Richard Smith: Medicine’s need for the humanities

Richard SmithI spoke as well at the meeting on valuing the humanities at the London School of Economics (see blog below), and I argued that medicine needs the humanities badly.

The NHS and overseas aid are the only budgets that have been protected by the coalition government, and universities, particularly the teaching of humanities, have been hit especially hard. Even though “protection” for the NHS means 4% “efficiency savings” every year for four years,  those of us in health care should, I believe, speak up for other sectors. Indeed, I think that some, perhaps even many, within health care would argue that it might be better for the country to cut health care and invest more in education.

I fear—and I’ve written this before—that health systems around the world are engaged in “an unwinnable battle against death, pain, and sickness.” We will all die, and do we want in Britain to follow the US and eventually spend 16% of our GDP on health care in fending off death? As Atul Gawande, perhaps the US’s most influential doctor, has pointed out intensive care units in the US are “warehouses of the dying.” (Interestingly in this context of valuing the humanities Gawande has gained his influence not through his surgery or research but through his writing.) People have their day in intensive care as they have their day in court, and, as Gawande’s article makes clear, death is often protracted, undignified, dehumanising, and brutal in the US. A recent report in Britain—from Charles Leadbeater for Demos —has made clear that Britons are dying badly as well.

Perhaps the most urgent problem in health care is to change attitudes to dying, and here, I suggest, the humanities have far more to offer than medicine. Medicine is good on the statistics of dying and what we die of but poor on how to contemplate death. If we want to think more deeply about death then we need to study not medical textbooks but Montaigne, Seneca, Marcus Aurelius, Schopenhauer, Wittgenstein, Illich, Saramego, and Julian Barnes. Indeed, perhaps the best book written recently on death and dying by a doctor—that by Iona Heath—is composed largely of quotes by great thinkers in the humanities.

We also need philosophers to help us think deeply and correctly about assisted suicide, something that I’m sure will rise higher and higher on the agenda in the next 20 years.

More and more of life’s inevitable processes and difficulties—birth, sexuality, ageing, unhappiness, tiredness, and loneliness —are being medicalised, and we are growing the budget of health care to tackle them. But medicine cannot solve these problems, and again the humanities can help.

Jonathan Miller, who trained as a doctor but has spent his life in the arts, has talked about medicine’s need to rediscover the human side of medicine after several decades of being diverted by exciting technical possibilities.

We within health care also need the help of those in the humanities to define health. There is, it seems to me, growing interest in defining and promoting health, and we need to move beyond medicine’s de facto definition of health as “the absence of disease.” Health and the platonic idea of the good life may be close.

I believe as well that the humanities can help us with a problem as pressing as that of attitudes to death—climate change. Scientists have long identified the problem, but we have failed to act effectively– largely, I believe, through our evolutionary flaws of selfishness and lack of imagination. “I’ll let somebody else make the changes needed to reduce carbon emissions,  and I simply can’t imagine how awful the world is likely to be for my grandchildren and their children.” Imaginative works can help us, and George Monbiot, one of Britain’s leading commentators on environmental issues, has said that the greatest book written on climate change is Cormac McCarthy’s The Road. The ancients also created powerful images of the consequences of humanity over-reaching itself—read, for example, Ted Hughes’s  magnificent translation of Ovid’s Metamorphosis, particularly the poem about Phaethon, who lost control of “the chariot of the sun” and burnt the land.

Those who value the humanities are speaking up in their defence, and one of the best pieces I’ve read comes from  James Vernon, a Mancunian who is now professor of history at UC Berkeley.  In his essay, “The end of the public university in England,” he says how “The humanities…offer us the chance to think otherwise,” something I believe to be especially important for doctors. “The humanities,” he continues, “speak to different systems of value—of imagination, beauty, laughter, and wonder….Economic utility is not the measure of who we are or who we want to become.”

Medicine has increasingly recognised its need for the humanities, and courses in the humanities are springing up within medical schools and new journals are starting. But it would be fair to say that so far the humanities have been marginal within medical education. The current threat to the humanities should lead us to recognise their importance to medicine, incorporate them further into medical training and thinking, and speak up for them. Inevitably doctors arguing for the importance of the humanities will sound less self serving than humanities practitioners speaking for themselves.

G. John Kennedy

When power leads man toward arrogance, poetry reminds him of his limitations. When power narrows the areas of man’s concern, poetry reminds him of the richness and diversity of his experience. When power corrupts, poetry cleanses. For art establishes the basic human truths which must serve as the touchstones of our judgement. The artist . . . faithful to his personal vision of reality, becomes the last champion of the individual mind and sensibility against an intrusive society and an offensive state.

Richard Smith was the editor of the BMJ until 2004.