such it would seem that binocularity is predicated on the assumption that human technologies are not value-free, but inherently value-laden. Binocularity is, then, something that conforms to the worldview of the critics. However, it is not clear how well it might sit with those enthusiasts who cleave to the notion that technology is, or can be, value-free and that ethics is, or can be, considered in an ‘objective’ matter to be pursued through adopting an ‘impartial’ stance (p.23). If my analysis is well-founded, it is not clear to me why Parens’ putative opponents, the enthusiasts, would think the binocular approach worth considering; it seems to be founded on a set of values that seem anathema to their favoured approach.

In the chapter ‘Closing Thoughts’ Parens details how, when he embarked on his first major project at the Hastings Centre, he adopted a ‘high reason’ approach to (bio)ethical analysis of enhancement and did so against his own academic training and intellectual inclinations (p.161). Given that Parens identifies with the critics’ camp, one can see this as an attempt to adopt the stance of his opponents, the enthusiasts. Whether this was done to prove them wrong on their own terms or, as is more likely, something that naturally resulted from the process of entering a new field, of being a newcomer who naturally tries to fit in and find his feet by conforming to the rules of the disciplinary game, is not relevant. What matters is that the approach adopted by Parens belonged to his opponents. Whilst one cannot fault him for it – it was through doing so that Parens was able to fully develop his own ethical stance – it is nevertheless illuminating. In this light one might consider if Parens’ metaphor of binocularity fails to fully challenge his opponents; if, despite his intentions, it cedes too much ground to the enthusiasts thereby allowing their style of monocular ethics to flourish and, ultimately, maintain its position of dominance.

Against this one can, I think, point to an underdeveloped aspect of Parens’ account. On the one hand he claims binocularity runs against the grain of “the first law of thinking dynamics” (p.40), as conducting intellectual enquiries using more than one lens requires more effort than monocular thinking. However, towards the end of the book, Parens discusses a couple of cases that reveal the way in which ordinary individuals often appear to be thinking in a binocular manner and, furthermore, seem to be doing so with relative ease (p.149-151). If this is the case it seems to belie the notion that “we can’t actually think with any two lenses at once” (p.39). As the notion of lens is, here, a metaphor for ‘conceptual framework’ we should, I think, acknowledge that monocularity is a product of thinking from within specific disciplinary perspectives and may not be something that troubles everyday human reflection, at least not to the same degree.

To be clear, monocular disciplinarily has served us well. Nevertheless, given that the notion of ethical expertise or, at least, moral authority is widely rejected, then we should consider the positive and negative consequences that disciplinary rigour in the field of ethics has had for the way we understand our ordinary or everyday ethical thinking. Read as a plea to further reconnect academic ethics, and the study of meaning questions more generally (p.4), with lived experience as – for example, those working in feminist and disability ethics have done – and a broader, humanities based, understanding of human being, Parens’ argument takes on greater significance; it indicates that further reflexive development of this field of enquiry is possible. Indeed, consistent with this thought, Parens suggests that we are at the beginning of a ‘second wave’ in enhancement debates, one that exhibits a greater degree of binocularity (p.9 & 175). If what Parens calls the second wave is, as I suspect, marked by a relatively sophisticated and interdisciplinary approach to bioethical analysis, then his binocular habit of thinking may offer a much needed guide as to how such scholarship might be collectively understood and, ultimately, pursued in such a way as to contribute to and participate in the common good or, in Parens terms, human flourishing in the broadest sense.






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.


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.

The Reading Room: A review of James Rhodes’ ‘Instrumental’

2 Sep, 15 | by cquigley


Instrumental by James Rhodes

Canongate Books, 2015. £16.99 hardcover, £14.99 E-Book

Reviewed by Vivek Santayana, Postgraduate student in Literature and Modernity, The University of Edinburgh


James Rhodes’s controversial memoir, Instrumental, is about many things. On the one hand, it is about the trauma of child rape. There is an ethical dimension to the way this book talks about the trauma of child rape, suggested by its use of an epigram from US Marine Corps veteran Phil Klay about honouring stories of victims. This memoir is, in some respects, about a victim of severe trauma speaking out about his experience. Rhodes describes, with terrifying candour, his lifelong struggle of dealing with the catastrophic events of his childhood and the self-destructive state of victimhood the experience left him with for almost all of his life.

On the other hand, as Rhodes emphasises in the preface (and in his interview on Newsnight on 20 May), this is also a book about the power of music, and is intended to serve as a rejoinder to the bastardisation of the classical music industry. Supplementing this is a playlist of the many pieces discussed in the book, available free on Spotify ( Woven through this discussion of music is the harrowing story of Rhodes’ life, which he sees as the ultimate example of the profound and transformative impact music can have on one’s life, and how artistic expression gave him both the hope and the means for coping. Instrumental is nevertheless deeply complex, not just because of the difficult and painful main subject matter, but also because it challenges the expectations that might arise from classifying the book as either about trauma or music. What made this book particularly challenging for me was how rapidly it alternates between both of these narratives. This is a personal account of Rhodes’s life, and the sudden shifts in tone and texture serve to emphasise that the traumas of his past and his musical career are equal and contiguous parts of his life. There can be no clear demarcation between the one and the other, both in narrative and in practice.

Reading this book, it is important to bear in mind the context in which it has appeared in print. Publication came after a protracted legal battle between Rhodes and his ex-wife that lasted over a year, ending in May 2015 with the Supreme Court overturning the Court of Appeal’s decision to grant a temporary injunction on publication. It is open to interpretation whether or not Rhodes’s insistence that this is a book about music is in some ways an attempt at negotiating this censorious legal climate. However, even with the greatest of sensitivity to the parties involved and the greatest of care for their security and privacy, there is a sense in which preventing Rhodes from telling his story would in some ways be a repetition of the same attitude of secrecy and shame through which victims of abuse are silenced, much as Rhodes himself was when he was a child. Rhodes’ voice, when telling the story of his abuse, is inflected by these circumstances.

While he states quite passionately that music is what saved his life, there is a sense in which this is not an entirely accurate conclusion to draw from the story that Rhodes presents. He describes in great detail his experience of abuse, and subsequently his struggle with the self-destructive cycle of victimhood, self-harm, depression, breakdowns, suicide attempts, drug abuse, alcoholism and dysfunctional relationships. He elaborates on what he considers the numerous symptoms of chronic sexual abuse – OCD, dissociation, visual and auditory hallucinations, hypervigilance and eating disorders – as well as the painful process of his treatment through reparative surgery, forcible institutionalisation, therapy and, of course, music, which is one of the more significant contributing factors to healing. Music gave Rhodes something positive to aspire towards, as well as a sense of security and achievement that comes with a rigorous regime of practice and successful performances. Many of the experiences he describes, like the first time he heard Bach’s Chaconne from the Partita for Violin No. 2 transcribed for the piano by Ferruccio Busoni (36), the sense of comfort and security he felt when sitting at a keyboard the first time he performed live (113), the ‘spiritual epiphany’ he experienced when he smuggled an iPod into a psychiatric ward and listened to Bach under the sheets (133), as well as his experience of recording his first album (163), exemplify the transcendental power of music to heal. Rhodes claims that ‘creativity is… one of the most profound ways through trauma’ (225). However, despite his passion for music, there were times when his career as a musician, and the pressures and frustrations involved therein, only served to aggravate his condition. The transcendence and escape afforded by music were temporary, and he ultimately imploded again in a similar manner to before.

In addition to music, there were numerous other factors that contributed to Rhodes’ on going recovery, the most important being the birth of his son. Moreover, while he is quite scathing about mental health facilities in Britain (which he describes through allusions to Ken Kesey’s One Flew over the Cuckoo’s Nest in terms of their lack of empathy and their over-reliance on medication), it is clear that the private facility that he went to in Arizona, with its emphasis on therapy and support groups, was also vital for his treatment. Similarly, the relationships he formed with his son, manager, new partner and some of his closest friends, and their kindness and generosity in his time of need, were crucial to his recovery. While music did have a profound impact on Rhodes’ life, and while creative expression is a powerful mode of therapy, he is circumspect about claiming it as his sole miraculous, transformative force, and emphasises that music is one of many things in his life, along with psychiatric treatment, medication and support and empathy within a broader community, that are part of his ongoing recovery.

Rhodes’ narrative is conscious of its chaotic nature and sense of artifice. This is most strikingly observed in the preface, where Rhodes imagines the morning in which he writes the book as if it were a play in which he, quite graphically, commits suicide, leaving a shocking note to his partner (xvi-xviii). Interspersed within the memoir are a number of self-referential remarks that emphasise his awareness of how the story is an attempt to structure his experience into a coherent narrative. The narrative voice frequently vacillates between suffering and joy, such as when a sublime experience of listening to Bach in a psychiatric ward is juxtaposed with a botched suicide attempt, or when graphic descriptions of self-harming are followed immediately by lyrical descriptions of music. In the most unexpected of moments, the narrative is laced with a bleak sense of humour. The texture of this narrative, with its uneven tone and the sudden, drastic changes in mood, are especially important in the way they embody the disordered nature of Rhodes’ experience.

It is tempting to romanticise the notions of mental illness and suffering and see them as intertwined with creative expression. I found one of Rhodes’ remarks quite troubling, when he states in the context of Robert Schumann that ‘composers and mental illness go hand in hand’ (193), although it is quite probable that this is meant to be ironic. Evan Davis, when he recently introduced Rhodes on Newsnight, made a similar connection between suffering and musical talent, describing Rhodes as having a ‘tormented soul’ that ‘comes out in his music’. The notion that mental illness is in some way constitutive of genius ­– that it gives access to some heightened state of aesthetic sensitivity – is a dangerous oversimplification of the experience of mental illness. However, Rhodes’ narrative complicates this romantic image of the tortured genius. His celebration of composers’ lives and works is contrasted by the self-deprecating tone that he adopts while describing his own struggles when attempting to make music. Rather than depict his suffering as eventually culminating in his musical talent, he describes his experience exactly as it is, and instead suggests that music is a way of healing. When he discusses the lives of various composers, he does so to emphasise how music can be a source of hope when dealing with trauma and pain. While talking about his own life, Rhodes avoids the romanticised notion that all artists are tortured individuals, or conversely that all suffering leads to artistic excellence, and his attitude towards art and music needs to be considered in this light.

As promised in the preface, Instrumental does indeed contain a strong and broad focus on music. The later chapters are a scathing criticism of the Classical BRIT Awards, the snobbery of the gatekeepers of high culture and the dumbing down of the music. It also describes Rhodes’ ambition to start a new record label as part of a campaign to broaden access to classical music, to improve music education and to reverse the tide of the decline he describes. His story of dealing with the trauma of child rape becomes part of this argument, demonstrating the profound impact music can have on one’s life and why it is of paramount importance to save it. His campaign to change the music industry is as significant to his career as the trauma he suffered as a child. This goes to show that Rhodes’ life story, and the way he writes about it in his memoir, is about much more than just giving voice to a traumatic experience, as he shares his experience of being able to live through the trauma and of finding a positive and lasting outlet for his creativity.



Rhodes, James. Instrumental: a Memoir of Madness, Medication and Music. Edinburgh: Canongate, 2015.

—. Interview by Evan Davis. Newsnight. BBC, London: 20 May 2015. Television.

The Reading Room: ePatients Conference, Queen’s University Belfast

12 Aug, 15 | by cquigley



The Medical, Ethical and Legal Repercussions of Blogging and

Micro-Blogging Experiences of Illness and Disease


Institute for Collaborative Research in the Humanities

Queen’s University Belfast, 11-12 September 2015

The provisional programme for this conference is now available:

Friday 11th September

11.00 – 11.30         Registration

11.30 – 11.45          Welcome

11.45 – 12.45          Keynote 1:

                                      Anne-Marie Cunningham (Cardiff University)

                                    Learning with and from epatients

1.45 – 3.45               Panel 1:

                                      Chair: Nathan Emmerich (QUB)

Amy Brown (SUNY Upstate Medical University, Syracuse, New York): Grounding the Relationship Between Families and Physicians in a Digital Community: A Case Study

Columba Quigley (Reading Room Editor, Medical Humanities): The ePatient and Stories of Illness

Kristen Larson (Duke University): Autopathography and Online Community: Applying Biovalue to Understand the Lisa Adams Controversy

Yewande Okuleye (University of Leicester): You call it Marijuana and I call it Medical Cannabis: Online Identity Construction and Illness Narratives from the epatient/activist Perspective.

4.00 – 5.40              Panel 2:

                                       Chair: Pascal McKeown (QUB)

Maggie Bennett and Deborah Coleman (QUB): Cultivating Compassion through Analysis of Online Patient Narratives

Sylvia Hübel (Interfaculty Centre for Biomedical Ethics and Law, University of Leuven, Belgium): IVF Blogs and Online Forums as Sites of Patient Empowerment and Moral Agency

Angela Kennedy (independent researcher): Power and Conflict between Doctors and Patients: the Case of the ME Community

5.45                            Drinks Reception, The Naughton Gallery

7.00                           Conference Dinner, Deanes at Queen’s

Saturday 12th September

 10.15 – 11.45          Panel 3:

                                      Chair: Paul Murphy (QUB)

Rebecca J. Hogue (University of Ottawa, Canada): Cancer Blogging – A Survivor’s Story

Marie Ennis-O’Connor (Digital Media Strategist and Health Blogger): Connecting and Protecting: The Benefits and Pitfalls of Online Disclosure

Anne Lawlor (22q11 Ireland Support Group): Social Media as a Virtual Lifeline: A Support-Group Perspective of the Issues

12.00 – 1.00             Keynote 2:

                                     Julia Kennedy (Falmouth University)

                                     In Our Blood: Mapping Multiple Narrative Accounts of Leukaemia Online

 1.45 – 3.15               Panel 4:

Victoria Betton (University of Leeds and mHealthHabitat programme director (NHS)): Mental Health Discourses in Social Networking Sites

Ida Milne (QUB): A Rash of Reaction: the e-parent and the 2015 Measles Epidemics

Sally Burch (Patient Blogger at “Just ME”): The Use of Patient Blogs as a Care Resource


The deadline for registration is August 14, 2015.

Further information can be found here:

The Reading Room: Upcoming workshop on ageing

12 May, 15 | by cquigley


Medical Humanities and Ageing, 29/06/2015


An initiative of the CHCI Medical Humanities Network Program, funded by the Andrew W. Mellon Foundation through the Consortium of Humanities Centers and Institutes (CHCI)

Old Committee Room, King’s Building, King’s College London, Strand Campus, Strand, London WC2R 2LSDate: Monday 29th June 2015

The Centre for the Humanities and Health, King’s College London, would like to invite you to our second workshop on medical humanities and ageing. We are one of the six CHCI member centres and institutes working on a project to further the development of medical humanities as a subject of study: each partnering centre conducts specific research on ageing, undergirded by collaborative reflection on issues of evidence, value, and evaluation.


10:00 – 10.30: Welcome

10:30 – 11:30: Panel: Reflections on Old Age

Dr Claire Hilton, Sauerkraut and African Violets: the Art of Old Age Psychiatry

Dr Elizabeth Barry, ‘Narrower and Narrower would her Bed Be’: Woolf, Beauvoir and the Change of Life

11:30 – 12:00: Coffee break

12:00 – 13:00: Panel: Stories from the End of Life

Dr Columba Quigley, How We Die: Palliative Care and an Ageing Society

Dr Maria Vaccarella, Narrating Decay

13:00 – 13:30: Concluding remarks

Seating is limited, so if you would like to attend, please contact Dr Maria Vaccarella ( by Monday 15th June 2015


Review: “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.”

28 Apr, 14 | by gbelam

We have another great review today, of Lori A Brown’s book “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.” It’s by Sophie Jones of Birkbeck College, University of London, and considers aspects of architecture, landscape & design, and wider ideas about feminism and attitudes to women’s health in the USA.  Looks like a fascinating area for discussion. 

– Georgia Belam


Review: “Contested Spaces: abortion clinics, women’s shelters and hospitals.” by Lori A Brown

By Sophie Jones


‘Is it possible to build non-sexist neighborhoods and design non-sexist cities? What would they be like?’[1] Posing these questions in 1980, Dolores Hayden vocalized the utopian impulse of feminist architecture. A generation of women architects were convinced that Hayden’s question had an affirmative answer. Their plans for housing complexes with integrated childcare centres and cooperatively-run kitchens were not merely isolated amendments to the world as they knew it, but blueprints for a materialist feminist revolution. In Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals, Lori A. Brown brings this heritage of feminist architecture to bear on contemporary approaches to these charged sites. Brown asserts, ‘Space matters. Space is at stake. Control over geography is being legislated by those who want to eliminate a woman’s right for reproductive choice.’[2] Her proposals, which include bullet-resistant windows and abortion clinics in shopping malls, bespeak a different political climate: these are constrained negotiations, not revolutionary demands.


Brown’s research into the spatial politics of abortion clinics—and, to a lesser extent, women’s shelters and hospitals—is primarily focused on the United States, with some comparative analysis of Canada and Mexico. The author, an architect based at Syracuse School of Architecture, announces her project as a dual intervention, correcting her discipline’s lack of social engagement while drawing public attention to the feminist politics of the built environment. Debates about abortion often prioritise the subject of time, dwelling on the abstract question of when the foetus acquires a right to life. Contested Spaces marks a welcome turn to the spatial, as growing numbers of women across North America face harassment outside clinic doors, if and when they manage the long, expensive journey to their nearest abortion provider. Brown has transformed these hostile landscapes into diagrams punctuated by sobering statistics. On one map, a stark black line represents a 404 mile journey across South Dakota to the only clinic in Sioux Falls—a route served by no public transportation.


The book, which Brown positions ‘somewhere between theory and practice’, is concerned not only with the siting, accessibility and security of buildings, but also with the way architecture manifests social antagonisms.[3] This approach makes sense, but the abrupt shifts between registers are telling. A section about Dr. George Tiller, the Kansas abortion provider shot to death by a terrorist in 2009, segues awkwardly into a recommendation that clinics install meditation rooms for quiet reflection. The story of Paulina del Carmen Ramírez Jacinto, who was refused an abortion at the age of 13 after being raped during a break-in at her family home in Baja California, is followed by a consideration of the importance of lighting and paint choices in reproductive healthcare facilities. Noting the disjunction here is not a matter of policing the boundary between the serious and the trivial. Rather, it is to pay attention to the conditions that interrupt feminist blueprints for the future before they become reality.


Women, as Contested Spaces demonstrates, have historically found ways to repurpose structures designed to enclose them. In the 1960s and early 1970s, California’s Army of Three and Chicago’s Jane Collective helped women to access ‘menstrual extraction’ procedures, often in domestic spaces. Brown notes that, for these underground collectives, ‘Domestic space became the space of choice, liberation, security and safety from the law.’[4] Meanwhile, the Netherlands-based initiative Women on Waves dodges national abortion laws by providing terminations at sea. As Brown astutely observes: ‘Connected with neoliberal policies, this project exploits the idea of free trade zones and International waters and exists because it plays against hegemony’s own system through legal loopholes of globalization.’[5] A similar intervention occurred recently in South Dakota when, faced with a prospective ban on almost all abortions, Cecilia Fire Thunder proposed opening a clinic on her reservation, which was beyond federal jurisdiction. In mapping the coordinates of a world without punitive borders, these projects testify to the potential scope of feminist spatial theory.


Yet the visions for feminist space projected by past generations of abortion rights activists seem woefully truncated by contemporary compromises. Among these are the ‘bubble laws’ adopted in some US states, which institute ‘zones of protection’ around clinics and the patients entering them. For Brown, the difficulty of enforcing these laws lends their name an ironic resonance: the translucency and fragility of bubbles mirrors the precarious status of abortion access. Her interviews with private clinics in the most restrictive US states—which include Mississippi, South Dakota, and Utah—uncover inventive tactics for grappling with government pressure and anti-abortion hostility. Clinics have developed an impressive repertoire of strategies for combating the harassment of their patients: installing sprinkler systems outside clinics, scheduling landscaping work to spray demonstrators with grass, and setting up speakers to drown out protest noise with music.


With the battle lines drawn, the project of drawing up blueprints for revolutionary feminist health spaces appears simultaneously urgent and remote. Few clinics have the freedom to choose their location because many landlords refuse to let space to abortion providers. Meanwhile, renovation proposals attract excessive levels of scrutiny from public officials beholden to the anti-choice movement. Is it better to be a free-standing clinic, with the autonomy to install tight security at entrances and exits, or to be absorbed into a multi-unit complex, where patients and workers have more anonymity? When making design decisions such as these, providers feel trapped between a rock and a hard place.


Brown writes, ‘Reproductive healthcare facilities have become twenty-first century equivalents to medieval cities where walls and moats were once used for security from intruders.’[6] There is, perhaps, an alternative to this state of enclosure. One of the clinic directors told Brown that abortion needs to become part of a larger movement for social justice, linked to campaigns for childcare, education, and health. This is the insight of the reproductive justice movement, instigated by women of colour in the US who have drawn attention to the problems of isolating abortion as a single issue.[7]


Contested Spaces opens with a synoptic journey through feminist geography and architectural theory, taking in Nancy Fraser on subaltern counterpublics, Iris Marion Young on pregnant embodiment, Homi Bhabha’s notion of a third space, and Elizabeth Grosz on the mutual constitution of bodies and cities. In her conclusion, however, Brown risks collapsing this nuanced discussion of space into a question of location. She writes:


I advocate for clinics to become more centrally located in our daily spatial lives. They need to be front and center in our society, not hidden away and difficult to access. Locate them in shopping malls where protests cannot happen due to malls not being public space.[8]


Brown goes on to argue that terminations should be provided not only in mainstream hospitals but in shopping malls, military bases, jails, prisons, high schools and churches. Grouping these institutions together as elements of our ‘daily spatial lives’ evades the important distinctions between their modes of funding and management. It is odd that Brown does not consider the stake shopping mall abortion clinics might have in a privatised healthcare system, given the centrality of abortion to debates over the Obama administration’s Affordable Care Act. Meanwhile, the nuances of reproductive healthcare in prison are ill-served by the proposal for jail-based abortion clinics, particularly in the wake of revelations that California prisons subjected female inmates to forced sterilisation as recently as 2010. A tension between pragmatism and utopianism animates Contested Cities, and its conclusion appears to decide in favour of the former. Meanwhile, Hayden’s challenge – ‘What would a non-sexist city look like?’ – reverberates, as a reminder of way the architecture of reproductive justice can be integrated into a broader vision for social change.



[1] Dolores Hayden, ‘What Would a Non-Sexist City Be Like? Speculations on Housing, Urban Design, and Human Work’, Signs, Vol. 5, No. 3, S170-S187.

[2] Lori A. Brown, Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals (Farnham: Ashgate, 2013), p. 101.

[3] Contested Spaces, p. 37.

[4] Contested Spaces, p. 78.

[5] Contested Spaces, p. 82.

[6] Contested Spaces, p. 185.

[7] See

[8] Contested Spaces, p.

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