Podcast: Heart in Medicine, History and Culture

Today we are joined by Therese Feiler, a Postdoctoral Researcher in Systematic Theology and Ethics at the Ludwig-Maximilians-Universität in Munich. She is part of the project DigiMed Bayern, a multidisciplinary consortium working on digitalized and personalized medicine in in the field of athero-sclerotic diseases. She’ll be speaking to EIC Brandy Schillace about the upcoming December special issue (part of the 2020 double issue).

  • Listen Now [transcript below]

Based on the 2017 Flavell Symposium at the Apothecaries Society in London, This SI brings together leading cardiologists, cardiac surgeons, cultural historians and theologians to explore the past and present of the heart in history, medicine and culture. “It was a delightful, inspiring day,” explains Therese, “I’m delighted that one of the symposium speakers, Fay Bound Alberti, and one of the organizers, Andrew Papanikitas, have each agreed to write a short comment on the contributions to the present special issue.”

Therese with blond hair swept into a low bun. She stands against a green background and smiles slightly.Therese Feiler studied English and Religious Studies at Berlin, Aberdeen, and Oxford. She completed her DPhil in Theology (Christian Ethics) at Oxford in 2013. Eventually this developed into her first book, Logics of War: The Use of Force and the Problem of Mediation (Bloomsbury T&T Clark, 2020). She pursued her interests in political theology working on the welfare state and modern political demonology. From 2015-2018 she was a postdoctoral researcher at the Healthcare Values Partnership at the University of Oxford, where she focused on personalization and responsibilities in medicine and healthcare. As part of her work with the consortium DigiMed Bayern (led by the German Heart Centre, Munich), she is currently researching the medical-ethical, practical and political implications of theological notions of personhood. She is an active member of the Institute of Technology – Theology – Natural Sciences (TTN) at the LMU Munich.

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More from Therese:

    • Co-editor and contributor to a volume on the heart and its implications for epistemology. Working title: The Heart: Knowledge and Constitution of Being (publication in German. Out with Brill: Ferdinand Schoeningh, 2021/2022)
    • Logics of War: The Use of Force and the Problem of Mediation (Bloomsbury T&T Clark, 2020)

‘The Ontology of Personhood: Distinguishing Sober from Enthusiastic Personalised Medicine’ (Studies in Christian Ethics, März 2018, Online First)

TRANSCRIPT

BRANDY SCHILLACE: Hello, and welcome back to the Medical Humanities podcast. I’m Brandy Schillace. And today we’re joined by Therese Feiler, a postdoctoral researcher in Systemic Theology and Ethics at the Ludwig Maximilian University in Munich. She is part of the project that’s a multidisciplinary consortium working on digitalized and personalized medicine in the field of disease that she’s going to actually explain a bit more to us. But the reason I want to talk to her today has to do with an upcoming December special issue that will be part of our 2020 double December issue for those readers of the Medical Humanities Journal. Therese, what I’m really hoping you might do is give us a bit more information about what it is that you do and where it is that you’re coming from, particularly your field, and then what led you to work on this special issue?

 

FEILER: So, I’m one of these people who you might call a fox rather than a hedgehog.

 

BRANDY: [laughs]

 

FEILER: So, I have multiple interests. And for some reason, they do cohere in my head, but not necessarily when you read about them. I’m interested in political theology. That’s my background. And starting from there, I looked at welfare state reforms and then eventually moved into medical ethics coming from there. And that very soon, and today, of course, connects with questions about technology, questions about how do we diagnose people, how do we conceptualize people? So, there is a deep anthropological element to this, which then, of course, connects to the medical, ethical, and political practice.

 

BRANDY: Mmhmm.

 

FEILER: So, my focus on personalization and digitalization in medicine is kind of embedded in an anthropological and political anthropological background.

 

BRANDY: I think that’s fascinating. And I’m actually multidisciplinary as well, though not coming from it in the same direction that you are. And so, I find these connections really interesting. And I think Medical Humanities is such a rich and fertile place for these kinds of explorations to take place. I’m particularly interested in what you say about digitization and personalization, because I feel especially now, in this age of pandemic and we all are on Zoom, there seems no better time than to be asking those kinds of questions.

 

FEILER: Yes. I mean, there are so many ways in which you can approach this, right? So, digitalization, the digital world can just be this sort of thing that lands from outer space. And we’re all trying to approach it from our disciplines, and we’re trying to figure out well, what is this thing? And so, I would say coming from my perspective, it’s a question of what is the body politic, and what is the individual human being? The body politic, you can see, is being atomized. It’s coming apart, but through the digital world is also becoming, in a way, spiritualized. I went to an online conference where somebody said, you know, “The Internet is the Holy Spirit.” And I thought that is unbelievable in a way. But this is how people think they are constituted and connected as individuals and as a community. And I think it’s interesting to ask, is this just yet another form of a kind of spiritual or intellectual life that we lead? Or is this a new thing or maybe even a travesty of it?

 

BRANDY: Mm. That’s really interesting. It’s almost a Jungian unconscious kind of thing if we’re all connected in this certain way.

 

FEILER: Yes, I think yes! That aspect, it certainly plays a huge role. Definitely.

 

BRANDY: That’s fascinating. So, tell me a little bit about, as I said, the December special issue is actually embedded in our December double issue, which is quite large. And the December special issue will head that issue up. It’ll lead it. So, tell me a little bit about what brought this together. It’s called Heart in Medicine, History and Culture. And how did this come to be, particularly from these diverse and interdisciplinary directions?

 

FEILER: This is based on a get together of scholars, cardiologists, researchers in cardiology, cultural historians, and theologians in 2017 at the Apothecaries Society in London. It was the Flavell Symposium, which takes place, I believe, once every year. And this event was so, to my mind, it was so special. I really thought, here is a topic, here is a theme, here as a motif that is uniting so many concerns: medical concerns, cultural concerns, political concerns, psychological concerns. And I learned so much. I learned so much about the history of cardiology, about the techniques, about the characters, you know. I mean, cardiologists are a bunch of people who have a particular kind of enthusiasm.

 

BRANDY: Right.

 

FEILER: And so, we thought, let’s bring these people together, and let’s publish something. And what could be a better place than Medical Humanities?

 

BRANDY: That’s fantastic. And now, the articles themselves are quite different from one another.

 

FEILER: Yes.

 

BRANDY: And did you wanna say a little bit about how they work together in the context of this issue?

 

FEILER: Yes, I think what we’re all kind of starting from is what is quite conventionally known as some kind of medical reductionism. So, the idea, you know, we look at the heart, we look at the body, and we see it just as this machine, this thing, and obviously, the heart as a kind of pump. And that’s simply, in a way, the situation where we are. But the interesting question is, where do we go from there? Because of course, he can’t just sit there and say, this is how we got here. Isn’t that terrible? Isn’t that reducing people and patients and how we practice medicine? So, I think what each contributor is doing is saying, what do we make of that? How do we continue from here? And there are obviously very different ways to do that.

 

And somebody like David Cooper, who works on xenotransplantation has a very different idea what to make of this gap between the heart and the human being, as it were, than somebody like Joshua Hordern, who is a theologian and who really wants to see the person as a holistic, unified human being. So, there are tensions in the special issue, definitely.

 

BRANDY: Right. Right. And I think it’s interesting as well, because in some ways, Medical Humanities as a field has been understood really differently in different cultures and in different spaces.

 

FEILER: Yeah.

 

BRANDY: And so, for instance, I’m in the United States. And for many years, Medical Humanities, as it was practiced in medical schools, was almost to the exclusion really of these kinds of critical discussions. I don’t wanna say that it wasn’t doing useful things, but it tended to be very medicine focused, very focused on the gaze of medicine looking at Humanities rather than Humanities as a lens to look back at medicine. And I think what has expanded, certainly as we do it here in the journal, is a much greater sense of how can the Humanities reinterpret what we mean by health? What we mean by access to health. What we mean by the political implications. What we mean by the ethical implications. And because we have a focus on social justice at BMJ’s Medical Humanities that’s particularly useful to us. And so, when you bring together these different people to have these conversations and you realize they don’t have a common language sometimes, I think the question becomes whose voice leads, right? ‘Cause we always have a tendency to wanna know, well, who’s the authority? Who’s speaking? Who’s the one that we are supposed to listen to? And in so many situations, it’s actually the medical practitioner whose voice gets top tier, top billing, right?

 

FEILER: Yes.

 

BRANDY: And I don’t think that that’s what’s happened in your special issue. And I think that that’s really important.

 

FEILER: Yes. I think one reason for that is that the people who’ve written and contributed are not necessarily drawing such a strong line between medicine and the Humanities.

 

BRANDY: Mmhmm.

 

FEILER: Each one has a sense in which they are, you know, either they have a direct interest in a field like Philosophy, and they say, “This is what I wanna do. This is what I wanna do in my spare time.” But each one of them has a feeling that the other discipline inevitably is part of what they do. And that medicine in itself has a history. It’s got an underlying philosophy, even if that is just very often reduced to methodology. But as soon as you kind of bring that out, it’s much easier to find a common language. And there’s a lot of learning involved as well and I think also a lot of respect. And I think when there is this mutual respect and interest, then the power question suddenly is subdued almost.

 

BRANDY: Mmhmm. Well, and I think the other thing, too, is by mutual respect, it’s not just respect. Well, it is respect of each other as human beings, but it’s also respect for what the individual fields do and that they matter.

 

FEILER: Yes.

 

BRANDY: So, for instance, a medical practitioner might have a love of history but is never going to understand history like a historian, any more than a historian might be interested in heart surgery but isn’t going to try and practice one, you know.

 

FEILER: Yes.

 

BRANDY: So, I think that we know that it’s silly when, we wouldn’t want a historian practicing heart surgery, but sometimes we forget that we shouldn’t have heart surgeons trying to practice history as though they are historians.

 

FEILER: Yeah.

 

BRANDY: And so, I think it’s really useful to have these conversations where each participant realizes the value of the other’s field of knowledge and doesn’t put their own, as though somehow, it is more valuable. Because I think that’s really dangerous. And I want to say that our present climate right now might be proving that for us. Because you don’t just treat a pandemic by throwing a lot of money at medicine. That is part of it, right? There’s development of vaccines. But it’s also who has access to healthcare, whose bodies matter, how do we protect the vulnerable? How do we institute proper communication about mask wearing? How do we— There’s this much, much broader sense of what kinds of fields are brought to bear to understanding the pandemic.

 

FEILER: Yes, yes.

 

BRANDY: And that, I think, should hopefully teach us that these multiple and multidisciplinary perspectives are, in fact, the only way forward for an actual humanistic way of practicing medicine.

 

FEILER: Yes, I agree. And there is a sense in which certainly ethics—and I don’t mean ethics in a kind of merely analytical or technocratic way. I mean ethics in a practical way—there’s a sense that this is something we really need to talk about. And this is also where I think the different fields come together, kind of at the point of a practical wisdom that doesn’t just, as you say, chuck money into creating more and more facts. I mean, how many million studies do we have on COVID-19 now? But that doesn’t tell you what exactly we should do. Because that derives from a sense of well, who do we wanna be? What do we wanna be? How do we— How should we live? Which you can’t find out through doing many empirical studies. So, I think this is definitely a field where the Medical Humanities can also start the conversation about practical wisdom.

 

BRANDY: In some ways, I sometimes wonder if there’s technically any medicine that isn’t Medical Humanities, really. Because I’m not sure that you can practice it effectively any other way.

 

FEILER: Yes.

 

BRANDY: Now, before we leave, I do wanna say again, the special issue is called Heart in Medicine, History and Culture. And it’s not an accident that you chose the heart for this particular special issue. But I also feel that this treatment isn’t exclusionary, isn’t exclusive to the heart. You easily could’ve probably focused on all sorts of, like the brain, for instance, as well. And I wonder, are you thinking about possible ways in which this model might be utilized in the future?

 

FEILER: Well, I mean, mm…I would question whether you can use the brain in the same way. I mean, I suppose you’re asking about the model and how to approach a topic. Do I get you right?

 

BRANDY: Mmhmm, right. Mmhmm. Because you have your theologians and you have your surgeons and you have your, obviously, it would be much more difficult to talk about transplantation in the brain!

 

FEILER: Yes, exactly.

 

BRANDY: But I mean, in general, though, you could sort of take any field of medicine and use this treatment. Would you be interested in having symposiums in the future that sort of look at different aspects?

 

FEILER: I think there is a general need, perhaps, for broadening this out into the question of the body as a whole, so even if you can’t exercise topics like transplantation, as you say, to the brain. And of course, the focus on the brain is a different one. And the philosophy of the brain, neuropsychology, neuroscience, neuro-philosophy, these are different fields. So, I think there is a, as soon as you switch organs, as it were, you enter a completely different set of disciplines, I would almost say, which has to do with the way we understand the symbolism and the history of these organs.

 

BRANDY: And yet I think theology would probably end up being part of most of those discussions in some way.

 

FEILER: Yes. Yes. And I think sociology would then, in that sense, probably enter by the foundations of philosophy or a meta-philosophy. Whereas if you look at the body as a whole, for example, a new, a completely different field opens up. You have corporate bodies, you have corporate identities, you have corporate persons, and so on. So, that I mean, you could replicate this kind of focus, and you would, with each different focus, you would attract a whole new set of very interesting people and very interesting voices, no doubt.

 

BRANDY: I feel like we could have a really interesting edited collection or series based on this very model. It’s really interesting.

 

FEILER: Definitely.

 

BRANDY: So, again, thank you so much for joining us. I hope everyone will tune in to the December issue. Just so our listeners know, you can see a summary of the different articles appear on the blog. And there will also, frequently, they are attendant with a short audio blurb from the authors as well. And we’ll be tweeting those out. It should be launched sometime in mid-December. And we look forward to you being part of it. Again, Therese, thank you so much for being part of this.

 

FEILER: Thank you so much, Brandy.

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