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5th International Symposium on Poetry and Medicine at the Royal Society of Medicine, Wimpole Street, London on Saturday 10 May 2014

17 May, 14 | by BMJ

Reflections from the 5th International Symposium on Poetry and Medicine by Clare Best

 

This year’s Symposium invited us to focus on how we might begin to define the term ‘medical poetry’ and asked if that is even a useful aim. Michael Hulse started the day with a thought-provoking talk proposing that the Romantic ego has evolved and survived in the area of medical poetry whereas it is now rare in other contemporary poetry. He argued that the natural successors of the Romantic poets, those foregrounding the self in extremis, are concerned with what he terms ‘primary medical poetry’ –  in which a person writes about his/her own experience of illness or treatment from the point of view of an existential self. ‘Secondary medical poetry’ is the term Michael used to describe poetry written about medical experiences happening to a close other. He saw ‘tertiary medical poetry’ as including poetry that stands at another remove from the medical experience, being more engaged with scientific, historical, ethical and other aspects of medicine.

 

Michael’s talk was a helpful starting point, and throughout the day speakers came back and back to the different kinds of medical poetry he had suggested. After years of hearing nothing but the term ‘confessional poetry’ used in reference to poetry of extremis written in the first person, I liked Michael’s idea of affirming ‘a central literary site’ for the Romantic ego.

 

A particular highlight of the Symposium, for me, was Sandy Goldbeck-Wood’s beautifully fluent and convincing presentation of her work on how biography drives biology. I have always been interested in how the body expresses adverse experiences as symptoms, and I found myself nodding as Sandy spoke about how ‘both poetry and psychosomatic illness might be seen to be forms of embodied feeling or knowledge, both resisting “purely conscious” forms of communication’. Yes!

 

There were many, many other highlights, including Alan Beattie’s warm and generous account of Norman Nicholson’s life and poetry, Ahmed Hankir’s powerfully dramatic rendition of his ideas around the wounded healer, and Jens Lohfert Jorgensen’s brilliantly engaging presentation of the Danish poet Morten Sondergaard’s Wordpharmacy (do have a look at http://www.wordpharmacy.com) – I’ll be ordering my copy immediately.

 

Then there was poetry itself of course: poems of medicine and surgery, remedy and reverie, diagnosis and prognosis, all kinds of poems to make you laugh and cry. I was honoured to present some of mine from Self-portrait without Breasts alongside Rebecca Goss reading vivid and beautiful poems from Her Birth and Lesley Saunders reading from her stunning collection Cloud Camera.

 

Philip Gross gave gorgeous readings from Deep Field and Later, leading us on into the final part of the day which celebrated the winning and commended poets in the three categories (Young Poet, NHS and Open Awards) of the 2014 Hippocrates Prize for Poetry and Medicine. Conor McKee won the Young Poet section with ‘I Will Not Cut for Stone’, Ellen Storm won the NHS section with ‘Out of Hospital Arrest’ and Jane Draycott won the Open section with ‘The Return’. Many congratulations to all the winning and commended poets.

 

I came away from the Symposium once again inspired and uplifted by the truth and power of poetry that addresses medical subjects. I came away knowing that in the face of extreme and threatening medical events, in situations where our identities are challenged and even deconstructed or changed forever, poetry can excite us into new appreciations of life and of who we are and can be. As I see it, the more science probes and uncovers the physical and medical experiences of our lives, the more we need poetry to interpret and express these experiences. Poetry and medicine are perfect companions.

 

Thank you Donald Singer, Michael Hulse, Nicola Williams and all the others including the judges Sarah Crown, Robert Francis QC, Philip Gross and Kit Wright, who made Saturday happen. It was a wonderfully rich day. I’m already looking forward to next year’s Symposium.

 

Find out more about the Hippocrates Initiative for Poetry and Medicine at: www.hippocrates-poetry.org

 

Clare Best

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

 

 

Dr Nikesh Parekh: Film Review The Lunchbox- ‘Letters, chillies, and memories’

4 May, 14 | by Ayesha Ahmad

Set between an apartment block in suburban Mumbai and a modest office floor, The Lunchbox is a film of understated elegance exploring human emotions and connections. Ila (played by Nimrat Kaur) is a young, middle-class Indian woman who is desperately trying to rekindle a waning marriage by preparing her husband delicious lunches that are delivered by the ‘Dabbawala’ system that is widely acclaimed for its efficiency; Dabbawala is an Indian word for men who deliver vast numbers of lunchboxes hanging off the sides of their bicycle in Mumbai and some other cities in India.

more…

Beautiful Science at the British Library: A Review by Isobel Elstob

3 May, 14 | by Deborah Bowman

 

We are delighted to publish this guest review by Isobel Elstob who visited the Beautiful Science Exhibition at the British Library for Medical Humanities. The exhibition is showing until 26 May 2014.

 

Review of Beautiful Science: Picturing Data, Inspiring Insight

Folio Society Gallery, British Library

20th February – 26th May, 2014

 

Isobel Elstob

Correspondence to: izzyelstob@hotmail.com

 

 

How do we represent the material – and immaterial – world visually? This is the question that underpins the Folio Society’s exhibition Beautiful Science at the British Library. The Folio Society Gallery, in which the exhibition is displayed, is a small and awkward space that functions vertically and can be entered from two sides. This is important because such a space has very little to offer the curators in terms of dictating a visitor’s viewing route. The result of this is a non-linear viewing experience that the curators have counteracted through a thematic, rather than chronological, display of objects.

 

The themes that the curators have selected for representation are ‘Weather and Climate’, ‘Public Health’ and ‘The Tree of Life’. Within each of these sections, too, there is less a sense of chronology than the ambition to compare like-with-like pan-historically; in fact, the desire to demonstrate either the accuracy or the usefulness of past methods of visualising phenomena by displaying them beside recent, most often computerised, models. A particularly attractive example of this approach is the inclusion of HMS Rochester Ship’s Journal from the early eighteenth century (1709-12) displayed dialogically beside the UK Met Office’s computerised and interactive two-dimensional globe on which bright pink and blue lines shift and shimmer. These lines represent weather data collected along the spice trade routes between the continents, such as that laboriously recorded by the Captain of the Rochester. This relationship between two examples of data collation and representation demonstrates the intelligent contemporary exploitation of the documentation of information historically. But it reveals something more problematic, too, for an exhibition that seeks to contrast the sophistication of our technology with the originality of our predecessors: the finely-rendered tabulated descriptions found in the Rochester‘s captain’s journal are more beautiful – to use the exhibition’s own choice of word – than the impressive computerised globe etched with brightly-coloured streaks. Beauty is not simply in the eye of the beholder. Beauty is inherently a natural phenomenon, and, therefore, one that exists – and that we will find – in our own, human, creations. The page of the Rochester‘s journal that has been selected for display demonstrates this – beautifully. Perched amongst the looping, precise handwriting of the ship’s captain, that describes ‘Moderate gales of Wind and fair Weather’, sits an ink drawing of a small, speckled bird. The captain, we are told, frequently interspersed his tables of data and description with similar sketches of ships, wildlife and places that he observed throughout his voyages. In such pages, then, are represented two aspects of this man’s – and all men’s – approach to the world: the objective and the subjective. The interaction and relationship between these two ideals permeates this exhibition. Before the mid-nineteenth century the concept of objectivity, as we understand its meaning today, did not exist. Rather than science requiring the removal of human agency in the representation of natural phenomena, it was experience, not self-effacement that had counted previously. We can see this in the words of Edmond Halley, whose 1686 map, An Account of the Trade Winds and Monsoons, is exhibited. Halley writes: ‘It is not the work of one, nor a few, but a multitude of Observers, to bring together their experience requisite to compose a perfect and complete History of these winds.’ The change in attitudes might be traced in Luke Howard’s 1847 Barometrographia, which we are told is amongst the earliest consistent scientific observations recorded, and, more than that, is, in part, mechanically drawn by a self-recording barograph over which Howard subsequently plotted the phases of the Moon. Mechanical objectivity in its genesis is thus displayed.

 

Objectivity today relies on the satellites and the supercomputers that are now at the disposal of scientists. But the representations that such methods produce may well still be beautiful, such as the NASA map depicting the ocean surface currents between 2005 and 2007 that is shown at one of the exhibition’s entrances. One wonders, however, if it is not the subject – our blue and swirling oceans as seen from space – rather than the method of representation, that makes such computerised renderings so appealing. A direct comparison can be drawn between paper and screen within the ‘Public Health’ section, which includes Florence Nightingale’s ‘Rose Diagrams’ depicting the causes of mortality in the ‘Army of the East’. Professor David Spiegelhalter of Cambridge University has taken Nightingale’s engraving and made it interactive to help the viewer better understand its purpose. Such an appropriation is a productive method, too, for highlighting the ‘Lady with the Lamp’s’ work as a statistician in her own right, rather than merely an attendant of wounds. Furthermore, whether it be the Rochester voyaging in gales along the spice routes, or Nightingale sourcing her data from the military field hospital through which she paced, many of the historical documents in Beautiful Science invoke a far wider cultural context than the particular information that they describe. John Graunt’s Natural and Political Observations upon the Bills of Mortality (1662), for example, is a collation of sixty years of London parish records on causes of death. Within the table we find that the number of people in the capital who died due to being ‘Burnt or Scalded’ was three in the year of 1647, and rose to eleven in the year of 1651. Medical conditions such as French Pox, Rickets and Worms are listed alongside causes of death such as ‘Hanged and made with themselves’ and even ‘Frighted’ (of which nine people are recorded to have died in 1660).

 

But it is Beautiful Science‘s exploration of the motif of ‘The Tree of Life’ that is the most poignant section of the exhibition (this is also borne out, perhaps, by the fact that this area appears to attract a far greater concentration of viewers). Interactive technology here, in the form of the One Zoom Tree, allows the viewer to discover the evolutionary links between thousands of species of mammals, birds, reptiles and amphibians. Interestingly, these, very modern, representations of our own – and many other creatures’ – location within the animal kingdom is depicted as a sprawling tree, with branches emerging intermittently from a central trunk. Life on earth has been represented in the form of a tree across the ages and across multiple civilizations. From Mayan to Nordic culture, to the tree from which Eve plucked the apple, this organic life form has functioned pan-historically and pan-culturally as the most apt metaphor for visualising the force and centrality of Life on our planet. Beautiful Science reveals this tendency through some remarkable inclusions. Ernst Haeckel’s The Pedigree of Man (1879) is displayed beside Charles Darwin’s On the Origin of Species by Means of Natural Selection (1859), which is open at the only page within the publication that contains an illustration: a lithograph by William West that depicts the relationships between various species and their descent from common ancestors in what has become known as ‘The Tree of Life’ diagram. At once more problematic and more affecting, cultural attempts to depict the very nature of life will always be more personal to us than representing ocean current patterns or even epidemics of disease. For what is being represented in such imagery is our selves. Beside the historical publications of Haeckel, Darwin and Jean-Baptiste Lamarck is displayed a pair of back-lit black panels that contain a series of brightly-coloured circular diagrams – each one shining with a luminosity that is indeed beautiful to behold. These Circos Visualisations of Genomic Data compare the human genome with those of the chimpanzee, the dog, the opossum, the platypus and the chicken. Within each circular frame these comparative diagrams rise and descend and swirl and ebb like a collection of precise but abstract paintings. Perhaps technological representation is most striking when it represents the essence of us and how it is that we slot into nature’s own material manifestations. In contrast to the evolutionary implications of Haeckel’s and Darwin’s diagrammatic representations of life stemming from a unifying central source, the curators also show us an example of the way in which the relations between creatures had been visualised in Western culture prior to evolutionary theory’s successful claim of the mantle for understanding the natural world. Robert Fludd’s 1617 The Great Chain of Being depicts an hierarchical pyramid encircled by the cosmos, with Sophia the Goddess of Wisdom represented in human form standing for the pinnacle of natural perfection: us. A human-centric model such as this has Aristotelian roots, and monopolised cultural interpretations of the natural realm right up until the nineteenth century. It is not only possible but probable, therefore, that the ‘Tree of Life’ itself will be replaced with what will be considered to be a more suitable model at some point in the unforeseeable future.

 

The question that Beautiful Science most explicitly asks is how have we represented the world around us. But perhaps a more intriguing thesis might be why do we possess the compulsion to represent it at all? It is clear from this exhibition that the motivations behind visualising data and information have been as numerous as the methods invented to do so. The ways in which such visualisations have been accomplished suggests that science is not yet (and may never be) entirely objective. Indeed, Beautiful Science demonstrates, rather, that the human, subjective desire for beauty is as strong as the human, objective desire to possess information, and that our thirst for images is as compulsive, perhaps, as our thirst for knowledge. But let us hope that the technological age in which we live does not alienate us from nature to such a degree that we consider ourselves once more to be Gods of Wisdom, superior and dissimilar to all that surrounds us.

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 http://www.sistersong.net/index.php?option=com_content&view=article&id=141&Itemid=81

[8] Contested Spaces, p.

“The One-Sex Body on Trial: the Classical and Early Modern Evidence” – a new review by Brandy Schillace

23 Apr, 14 | by gbelam

We are thrilled to be able to publish here a  wonderful review by Brandy Schillace, of Helen King’s book “The One-Sex Body on Trial: the Early and Modern Evidence.” (Surrey: Ashgate Press 2014.) Thank you so much to Brandy for her contribution to the blog – I will very much look forward to other pieces from her in the future!

- Georgia

The One-Sex Body on Trial: The Early and Modern Evidence

In so many important ways, I’ve been long anticipating this book. Where there is a lack, a need, we naturally look for satiety—and there has been a considerable gap in studies of the sexed body since the (pardon me) seminalwork of Thomas Laqueur: Making Sex. I do not mean to suggest a lacuna where none exists; certainly plenty has been written on the one-sex/two-sex body since the early 1990s. However, as Helen King herself points out, none of these works have, in a meaningful way, challenged—or even added to—Laqueur’s original analysis. If anything, they have solidified it, casting it as the background upon which all else must be built rather than as a concept or theory in its own right. Twenty years after its publication, Making Sex was still described as the standard, and as a graduate student I was given a copy as the potential foundation of my dissertation on women’s education and women’s bodies in the 18th century. There was only one problem: I found that I did not agree with aspects of Laqueur’s premise. It did not ring entirely true to what I was finding in women’s writing about their own bodies and minds in the eighteenth century.

That happens frequently, does it not? And any reasonable student seeks out the next text, and the next, to gain a broader perspective. But for me, in 2007, there were no other options. Or rather, all other options likewise returned me to the original as to the foundation, the blank background from which I was to begin. To be so statically conceived is unhealthy for any idea, no matter its worth. Closed to inquiry, its kernels harden. In The One-Sex Body on Trial, Helen King, historian and professor of classical studies at Open University, at last provides the counterpoint. Gracefully acknowledging the value of Laqueur’s work, she also offers its first real challenge. With her usual depth of perception, careful research, and immanent readability, King elaborates the other side of the one-sex/two-sex story.

One of the greatest strengths of King’s work related to her “storied” presentation. The medical humanities, though multiple and varied in definition and mission, largely seek to divine the human narrative behind medical meanings. Rather than asserting or denying the ‘one-sex’ body, King provides a reading of two key classical texts that problematize a single narrative of progression away from one model or towards the next. Close reading provides a new means of perceiving the terms in context, reminding us that in holding too close our own cultural understanding, we miss significance—or worse, misrepresent data. Using the story of Phaethousa (a woman and mother who seems to undergo masculinization) and Agnodice (a woman who wears male costume in order to become a physician), King demonstrates the variety of ways in which connotation and denotation collide. Even so common a thing as Agnodice’s calling card refuses to parse properly—to be “the WOMAN physician” can imply either that she is a woman and a physician, or a physician of women (she was, in fact, both).

In part one of King’s book, she assembles the classical evidence not of a strict adherence to the one-sex model, wherein women are men turned inside out with organs of generation that neatly correspond, but rather of a two-sex model that existed at times alongside but always in contention with the one-sex version. King does not argue for linear progression, however; rather than insisting that the one-sex to two-sex revolution happened, but happened earlier, she makes it clear that there was a range of models of the body. Vesalius, for instance, retains some of the earlier understanding of the body, such as the heart-shaped womb, but clearly departed from Galenic descriptions. The reading of Vesalius becomes clear only when the full context is considered. The question, whether Vesalius ascribed to the Galenic one-sex or Hippocratic two-sex model, is partly answered by close reading the images but also the text and the captions (frequently omitted in Laqueur’s work). Why is the abstracted womb shown without the female testicles? Because it is not an homage to Galen, of whom Vesalius claims “not even in his dreams did Galen ever see a woman’s womb” (57). Rather, it is, as King describes, the “womb and its constituent parts” –a thing unto itself and not the inverse of the male organs (59). King also describes the work of Laurens in 1593, who finds the vagina-as-penis idea frankly absurd—and Jane Sharp’s The Midwives Book of 1671, where Sharp claims that despite certain similarities, male and female organs can never be considered the same. By a careful marshalling of evidence, close-reading and analysis, and copious footnotes, King makes clear the problems with Laqueur’s sweeping pronouncement that the two-sex revolution arrived in the 18th century. King’s first two chapters also serve as excellent reminders that history is complicated and close reading within a cultural context remains our safest guard against anachronism. However, the second part of King’s book departs from the usual means of explication and proof and offers an exploration of the two classic tales mentioned in the introduction. In her masterful engagement with these, King seeks to ask broader questions that remain deeply important and even foundational for the medical humanities—namely, on what authority does medical knowledge depend. Whose stories matter, and who gets to tell them?

In the second part of King’s work, we once again examine the story of Phaethousa, the woman who, after previously birthing children, stops her menses and grows a beard after (or possibly in response to) the exile of her husband. The chapters in this section highlight the frequently confusing contexts in which such stories appeared, asking us to re-evaluate their role as “true” case histories. To what extent does she represent a medical construct? Her name and place of abode would have had metaphorical relevance to readers; has she been included as proof of the Hippocratic two-sex model? She dies, after all, and does not fully change into a man. If anything, the beard is a sign of illness, possibly related to her inability to conceive children after the loss of her husband. Here, Phaethousa is at risk because she is, in fact, too womanly, too reliant upon pregnancy for health. Later contexts (and later centuries) reinterpret her story, however; she appears in Wit’s Theatre as a fully functioning male, having undergone the inversion successfully. Surely this usage supports the one-sex model wherein male and female organs are interchangeable with the proper heat. And yet, she also appears in lists of hermaphrodites in the early modern period. What do such changes in context and, indeed, meaning represent? The story represents a “blank canvas,” a place where divergent and overlapping understandings of sex and gender might be enacted and analyzed, and reading this broader context allows us to go beyond Laqueur’s dichotomy and to recognize the variety of markers that made sex apparent, such as beard, menses, and generative ability. Part three of King’s book, which provides a similarly close reading of the Agnodice story, likewise challenges Laqueur’s straightforward picture of the classical and early modern world. “True sex” means different things in different versions (and for different audiences) of these narratives.  Agnodice’s story, particularly, does not fit into a single genre; the “voice” shifts and the text is offered up both by Agnodice’s supporters and her enemies.

King’s chapters on Agnodice, which close the book, render explicit the role of interpretive context: Agnodice as assertive and active heroine; Agnodice as shameful woman from which no woman should learn, Agnodice as the pretender—not to be trusted, Agnodice as agent of change. To what extent does the story represent reality? To what extent myth and fiction? How are we to read her role or even her name (chaste before justice), considering she saves herself from accusations of philandering with her woman patients by exposing her genitals in the courtroom? Even more complex, if possible, than the tale of Phaethousa, the story of Agnodice toys with the Galenic one-sex model while depending upon the two-sex model for its happy conclusion. More importantly, as King remarks, “the reason why the story is being told affects how it is constructed” (206). In her final chapter, wherein she ties the two tales together, King returns again to the markers of sex. What is it that makes a woman a woman? Or a man? Even Galen’s one-sex model is not as simple as it first appears. Rather, King’s extensive research reveals a much more fluid history, where different models of the body existed simultaneously and possibly on a spectrum wider still.

King’s work does, at many points, contradict Laqueur, but at no time does it set itself up as antagonistic to it. In many respects she agrees, particularly with Laqueur’s point that what was “seen” depended much more on expectation than anatomy. However, where Making Sex relied heavily on a smaller selection of sources, and these occasionally out of context, King widens the scope of source material for a richer and more meaningful engagement. Applying specific labels—either one-sex or two-sex—“obscures the complexity of the different interest groups, readers and tellers,” whereas our consideration of cultural and chronological specificity allows us to engage not just with meaning, but with meaning-making.

Guest Blog Post by Poet and Writer, Clare Best, Part 2: On Scars and Memories

21 Apr, 14 | by Deborah Bowman

Guest blog for BMJ Medical Humanities by Clare Best

 

Recently I’ve been thinking about cutting/editing and scars/memories. In two linked pieces for the BMJ Medical Humanities blog, I take a look at my own relationship first with knives and cutting and then with scars and memories.

 

Part two: Scars and memories

 

If I, as a former artist-craftswoman and as a writer and editor, am some kind of surgeon, then surgeons are also editors and writers. They arrange and rearrange our anatomies, cutting away what is not healthy, what is no longer required, repairing what is not working as it should. They invent and create new mechanisms and implant them into our bodies. The aim of most surgery, it seems to me, is to alleviate suffering and allow bodies and human beings to function as fully as possible. Surgeons facilitate – as far as they are able to – our wholeness. Our bodies, subjected to their hand work, become altered and edited versions of our earlier, or first draft, selves. Surgery is one agency in the mutability of human experience.

 

My own body has been revised and edited in many ways, as of course have all human bodies – by growth, by accidents, by disease, by ageing and even by self-harm, as well as by surgery of various kinds. In my case, the most dramatic revision and editing happened in 2006 when I underwent elective double mastectomy as a way of reducing my risk of contracting a hereditary breast cancer in my mother’s family.

 

I have written elsewhere about the decision-making journey leading to my surgery, as well as about the creative processes that sustained me before, during and after surgery – the creative processes which later developed into the project Self-portrait without Breasts (http://selfportraitwithoutbreasts.wordpress.com). Here, I want to think about scarring as evidence and reminder of trauma and loss. And I want to raise questions about the ways in which scars are read and interpreted – both as signs of surgery and as memorial sites.

 

The surgeon who operated on my mother was a kind and gentle man who nonetheless believed in radical mastectomy, which involved removing not only all the breast tissue but also much of the underlying muscle of the chest wall, and all the lymph nodes. Considering that the particularly aggressive nature of inherited breast cancer was not recognised in the 1970s (when my mother’s cancer was first found) she was lucky to encounter a surgeon who believed in this approach. Her radical mastectomies five years apart, following multiple primary tumours in both breasts, almost certainly gave her the additional twenty-five years of life she enjoyed until she died in her early seventies. But the resulting scars, both visible and invisible, were terrible to her. She never wanted them to be known about, let alone witnessed. She and I were very close, and yet throughout the many times I nursed her, and right up to the end of her life, she made enormous efforts to keep her morbidly scarred torso and upper arms from my sight. I saw the scars only twice, on both occasions by accident.

 

My mother was not unique in her shame and suffering. Although we now find it hard to imagine a world in which the words ‘breast cancer’ were unspeakable, that was the world my mother, and countless other women, inhabited. With the prominent outer features of their gender and sexuality invaded by disease and/or surgically removed, women with breast cancer struggled to maintain a sense of identity. But by the same token there was no language in which to talk about their loss and fear, and the scars had to remain unseen, both literally and metaphorically.

 

So taboo was this disease, in the world and in our family, that when my first cousin was diagnosed with aggressive ductal carcinoma in the mid-1990s, she had no knowledge of her aunt’s (my mother’s) experiences, even though her own mother (my mother’ sister) had also developed breast cancer. It was only when my cousin and I began to correspond about our mothers’ breast cancers that the extent of the deeper family scarring became visible and tangible. We began to read the scars and interpret our own situation, the risks we faced. We could also finally perceive the scars in our mothers’ generation as the memorial sites they were – places where loss and pain should have been respected, remembered and properly grieved, instead of turned away from and covered up.

 

The good news is that the current climate around surgical scarring is much more open. This has to be a very positive change for individuals and for society. Some of the mainstream breast cancer charities such as Breast Cancer Care are now running campaigns that address body image issues with photographs of women at ease with, and baring, their scars. The recent Under the Red Dress project has drawn a groundswell of support for making scars visible, even legible, and the project clearly links that legibility with raising awareness of breast cancer. My own work explores and extends the ways we tell the stories of our bodies; in speaking out through poetry and photographs, I speak for other women in my family and beyond.

 

But there is more work to be done. If scars are both evidence of cutting/editing and sites of memory, we are presently at risk of overemphasising the evidence whilst sometimes failing to properly acknowledge the memories. A recent statement from Judy Kneece, sent around social networking sites by the (American) National Breast Cancer Foundation, asserts that ‘Breast cancer has invaded my body, but it need not invade my spirit. There may be scars on my chest, but there need not be scars in my heart.’ Apart from the use of the stale military terminology by which all experiences of cancer seem to be set up as battles to be lost or won, the core of the message is, I think, distressing in its denial of the need to admit inner wounding and thereby begin to integrate trauma and loss. Of course the scars are in the heart as well as on the chest – how could it be otherwise, and what is wrong with that?

 

We should seek to accept the hand work – the cutting – where it is necessary, and treat with tenderness and care the consequent scars and the memories they represent. Surely this honouring of the memory as well as the scar, the material edited as well as the knife and the cut, makes the move towards true healing both more imperative and more likely.

 

Clare Best is a poet and writer with particular interests in writing body and landscape. Her poems are widely published in magazines including The Rialto, The London Magazine, Magma, Resurgence, Agenda and The Warwick Review. A chapbook, Treasure Ground (HappenStance 2009), resulted from her residency at Woodlands Organic Farm on the Lincolnshire fens. Breastless – poems from the sequence Self-portrait without Breasts with photographs by Laura Stevens – came out with Pighog in 2011, and Clare’s first full collection, Excisions (Waterloo Press 2011) was shortlisted for the Seamus Heaney Centre Award. She teaches Creative Writing for Brighton University and the Open University, and lives in Lewes, Sussex.

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

Guest Post by Poet and Writer, Clare Best: On Cutting and Editing and Scars and Memories

13 Apr, 14 | by Deborah Bowman

 

 

Recently I’ve been thinking about cutting/editing and scars/memories. In two linked pieces for the BMJ Medical Humanities blog, I take a look at my own relationship first with knives and cutting and then with scars and memories.

 

Part one: Knives and cutting

 

Among my clearest memories of childhood are strong sensory images of my father sharpening the carving knife each Sunday morning. He had an old bone-handled carver with a steel blade worn concave by years of service and he would stand at the kitchen worktop with the carving knife in his right hand and a cylindrical steel in his left, dancing the two metals together in front of him. The scraping and clashing were scary and magical – scary because of the glint of bright metal as the cutting edge became sharper, magical because this ritual heralded the final preparations for Sunday roast lunch. My father was always totally absorbed in the activity, pausing occasionally only to test the blade on the thumb of his left hand. In fifteen or more years, I just once saw him draw his own blood. He was an expert, and maintaining the tool of his Sunday task was a source of pleasure and satisfaction.

 

My father was a papermaker by trade and the plentiful currency of paper in our home had imbued me with a love of the material as I grew up. His passion for sharp knives must also have lodged in me. I put the two together, and for eight years of my life I sharpened blades and used them, in my first career as a fine bookbinder. I had many blades to look after, each one essential to my craft.

 

The guillotine blade was curved and heavy and the length of a sabre. It had to be removed from the work bench every few months to be sharpened professionally. I can still hear the decisive clunk as the newly honed and reinstalled blade sliced down through mill board.

Then there was my binder’s knife, a workaday tool of raw steel with a wooden handle darkened by my sweat. I used it for cutting against a rule. Over time the blade was thinned by sharpening until it became my ideal flexible knife. Just standing and thinking with it in my hand was almost enough to effect a precise cut. It was the first blade I worked each morning on the oiled carborundum stone. I had Stanley knives too of course, and penknives, and scalpels.

When I began work on a leather binding, it was the blade of my spoke-shave that needed attention. The spoke-shave is used for removing areas of the underside of the goat or calf skin, thinning the soft tissue before it is wetted and pasted for moulding around the prepared book block. Once I had chosen the right skin, I would dismantle the spoke-shave and take out the piece of flat steel with its cutting edge angled at 45 degrees. Back at the carborundum stone, I pushed the blade to and fro. Then I reassembled the tool, clamped the leather to a paring stone, and shaved the underside of the skin away from my body, always out and away. The flesh came off in soft rolls of colour until the leather had well-defined thin areas where it would be required to mould across joints, where corners could be mitred and edges turned.

There was another knife – a bone-handled kitchen knife with a tame blade and rounded tip. I used it for cutting gold leaf on a suede cushion. The gold-knife had at all times to be completely free of grease, as did the cushion, or the gold leaf would adhere where it should not. I used to sharpen the fine edge of my gold-knife with glass-paper. I enjoyed laying out the gold from its square tissue-leaved book by blowing one edge of a square of gold across the blade, lifting the leaf slowly on the knife and placing it on the gold cushion. With my mouth positioned over the centre of the leaf, I whistled silently to flatten it across the suede.

When I was ready to lay the gold on the leather binding, I would pick up small sections of gold leaf using greased cotton wool and dab the gold down onto the leather. Now to strike with the hot brass tools! If the flour paste and egg glair in the blind tooled indents had just the correct tackiness, the gold would fuse with the grain of the leather while the smooth surface of the brass tool simultaneously polished it. All this happened, if it was going to, in a second.

The daily ritual of sharpening also honed my senses and my purpose: the work was to measure and cut, fit and cut and refit, mould and fit. I was trained with the motto: ‘Measure twice, cut once’. The blades were extensions of my hands and mind. I cut into animal skins and dressed books in them. I cut gold and tooled it onto the leather. I fitted things to other things, making sense of disparate parts. By the end, if the knives had been sharp and my work skilled, most of the preparation was invisible – pages turned freely, boards opened well along joints, the book had the correct gravity. The mitred corners were so well-judged that they were flat under the thumb. All the cutting and making actions came together in one object. The binding was sensuous in the hands, pleasing to the eye.

 

It was years after I sharpened my knives for the last time and ceased working as a bookbinder that I fully realized how writing and editing are also ways of shaping and cutting, re-forming reality. It is all craft. And – here I come to the links with medicine – it is a surgeon’s work. The very word surgery comes originally from the Greek kheirourgia (kheir meaning hand + ergon meaning work) – the etymology from the Greek having more to do with art, handwork and finesse than with cutting. So I was and remain a kind of surgeon – I have worked with the anatomy of books and with animal skins, and I now work with texts of many kinds.

 

All writers take things in hand. We work, alter, reshape and adapt them. We cut away diseased, superfluous or useless parts, connect ideas to one another. And as we do our hand work we attempt to make whole, to heal, the body of text on which we are focused.

Stories behind closed doors: two films exploring group and drama therapy in prison

2 Apr, 14 | by Dr Khalid Ali, Senior Lecturer in Geriatrics, BSMS

The applications of dramatic and theatrical interactions between individual therapists and patient groups were first introduced by Moreno as early as 1920. The term “psycho-drama or drama therapy” was later coined by Kellerman in 1992, and was described as an effective means of supporting individuals in high secure units such as prisons and mental institutions. Two recent films “Scheherazade’s Diary” and “Starred up” explore the dynamics and experience of drama and group therapy in two different settings; in a women’s prison in Lebanon, and a men’s prison in the UK.

Scheherazade’s diary

Human Rights Watch Film Festival – March 18 – 28 2014

A review of Scheherazade’s Diary directed by Zeina Daccache, screening at the Human Rights Watch Film Festival 18 – 28 March 2014, across London.

By Yasmin El Derby, Independent film curator and critic.

Stories of people behind bars is not an alien subject to British audiences; TV soaps back in the 1970s and 80s such as Porridge (BBC, 1974 – 1977) and Prisoner Cell Block H (ITV, 1979 – 1886) and in more recent years Bad girls (ITV1, 1999 – 2006) and HBO’s Prison break (2005 – 2009). We have also seen various documentaries set in prisons from Louis Theroux and Trevor McDonald (including an ITV Women Behind Bars series) and a recent BBC3 documentary series Life and Death Row. However, all these series have focused on the Western world. Now for an insightful look inside an Arab women’s prison comes a thought-provoking documentary film Scheherazade’s Diary directed by actress and drama therapist Zeina Daccache. The film follows the emotive journey of several women inmates through a 10 months drama therapy project in Lebanon’s infamous Baabda prison. In an unprecedented event, the audience are given intimate access into the lives of women who have been imprisoned for ‘adultery, murder, drug trafficking and fraud’. The theatre initiative entitled Scheherazade allowed the women to reveal their extremely personal stories in a supportive, therapeutic environment through group ‘therapy’. We are introduced to the background stories that made these women the societal ‘rejects’ they are: the sad stories of domestic violence, underage marriage, traumatic childhoods, tragic relationships, and failed marriages. Lebanese society, as most Arab cultures, is very conservative and seldom discusses such sensitive subjects in public. However this code of silence has been recently broken by Lebanese women demonstrating in Beirut on International Human Rights Day on the 10th of December 2013 calling for an end to women’s suffering in prison.
http://www.dailystar.com.lb/News/Lebanon-News/2013/Dec-11/240627-activists-call-for-reform-at-womens-prisons-in-lebanon.ashx#ixzz2xXjLRAJe

The idea for the project originated when Daccache saw a similar prison scheme in Italy in the 1990s. During the 34 day war with Israel in 2006, Daccache felt trapped and helpless in her own home in Lebanon, and identified with women in prison. Daccache set up Catharsis – Lebanese Centre for Drama Therapy (www.catharsislcdt.org) which received funding from the Italian Embassy in Lebanon. It took a further 2 years of lobbying the government and prison officials to allow her to create this drama therapy programme. Daccache began the project in a men prison in 2008 (resulting in the film Twelve Angry Lebanese). After the success of that project Daccache wanted to recreate the same initiative in a women’s prison.

The aim of the project was to offer women a way to express themselves through a creative artistic release of making a theatre and dance performance which family and friends of the inmates came to see. Each woman in the performance did not necessarily perform her own story to the audience, eliminating the ‘shame’ factor allowing women more freedom and confidence. The journey these women went on, their thoughts, feelings and hopes for a better future and of course, the final performance all made the documentary Scheherazade’s Diary.

It is not an exaggeration to say that the project transformed the lives of some of the women who took part; for example it resulted in one woman being offered a job by someone who saw the Scheherazade play. Not all women though had a “happy ending” as many of them still remain in Baabda prison. During the post-screening Q+A with Daccache, she revealed the significant number of women she came across who had been imprisoned on charges of ‘adultery’ but has yet to come across a man imprisoned on similar charges. The project and the film have helped shed a light on the abuse and discrimination that women face in today’s contemporary Lebanese society. The film sends a clear message “women are suffering in prison, and drama therapy may be able to help them”.

The Human Rights Watch Film Festival runs until 28th March https://ff.hrw.org/london and the film itself can be purchased online at http://www.antoineonline.com=

Starred up

In general release in the UK

Review by Tony Gammidge, an artist, filmmaker and art therapist who runs collaborative video and animation projects, ‘Voices from behind the Fence’ with service users on forensic and psychiatric units.  www.tonygammidge.com

This prison drama directed by David Mackenzie, with screenplay by psychotherapist Jonathan Assler is a compelling violent and brutal portrait of the extremes of life in prison in which status and indeed survival depends on how psychopathic someone is or is prepared to be.

The term ‘starred up’ refers to young offenders with a reputation for extreme violence and this is well represented in the character of Eric Love (Jack O’Connell) the main protagonist. The film starts with his arrival at an adult prison after he is moved from a young offenders institute to the prison where his father (Ben Mendelson) is also serving a prison sentence. In a symbolic sense, this coincidence could be seen as the son returning to the source of his violence (in the form of his psychopathic father). The only chink of light in this tragic scenario is a ‘volunteer, Oliver (Rupert Friend) who runs a ‘therapy’ group in the high-security unit. Oliver persuades the authorities to give Eric one more chance after a particularly violent introduction to prison life, and to give Eric the opportunity to join his ‘therapy group’ to work on his ‘anger’ issues (a major understatement!). Eric though is predictably reluctant, suspicious and scathing at this helping hand and accuses Oliver of either merely wanting to look tough by taking someone ‘like him’ on or having a sexual motivation. However just as the group begins to earn Eric’s trust, a sadly predictable turn of events brings him back to his starting point.

For all of the film’s explosive and relentless violence there is a much understated   intelligence and subtlety at play from Oliver in his motivation for doing what he does without pay, and certainly without gratitude neither from the prison authority nor from the prisoners; Oliver life in prison is a health and safety nightmare.  The group work itself, its process and dynamics are fascinating and as someone who works on secure psychiatric units, I would have liked to see more of these intimate and reflective moments. However they are frustratingly brief in favour of the brutality and violence that drives the film. Perhaps this is an intentional metaphor for the reality of life in prison where therapeutic processes might be rare and indeed often railroaded by the very people and authorities who should be supporting them. I was reminded of this extract from Felicity De Zulueta’s book ‘From Pain to Violence; The Traumatic Roots of Destructiveness’ who asks this question;

“To what extent is our society responsible for the abused individual’s violent behaviour?” (De Zulueta p. 233)

Cleverly the film doesn’t give us any easy answers; any background information on the film characters is sketchy and hinted at rather than drawn too definitively. Showing the skeleton rather than the full flesh of the characters is one of the film’s strength as it gives the audience the liberty to fill in the gaps in the characters’ stories. I was particularly left craving for more information about Oliver and why he ‘needed’ to do this work. The script writer, Jonathan Assler, winner of the best British newcomer at the London Film Festival (LFF) 2013, said that he based his characters partly on people he saw while working in prisons.

The performances from Jack O’Connell as Eric Love, Ben Mendelson as his father and Rupert Friend as Oliver are electric and completely immersive as are the rest of the cast. The cinematography manages to be both unforgiving in its portrayal of the harsh environment it portrays but also beautiful in some of the details. For instance at the end of the film Eric looks out through a broken window into the prison yard where his fellow group members call him showing empathy and concern. As small and brief a gesture as it is, this sense of comradeship remains a faint glimmer of hope in what is otherwise a damning document about our criminal justice system.

Review edited by Dr Khalid Ali, senior lecturer in Geriatrics, Brighton and Sussex Medical School, editor of “The screening room”

Dr Greg Neate: Film review – ‘The Man Whose Mind Exploded’

27 Mar, 14 | by Ayesha Ahmad

The Man Whose Mind Exploded

Documentary film by Toby Amies

Succulent Pictures

This affectionate, unflinching gonzo documentary sees arts and travel presenter Toby Amies go further than his original Radio 4 programme from 2008 with the same title. (https://soundcloud.com/toby-amies/the-man-whose-mind-exploded). In doing so and by bringing to screen this portrait of an eccentric, extraordinary man who lacks for short term memory, Amies has created the film that the self-styled Drako Oho Zarhazar was seemingly destined to star in.

With his shaven head, waxed moustache, tattoos and piercings; this caped and croc wearing septuagenarian definitely leaves a lasting visual impression. However, that only hints at what’s inside his cluttered, one bedroom flat, where much of the filming takes place. Here self-penned notes, old letters and homoerotic pornography dangle on countless strings creating a hectic, projected installation of his mind. With these hanging threads, ‘Drako’ remains connected to his past while Amies peers through them in wonder amongst the increasing disorder that surrounds them.

It’s poignant that a younger Drako would have no shortage of material to recount about a colourful life that included associations with the likes of Salvador Dali. Unfortunately, following two life-threatening brain injuries that have shattered his short-term memory, he is unable to recall daily events and only fragments from his recollected past remain. Thus, as well as documenting Drako in his “seventh life” on a Brighton council estate, the film also reveals universal themes about how brain injury can affect and threaten one’s personality and autonomy.

Although Drako insists that he lives “completely in the now”, interviews with his family demonstrate that the former dancer and interior designer can relate meaningfully with those he knows from his past. His sister even observes that whilst changed in character, the “damaged” Drako is more likeable though the family have also accepted that the risk of potential injury remains as constant a personal characteristic as his larger than life persona.

As interesting as The Man Whose Mind Exploded makes as a case study of brain injury, the film goes further by revealing the relationship between the two men. Whether a relationship is possible with an individual who can’t recall someone they’ve met repeatedly is another matter. Drako’s lack of capacity to provide reliable consent also poses ethical challenges for the first-time director beyond what is appropriate to record. These include when might it be necessary to intervene and even seek medical help due to the fluctuating health of his stubborn “star”. These exchanges of respectful but exasperated concern for his friend’s well-being will be familiar to many families and professionals who care for those with faltering cognitive faculties.

“Trust. Absolute. Unconditional” declares Drako as his motto whilst sat on Brighton’s pebbled, naturist beach and which he emphasises by pointing at the words that are permanently inked on his arm. It’s one of many repeated phrases and recollections that preserve his identity and prevent the past from becoming a stranger to him. Moments later that trust is most memorably demonstrated, when filmmaker moves away from the camera and appears cheekily in frame to help his disrobed friend with rising to his feet.

The Man Whose Mind Exploded is being screened at the British Film Institute, London as part of BFI Flare, the London LGBT Film Festival. Tickets are now on sale.

Mar 26 6:20 PM, Mar 29 6:40 PM, Mar 30 8:40 PM

Website: http://www.themanwhosemindexploded.com

Trailer: http://www.themanwhosemindexploded.com/#!trailer/c39n

Facebook page: https://www.facebook.com/TMWME

Edited by the ‘Screening Room’ Editor, Dr Khalid Ali.

Correspondence to Dr Greg Neate: Greg.neate@nhs.net

 

 

 

 

 

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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