Medical Humanities

Medicine, the Arts and the Humanities

"Knowledge is limited. Imagination encircles the world"
Albert Einstein ¹

 

Gillie Bolton

http://www.gilliebolton.com/

Medical and scientific developments and innovations, with their attendant social and ethical consequences, rely on a multidisciplinary involvement of science and humanities. The practice of medicine furthermore involves knowledge and skills based on education and experience in both. The arts and humanities can also contribute ways of reconceptualising medicine itself. Stephen Pattison² and Robin Downie ³ recently discussed what medical humanities is, what it might and might not be able to do, and what they hope it will not do. "Medicine and health . . . are human concerns in the widest sense", according to Pattison. Study of the humanities may not be able to make clinicians more humane, says Downie, but it can foster a depth of human and humane understanding, knowledge, and experience.

Arts and humanities approaches are intrinsic to society's understanding of medicine. Bodies, minds, emotions, and relationships are explored and xpressed through the arts and humanities as well as science; academically and intellectually, as well as personally. Do the sciences not also rely for their effectiveness on understanding, critical analysis, meaning, discernment, interpretation, visualisation, and creativity, all fostered by subjects traditionally considered to be based on humanities and arts? ⁴

The humanities are reflective and disciplined inquiries that involve the recording and interpretation of the range of human experience. ⁵ The medical humanities encompass history, literature, philosophy, ethics, theology, sociology, anthropology, and possibly law. These disciplines offer a multifaceted view. They value the aesthetic as well as reason, focus on meaning as well as emotion, and explore ambiguity, uncertainty, and complexity as well as theoretical lucidity. They offer understanding through synthesis as well as analysis-all integral elements of medicine. Educationally, the medical humanities can enable and develop critical conceptualisation and analysis of personal and professional values, and the reflexive and reflective capacities of empathy, collegiality, and teamwork. All these approaches can foster critical evaluation and effective understanding of patients' unique narratives and needs. ^6,7

Medical consultation is a complex communication, both verbal and physical, involving issues of risk, values, and ethics. The clinician brings tacit understandings and personal experience, as well as professional expertise and knowledge. Patients bring broken bodies or minds. But often more than the body or mind is broken: patients' understanding of themselves and the certainty of their lives is often also disrupted and disturbed. Together, clinician and patient can coconstruct a curative and healing narrative that involves medical and healthcare interventions, and mental and emotional understandings, which can help the patient constructively rebuild their life, or prepare for death. ⁸

A recent UK Government directive states that: "The greatest challenges for society . . . are all ones in which the arts and humanities, and science and technology need each other . . . [Medical] education is about understanding and imagination, as well as training and skills". ⁹ Medical humanities is responding fast, ¹⁰ and all involved in the field are asked to join a dialogue of its nature and effects. ¹¹

Medical practitioners work with people through the biggest dramas of life: birth, death, disablement, and life-altering disease. Such work also brings anxiety, harassment, frustration, and disillusionment. Some of these intimate and privileged encounters inevitably include extraordinary comedy as well as tragedy. The treatment and care of ill and often distressed people constantly confronts practitioners with fundamental questions about the meaning and sanctity of life and the problem of suffering. A sound grounding in the arts and humanities can enable an effectively critical, humane, and ethical response.¹²

For the medical humanities to continue to be of real use, they need to retain an intrinsic value, and not become "instrumental technologies" ² (as a mere means to promoting, for example, communication skills). An interdisciplinary breadth, inclusivity, vigour, and spirit of intellectual inquiry is needed. Pattison ² and Downie ³ also caution against pitfalls into which medical ethics has fallen: "routinisation, exclusivism, narrowing, specialisation, and professionalisation", ² which could result in the elimination of "radically different approaches to the big questions and issues of life". ² Medical humanities, like all other disciplines, is rooted in imaginative inquiry.

A dynamic communication between humanities, arts, and science can offer a challenge to medicine, as well as to the humanities. Developmental change is neither comfortable nor easy. Medical humanities, with the richness it has to offer practice as well as academic and intellectual pursuit and education, could support a rounded development of medicine, able to respond with cutting-edge research, as well as to human needs-social, ethical and scientific.

GB is involved in the first conference of the UK Association for the Medical Humanities, Durham University , July 21-22, 2003.

Gillie Bolton

School of Humanities , King's College, London WC2R 2LS , UK

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