{"id":1137,"date":"2017-01-17T14:12:28","date_gmt":"2017-01-17T13:12:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=1137"},"modified":"2017-08-08T19:01:32","modified_gmt":"2017-08-08T18:01:32","slug":"book-review-the-edinburgh-companion-to-the-critical-medical-humanities","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2017\/01\/17\/book-review-the-edinburgh-companion-to-the-critical-medical-humanities\/","title":{"rendered":"Book Review: The Edinburgh Companion to the Critical Medical Humanities"},"content":{"rendered":"

\"9781474400046\"\u00a0<\/em><\/p>\n

The Edinburgh Companion to the Critical Medical Humanities<\/strong><\/p>\n

edited by Anne Whitehead and Angela Woods (general editors) with Sarah Atkinson, Jane Macnaughton and Jennifer Richards (associate editors). Published by Edinburgh University Press, 2016.<\/p>\n

Reviewed by Josie Billington, University of Liverpool<\/em><\/p>\n

 <\/p>\n

\u2018Critical medical humanities\u2019, say the editors of this volume, marks a \u2018second wave\u2019 in the field. First-wave medical humanities was characterized by an emphasis on ethics, education (championing the arts in particular), and the subjective experience of illness, diagnosis and treatment. The second wave, by contrast, \u2018energised\u2019 by the social sciences, turns to interrogate the \u2018primal scene\u2019 of \u2018mainstream\u2019 medical humanities – the clinical encounter between doctor and patient, more specifically the diagnosis of cancer. Seeking a \u2018thicker\u2019 understanding, its focus is not \u2018the lived body of the patient qua patient\u2019 but the political, social and cultural contexts and factors (race, class, gender, sexuality, debility) which underpin or influence the illness experience. In thus self-consciously positioning itself as a foundational text of the new wave, the Companion<\/em>, as we shall see, is opposed to the old binaries of patient\/doctor, illness\/disease, medicine\/humanities within an orientation which saw the medical humanities as a \u2018benign helpmeet\u2019 to biomedicine. But this text is not seeking, therefore, to \u2018create new binaries\u2019 (between research and education, practice and theory). Rather, it stresses the \u2018mobility\u2019 and \u2018fluidity\u2019 of critical medical humanities offering \u2018an encapsulation of the field\u2019s current momentum\u2019 as an area of inquiry that is \u2018highly interdisciplinary, rapidly expanding and increasingly globalised\u2019.<\/p>\n

The book achieves this latter mission admirably. Formally organized into four thematic strands \u2013 \u2018Evidence and Experiment\u2019, \u2018The Body and the Senses\u2019, \u2018Mind, Imagination, Affect\u2019, \u2018Health, Care, Citizens\u2019 \u2013 the book\u2019s introduction nonetheless acknowledges, and explicitly offers, numerous alternative trajectories. Among these, \u2018Spatial Pathways\u2019 emphasizes the value of social scientific methodologies within a global health context: Hannah Bradby\u2019s and Sarah Atkinson\u2019s chapters, for instance, on the migration of medical care resources (staff and organs) and Lucy Burke\u2019s and Rebecca J. Hester\u2019s on the politics and institutionalization of (respectively) \u2018care\u2019 and cultural \u2018competence\u2019, offer exemplary demonstration of how fine-grained interdisciplinary approaches (comprising history, sociology, human geography, labour and health studies, feminist and literary approaches) are critical to an understanding of the forces which shape health outcomes and policies. \u2018Disciplinary pathways\u2019 fulfils the volume\u2019s remit of \u2018extending to arts disciplines which have not been so influential to date\u2019, the visual arts in particular. Suzannah Biernoff\u2019s chapter on the \u2018cultural scripts for being in pain\u2019 (religious and secular) to which art from past ages gives access, Rachael Allen\u2019s on the artist\u2019s unique engagement with the body in the anatomy lab, and Edward Juler\u2019s on the surrealists\u2019 depiction of viscera as the dark and amorphous centre resisted by the \u2018hygienic\u2019 ego, emphasize the role of the visual arts in \u2018reconceptualising the body and probing its position and status\u2019 within biological constructs.<\/p>\n

For all these second-wave emphases, the most dominant of these pathways across the volume is a rather familiarly \u2018Historical\u2019 one (isn\u2019t that also a characteristic emphasis of mainstream medical humanities?), though the offerings themselves are fresh and rich. Corinne Saunders suggests that the literary representation of visionary transport and voice-hearing in medieval texts offers an alternative model to the contemporary diagnosis of psychotic symptom. In relation to the early modern period: Cynthia Klestinec explores the relation of touch and trust in the physician-patient dynamic and its contribution to the historical development of patient compliance; Jennifer Richards and Richard Wistreich recover what has been rendered invisible to modern medicine through the dominance of visual and written information – the primacy of the voice in the transmission of knowledge;\u00a0 Lauren Kassell considers how digitization of medical records of the period, themselves newly driven by the advent of paper technologies, beg question about the kinds of evidence which constitute medical history. Looking back to the nineteenth century: Heather Tilley and Jan Eric Ols\u00e9n find a valuable perspective on constructions of disability in pedagogy relating to blind pupils; Peter Garratt contends that the period\u2019s shift away from metaphysical explanations for art to those of embodied psychological aesthetics offers valuable insights for contemporary models of bibliotherapy; Lindsey Andrews and Jonathan M. Metzl argue that nineteenth-century imaging practices help make visible a racial legacy within present-day imaging technologies.<\/p>\n

I would add to the editors\u2019 suggested pathways an Activist <\/em>or Interventionist<\/em> one, as this characterizes, for example, Lisa Guenther\u2019s searing elucidation of the nexus of political, legal and medical power which legitimizes the barbaric practices of lethal injection for death row prisoners, as well as Bethan Evans\u2019 and Charlotte Cooper\u2019s challenge, via Queer and Disability Theory, both to dominant medicalised accounts of fatness and the tendency hitherto of conventional medical humanities to exclude or neglect activist movements. But I would also stress that \u2018first-wave\u2019 or \u2018mainstream\u2019 concerns are just as readily traceable. Ethical<\/em>, for example, is an emphasis which (implicitly or otherwise) runs through William Viney\u2019s study of twin research and the dangers inherent in the idea of \u2018natural laboratories\u2019; Luna Dolezal\u2019s\u00a0 argument that the increasing opportunities for technological enhancement of the human body urgently require a range of humanist perspectives to grasp the physical and existential toll, as well as the satisfactions, of morphological freedom; and David Herman\u2019s contention, in relation to the value of animal companions for people living with autism, that a proper understanding of selfhood as situated within wider webs of creatural life, demands a new kind of \u2018interdisciplinary and collective\u2019 story.\u00a0Experience<\/em> of illness is at the centre of Jonathan Cole\u2019s and Shaun Gallagher\u2019s fascinating demonstration of neuroscientific and phenomenological\u00a0 understandings working hand in hand within a clinical setting to de-pathologise chronic conditions and contribute to insights of therapeutic benefit; and, with a more decidedly historical inflection, Ian Sabroe and Phil Withington transpose the Renaissance-humanist conception of \u2018counsel\u2019 to modern-day clinical consultation to highlight the value of the emotional space opened by genuine dialogue between doctor and patient.<\/p>\n

The really valuable aspect of this book, in fact, is its eclectic inclusiveness \u2013 ranging (as Patricia Waugh puts it in her helpful afterword to Part 1) from \u2018the performatively paratactic and experimental to scholarly sobriety and sharp socio-cultural critique\u2019 \u2013 enabling one to find the contemporary medical humanities one is looking for. This is perhaps the principal reason why some of the terms and concepts used to tie these strands together prove problematic.<\/p>\n

\u2018Critical\u2019, for example, usefully signals the influence upon second-wave medical humanities of twentieth-century post-war critical theory. But the influence of Foucauldian or feminist thinking is, from the evidence of this volume, a scattered and partial one and markedly less visible than the historical scholarship which, as mentioned above, predominates. Critical, in this particular sense, then, does not really hold the new medical humanities together. And, as Martyn Evans forcefully points out in his introduction to Part 3, a progressive critique is visible in the mainstream of medical humanities and traceable back to forebears in medical ethics, philosophy and sociology of medicine: indeed, \u2018humanities have been seen as critical in the sense of being vital <\/em>to medicine since long before medical humanities emerged as a discrete field of study\u2019. Brian Hurwitz and Victoria Bates, on the place and history of narrative in contemporary clinical practice, and the challenges to models of narrative coherence offered by Laura Salisbury\u2019s study of \u2018disrupted, disordered\u2019 aphasic speech in relation to the expressive practices of literary modernism and Jill Magi\u2019s, Nev Jones\u2019s and Timothy Kelly\u2019s experimentally \u2018cut up\u2019 rendering of psychotic subjectivity, all – in their distinct and partly opposing ways – continue that trajectory. This is valuably the case, too, in relation to Rosemary J. Jolly\u2019s contention that literary narrative \u2018has a unique capacity to explore transcultural encounters of radically differing conceptualizations of wellness and disease\u2019 and Anna Harpin\u2019s analysis of the power of Shakespearean tragedy in a high secure setting (Broadmoor) \u2018to relocate the patients\u2019 index offences back within the continuum of human experiences\u2019. The texts and contexts have changed or expanded but, as Jo Winning says in another of the overviews which usefully punctuate the Companion<\/em>, these chapters \u2018collectively and forcefully remind,\u2019 as medical humanities has always sought to do, \u2018that biomedical discourse is not the only knowledge base\u2019.<\/p>\n

While the volume thus witnesses and acknowledges these continuities, what critical <\/em>medical humanities fundamentally represents nevertheless, the Companion<\/em> asserts, is a displacement of the \u2018common calculus\u2019 within medical humanities whereby the biomedical \u2018registers as the cold and deadening engine of facts and hard-nosed pragmatism\u2019 and the humanities as the \u2018non-reductive, life-affirming context expert\u2019, where \u2018all affect and feeling are to be found\u2019. Thus, the new \u2018E\u2019 proposed as replacing Ethics, Education and Experience in critical medical humanities is that of \u2018Entanglement\u2019. Originating in science and technology, as Des Fitzgerald and Felicity Callard explain in their polemical chapter at the opening of Part I, the concept rejects the notion of separable units with determinate boundaries (persons, disciplines, ideas) whose telos is integration, in favour of a dynamic of intersection, inseparability, interdependence. \u2018We cannot easily divide the practices (or objects) of \u201cscience\u201d and \u201cmedicine\u201d from the practices (or objects) of social and humanistic inquiry. We do not, as scholars from various disciplines, bring our objects and practices to one another through a kind of free-trade agreement; rather we re-enter a long history of binding, tangling and cutting.\u2019 This thinking has self-evident applicability to the exemplary chapters which immediately succeed it: Annamaria Carusi\u2019s on computational modelling of biological processes (a hybrid of interconnected experiments, equations, simulations) which underscores \u2018the continuities between science and art as expressive modalities of meaning which do not merely communicate pre-existent meanings but forge new styles of knowing\u2019; and Volker Scheid\u2019s tracing of the genealogy of holism, a concept less emergent from, than retrospectively \u2018accommodated\u2019 to, ancient Chinese thought under mid-twentieth century communism, and subsequently assimilated to a Western systems biology. Entanglement as a conceptual frame for diverse interdisciplinary methodologies also promises, it is true, robust theoretical backing for a discipline which, as Stuart Murray points out, is often unfairly categorized as representing \u2018a soft humanities approach\u2019.<\/p>\n

Still, there is something unconvincing about the way in which the notion is self-consciously introduced into separate chapters in order intellectually to stitch together these highly individualized offerings. Not only does the effort after conformity to the \u2018critical\u2019 line fly in the face of the ever-indeterminate heterogeneity which the concept of entanglement is intended to represent: in its recurrence, the idea begins to seem rather modish, especially when offset by the wealth of historically-oriented chapters which give priority to time-honoured practices and thinking over the latest scholarly fashions. The real paradox, however, is that what is potentially most valuable about entanglement in the context of medical humanities \u2013 its engagement with the \u2018messy\u2019, the \u2018knotted\u2019, its \u2018staying with the trouble\u2019 \u2013 is still best (or most authentically) demonstrated in this volume by examples of lived experience. So, for instance, when Christoph Rehmann-Sutter and Dana Mahr \u00a0show how a bio-medical construct inaccessible to direct experience \u2013 the genome \u2013 is nonetheless intrinsically part of<\/em> the experience of those individuals who embody and \u2018live\u2019 it; so, too, when Jane Macnaughton and Havi Carel offer a compelling account of breathlessness as engaging cultural, emotional and existential dimensions which while \u2018not part of the language of the clinic, are central to the patient\u2019s experience\u2019, thereby powerfully underscoring their contention that bridging this epistemic gap can challenge and broaden the evidence base on which symptomology is addressed clinically. These are exemplary models for what Macnaughton calls \u2018a critically engaged \u201chelping\u201d medical humanities\u2019, in which the \u2018moral imperative\u2019 is to improve understanding not only in scholarly\/disciplinary fields, but also \u2018in the clinic\u2019. The primal scene, or the lived illness which it represents, is not so easy to leave behind, nor so necessary or desirable to reject, as the editorial introduction proposes. Indeed, medical humanities without the patient qua patient at its centre, Macnaughton appears to suggest, is in danger of facing an ethical dead end. Fortunately, the evidence of this volume is that second-wave medical humanities still has a strong orientation towards, as Callard and Fitzgerald put it,\u00a0that \u2018most central object of the medical humanities\u2019 \u2013 life.<\/p>\n

 <\/p>\n

 <\/p>\n

Related reading – themed issue on Critical Medical Humanities:<\/em><\/strong><\/p>\n

http:\/\/mh.bmj.com\/content\/41\/1.toc#Criticalmedicalhumanities<\/a><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0 The Edinburgh Companion to the Critical Medical Humanities edited by Anne Whitehead and Angela Woods (general editors) with Sarah Atkinson, Jane Macnaughton and Jennifer Richards (associate editors). Published by Edinburgh University Press, 2016. Reviewed by Josie Billington, University of Liverpool   \u2018Critical medical humanities\u2019, say the editors of this volume, marks a \u2018second wave\u2019 […]<\/p>\n

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Published by Edinburgh University Press, 2016. 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