Critical medical humanities: embracing entanglement, taking risks

The Value of Researcher Reflexivity in the Coproduction of Public Policy: A Practical Perspective

Coproduction of public policy involves bringing together technical experts, practitioners, and people with lived experience of that policy to collaboratively and deliberatively codesign it. Coproduction can leverage different ways of knowing and evaluative perspectives on a policy area to enhance the legitimacy and efficaciousness of policymaking. This article argues that researcher reflexivity is crucial for getting the most out of coproduction ethically and epistemically. By reflecting on our positionality, habitus, and biases, we can gain new insights into how we affect the research design, production and analysis of data, and communication of findings. This reflexivity helps to disrupt power dynamics that underly research and policymaking, helping to realise the radical potential of coproduction to democratise practice, empower citizens, and make research more relational. We demonstrate the value of reflexivity through an analysis of our work coproducing a theory of thriving in financial hardship in partnership with the UK national anti-poverty charity Turn2us. We contextualise our advocacy for reflexivity within the practical realities of advancing coproduction in the UK today.

Towards a transformative health humanities approach in teaching the Sustainable Development Goals (SDGs)

The adoption of the United Nations' Sustainable Development Goals (SDGs) marks a significant shift in global political agendas, emphasising sustainability in various fields, including health. To engage meaningfully with sustainability, a transformative educational approach is essential. Lange's concept of transformative learning encompasses three levels: personal and cognitive change (micro level), changes in our interactions with others and the environment (meso level) and societal changes (macro level). This paper posits that applying health humanities approaches, particularly narrative medicine, can enhance transformative education at these three levels, leading to a powerful, transformative health humanities framework for teaching sustainability and the SDGs. This interdisciplinary method, which includes reflective self-assessment, exploration of different relational perspectives and social reality comprehension, facilitates transformative learning. However, implementing this transformative strategy requires a critical reassessment of some core principles and methods within the existing health humanities paradigm.

History at the heart of medicine

With a focus on the challenges of today and tomorrow in the critical medical humanities the role of history is often overlooked. Yet history and medicine are closely intertwined. Right now, with the surfacing of knotty problems such as changing demographics, chronic pain, loneliness and Long Covid - and the consequent necessity to change directions and policies - history seems more urgent than ever. However, historians of medicine have sometimes been reticent to play a role in medicine and policymaking. The recent and welcome development of the critical medical humanities has intervened in medicine in important ways, but often without clear engagement with the history of medicine. In this letter, we make a renewed case for coherence and collaboration between history of medicine, medicine, and medical humanities, emphasising the continuity and links between all three. The skills and focus of the historian of medicine bring crucial historical context to the table, enabling better understanding of medical collecting, new imaginative futures, profound critiques of key medical concepts, and understandings of the body through time. By emphasising what historians can do for medicine and medical humanities, we call for building historical work into how medicine, illness and health are understood now and in the future. We suggest three potential roles for historians: keepers of memories, conversation partners, and futurist thinkers.

Narrative Medicine Theory and Practice: the Double Helix Model

The genesis of the medical humanities as a discrete academic discipline engendered a need for a theoretical framework, a function taken on by the growing narrative medicine movement. More recently, scholars have begun to develop a critical medical humanities, an analytical movement that emphasises the fundamental enmeshment of the sciences and humanities. Building on Helene Scott-Fordsmand's work on reversing the medical humanities, this paper develops an alternative to the current version of narrative medicine. We propose a new interpretive heuristic, the Double Helix Model, and place it in critical dialogue with the Columbia School's close reading based-approach. Through this new conceptual frame, we suggest that critical narrative medicine may empower clinicians to contribute to the reorientation of the roles of the sciences and humanities, benefiting providers, scholars and patients.

Postdigital health practices: new directions in medical humanities

Digitalisation has changed the way we understand and practice health. The recent pandemic has accelerated some of the developments in digital health and brought about modifications in public access to information. Taking this into consideration, this programmatic paper sets the stage for and conceptualises postdigital health practices as a possible field of inquiry within medical humanities. While delineating some central aspects of said practices, I draw attention to their significance in contemporary strategies of knowledge production. Spotlighting online environments as the point of ingress for the analysis of these practices, I propose three possible foci of critical and methodological engagement. By spotlighting the serialisation, multimodality, and transmediality of such environments, I argue, we have a chance to both augment and go beyond the field's long-standing preoccupation with narrative, attend to various strategies of communicating illness experience, and re-frame them within larger questions of systemic inequalities. On this basis, and taking as examples COVID-19 and Long COVID, I sketch some of the directions that future strands of medical humanities may take and some of the questions we still have to ask for the field to overcome its own biases and blind spots.

Does medical humanities matter? The challenge of COVID-19

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.

The art of equity: critical health humanities in practice

BACKGROUND

The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice - that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, utilizing the frameworks of critical consciousness and structural competency.

PRACTICE OF HEALTH HUMANITIES

Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities.

CONCLUSION

In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency - frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions.

Character and virtue development in medical learners: another role for the arts?

Medical education serves to teach students how to think and act as future physicians. Doing so successfully requires supporting learners' acquisition of clinical skills and knowledge, but also attending to their character education and virtue development. The arts and humanities are widely embraced as a fundamental component of a complete medical education. While not frequently touted as a useful pedagogical tool for teaching character and virtue, we argue the integration of arts-based activities into medical education can promote virtue development. In this article, we use the virtues framework from the Jubilee Centre for Character and Virtues at the University of Birmingham to review existing empirical studies of arts-based programs for each of these virtue domains of intellectual, moral, civic, and performance virtues. Learners may benefit from further exploration-both conceptual and empirical-of how the arts can scaffold character development in medical education.

Reversing the medical humanities

The paper offers the concept of reversing the medical humanities In agreement with the call from Kristeva et al to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent-but still to be articulated-possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.

Variation in medical humanities program mission statements in United States and Canadian Medical Schools

PURPOSE

In 2019, the American Association of Medical Colleges (AAMC) identified the discipline of medical humanities as a priority in medical education. Although medical humanities programs have existed in medical and osteopathic schools in the U.S. and Canada since the late 1960's, this interdisciplinary field remains difficult to define. We studied the mission statements of medical humanities programs to identify core themes and priorities.

MATERIALS AND METHODS

We conducted a content analysis of U.S. and Canada medical humanities MD and DO mission statements and associated descriptions (n = 56). We compared themes across programs whose directors had a clinical degree versus a terminal research degree, conducted comparisons between medical humanities programs housed in medical schools ranked in Top 20 U.S. News and World Report for Research or Primary Care, and conducted a word frequency analysis.

RESULTS

Content analysis revealed five themes: improving patient care, improving the provider experience, generating scholarship, cultivating community relationships, and promoting diversity/sociocultural awareness. 70% of programs emphasized patient care and provider experience. Only 34% included the promotion of diversity/sociocultural awareness as a theme. Word frequency analysis corroborated our findings.

CONCLUSIONS

U.S. and Canada medical humanities programs focus primarily on improving patient care and provider wellness.

Medical Humanism in the Posthuman Era: A Critical Examination of its Past, Present, and Future

This paper explores the historical and contemporary significance of medical humanism and its potential value in medical education. Medical humanities emerged as a response to the issues arising from science-driven modern medicine, most notably the marginalization of the individual in medical practice. Medical humanism has evolved to become a guiding ideology in shaping the theory and practice of medical humanities. However, the COVID-19 pandemic has brought about significant changes in medical humanities, challenging the foundations of humanism beyond medical humanism. The rise of posthumanism raises fundamental questions about humanism itself. The climate crisis, driven by human greed and capitalism's exploitation of nature, has led to the emergence of viruses that transcend species boundaries. The overflow of severely ill patients has highlighted the classic medical ethics problem of "who should be saved first" in Korea, and medical humanism is facing a crisis. Various marginalized groups have also pointed out the biases inherent in medical humanism. With this rapidly changing environment in mind, this paper examines the past and present of medical humanism in order to identify the underlying ideology of medical humanism and its future potential in medical education. This paper assumes that there are two axes of humanism: human-centeredness and anthropocentrism. Medical humanism has historically developed along the axis of human-centeredness rather than anthropocentrism, emphasizing the academic inquiry into human nature and conditions, as well as the moral element of humanity. Furthermore, this paper discusses the challenges that medical humanism faces from post-human centeredness and post-anthropocentrism, as well as the recent discourse on posthumanism. Finally, the implications of this shift in medical humanism for the education of the history of medicine are briefly explored.

'In the picture': perspectives on living and working with cancer

We explored working and living with cancer at a large research-intensive National Health Service hospital breast cancer service and adjoining non-governmental organisation (NGO). The project had three elements that were largely autonomous in practice but conceptually integrated through a focus on personalised cancer medicine. Di Sherlock held conversations with staff and patients from which she produced a collection of poems, Written Portraits At the same time, we conducted interviews and observation in the hospital, and hosted a public series of science cafés in the NGO. The trajectory of this project was not predetermined, but we found that the poetry residency provided a context for viewing participation in experimental cancer care and vice versa. Taking themes from the poetry practice, we show how they revealed categories of relevance to participants and illuminated others that circulated in the hospital and NGO. Reciprocally, turning to findings from long-term ethnographic research with patients, we show that their observations were not only representations but also tools for navigating life in waiting with cancer. The categories that we discovered and assembled about living and working with cancer do not readily combine into an encompassing picture, we argue, but instead provide alternating perspectives. Through analysis of different forms of research participation, we hope to contribute to an understanding of how categories are made, recognised and inhabited through situated comparisons. In personalised medicine, category-making is enabled if not dependent on increasingly intensive computation and so the practices seem far removed from mundane processes of interaction. Yet, we emphasise connections with everyday practices, in which people categorise themselves and others routinely according to what they like and resemble.

Creating Alignment: How the Humanities Can Help Heal Physicians and Patients

The medical humanities, an umbrella term for the fields of ethics, social science, and fine arts, are increasingly recognized as an important component of medical education. Since the Flexner report, the primacy of science and evidence-based medicine has replaced subjectivity and nuance. While this has been critical for standardization of care and patient safety, an exclusive emphasis on science in undergraduate medical education can devalue more humanistic pursuits. Modern medicine is now plagued with burnout, pandemics, and societal ills that permeate into medicine. Addressing these requires a thoughtful, holistic approach where we extend our sights beyond strict evidence-based medicine.

Entanglements and imagined futures: The subject(s) of precision in oncology

Precision oncology holds an increasingly powerful social function. In the era of precision, how people encounter, live with, and experience cancer, how they imagine their lives, how they navigate treatment regimens, and experience side effects, have been radically transformed. Innovations in oncology - in this case precision-related - are always more-than-clinical; their circulation exceeds the laboratory and the hospital, but what this 'circulation of innovation' produces has been thus far opaque. To begin to comprehend what is emergent at the cancer-precision nexus in people's everyday lives, we draw on qualitative interviews with twenty people diagnosed with metastatic non-small cell lung cancer undergoing immunotherapy and/or targeted therapy and we discuss how precision inflects survivorship, entangles subjects in chronic living, and induces novel temporalities. Through such inflections of survivorship, precision innovation re-shapes expectations and possibilities, and sometimes enacts new, unexpected (or, for some, unwanted) futures. Such illness and survivorship narratives indicate the importance of orientating the social science scholarship toward considerations of temporality and entanglements for comprehending precision innovation in oncology. And in doing so, provide a nuanced account of how innovations unsettle and recast, rather than unravel, the normative scene of cancer.

Neoliberal Misfits: Reconceptualizing Debility in the Critical Medical Humanities

In recent years, the concept of debility has gained a lot of attention. In critical theory and in the critical medical humanities, the concept has come to refer specifically to the general ill-health of ordinary lives under neoliberal capitalism; as such, it has triggered a surge of interest in large-scale affective assemblages that incapacitate multitudes of bodies. This article proposes neoliberal misfit as a conceptual tool to remedy the dissolution of subjectivity in these discussions. Pushing back against Jasbir Puar specifically, it argues that processes of debilitation produce a particular type of subject formation often ignored in this body of work. The article does so by distinguishing this subject formation in three contemporary illness narratives that dramatize encounters between ill bodies and accelerating rhythms, competitive atmospheres, and mobile attachments, respectively. Ultimately, the aim is to help the critical medical humanities capture how neoliberal environments affect the self-perception of people suffering from ill-health.

'Capable of being in uncertainties': applied medical humanities in undergraduate medical education

Numerous medical schools have been updating and modernising their undergraduate curricula in response to the changing health needs of today's society and the updated General Medical Council competencies required for qualification. The humanities are sometimes seen as a way of addressing both of these requirements. Medical humanities advocates would argue that the humanities have a vital role to play in undergraduate medical education, allowing students to develop the critical tools required by the 21st-century clinician to deliver the best person-centred care. While we endorse this view, we contend that such training must be taught authentically to have maximal impact. This article arises from a collaboration between Imperial College London and Birkbeck, University of London, which aimed to embed the humanities into Imperial's undergraduate medical curriculum. Here, we use a teaching session on graphic medicine and narrative as a case study to illustrate how the humanities can be a powerful tool for students to explore professional clinical complexity and uncertainty when taught in a transdisciplinary way. In this session, uncertainty operated on several different levels: the introduction of unfamiliar concepts, materials, and methods to students, transdisciplinary approaches to teaching, and the complexities of real-life clinical practice. Further, we argue that to manage uncertainty, medical students must cross from a scientific training based on positivist understandings of evidence and knowledge, to one which foregrounds multiplicity, nuance, interpretive critical thinking, and which understands knowledge as contingent and contextually produced. In facilitating such learning, it is crucial that the teaching team includes experts from both medical and humanities fields to scaffold student learning in an intellectually dynamic way, drawing on their disciplinary knowledge and wide range of personal professional experiences.

'Living in a Material World': Frankenstein and new materialism

This paper uses concepts from Karen Barad's theories from quantum physics and other theoretical approaches from new materialism to show how Frankenstein can be used to introduce this new framework and to challenge an older one based on dualism, representationalism and individualism. A new ethical understanding of the message of the text emerges from this reading-one that rethinks the prohibitions against 'playing God' or creating the unnatural and relies instead on an ethics of care.

Cinemeducation in medicine: a mixed methods study on students' motivations and benefits

BACKGROUND

Cinemeducation courses are used to supplement more standard teaching formats at medical schools and tend to emphasise biopsychosocial aspects of health. The purpose of this paper is to explore why medical students attend the cinemeducation course M23 Cinema (M23C) at LMU Munich and whether a film screening with a subsequent expert and peer discussion benefits their studies and their future careers as medical doctors.

METHODS

An exploratory sequential mixed methods study design was used. Qualitative research, i.e. three focus groups, four expert interviews, one group interview and one narrative interview, was conducted to inform a subsequent quantitative survey. Qualitative data was analysed using qualitative content analysis and quantitative data was analysed descriptively. The findings were integrated using the "following a thread" protocol.

RESULTS

In total, 28 people were interviewed and 503 participants responded to the survey distributed at seven M23C screenings. Participants perceive the M23C as informal teaching where they learn about perspectives on certain health topics through the combination of film and discussion while spending time with peers. The reasons for and reported benefits of participation varied with educational background, participation frequency and gender. On average, participants gave 5.7 reasons for attending the M23C. The main reasons for participating were the film, the topic and the ability to discuss these afterwards as well as to spend an evening with peers. Attending the M23C was reported to support the students' memory with regards to certain topics addressed in the M23C when the issues resurface at a later stage, such as during university courses, in the hospital, or in their private life.

CONCLUSIONS

The M23C is characterised by its unique combination of film and discussion that encourages participants to reflect upon their opinions, perspectives and experiences. Participating in the M23C amplified the understanding of biopsychosocial aspects of health and illness in students. Thus, cinemeducative approaches such as the M23C may contribute to enabling health professionals to develop and apply humane, empathetic and relational skills.

Authorship in the Medical Humanities: Breaking Cross-field Boundaries or Maintaining Disciplinary Divides?

PURPOSE

Medical humanities is a field which implies collaborative work across disciplines although the degree to which this actually occurs is unknown. Our purpose was to determine the degree of joint work in medical humanities through analysis of authorship and acknowledgements in the two main medical humanities journals.

METHODS

Observational survey of authorship. We studied authorship data in all papers published in the two major general medical humanities journals between 2009 and 2018 (n=595).

RESULTS

Two-thirds of papers (67.4%) had single authors, of whom a majority declared a single disciplinary affiliation (70.3%). The titles of 60.8% of papers explicitly suggested collaborative content of which 19.9% had multiple authors from more than one discipline (not within the same school); of the remainder, almost half (48.1%) had a single, single-disciplinary author (although 8.5% demonstrated interdisciplinarity in the acknowledgements). One-third of papers (193/595;33%) referenced one or more people in the acknowledgements. Among papers whose titles suggested humanities or medical content only, authorship lists of 10.2% and 17.9% respectively demonstrated collaborative scholarship.

CONCLUSIONS

Despite considerable involvement from both humanities and medical practitioners, there is still substantial scope for enhanced emphasis on collaborative (multi-, inter- and trans-disciplinary) seminars and exchanges in the medical humanities and editorial policies to promote transparency of the nature of collaborative work among disciplines. Journal editors and editorial boards should reflect on the opportunity to promote enhanced visibility of joint work in scholarship in the medical humanities through reflection and review of current editorial policies.

'The body says it': the difficulty of measuring and communicating sensations of breathlessness

Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.

How care holds humanity: the myth of Cura and theories of care

Modern medicine has often struggled to grasp the cultural aspects of interpersonal care. The medical humanities, on the other hand, have struggled to grasp the embodied, intimate character of care. In a recent appeal to the medical humanities, Julia Kristeva et al argue that care can be a point of crossing between these two 'ontological domains'. They evoke the myth of Cura, referring to previous utilisations by such diverse thinkers as Heidegger and Kleinman, as well as Kristeva's previous work. This study adds to these bodies of work by using the original text from Hyginus in much greater detail. Textual analysis, theoretical discussions and autotheoretical work unpack care as (1) a fundamental aspect of the human condition, (2) a holding-together of different domains of knowledge, (3) a withholding from these domains and (4) the site of intimate knowledge that both 'ontological domains' struggle to grasp.

"Now I know how to not repeat history": Teaching and Learning Through a Pandemic with the Medical Humanities

We reflect on our experience co-teaching a medical humanities elective, "Pandemics and Plagues," which was offered to undergraduates during the Spring 2021 semester, and discuss student reactions to studying epidemic disease from multidisciplinary medical humanities perspectives while living through the world Covid-19 pandemic. The course incorporated basic microbiology and epidemiology into discussions of how epidemics from the Black Death to HIV/AIDS have been portrayed in history, literature, art, music, and journalism. Students self-assessed their learning gains and offered their insights using the SALG (Student Assessment of their Learning Gains), describing how the course enhanced their understanding of the current pandemic. In class discussions and written assignments, students paid particular attention to issues of social justice, political context, and connections between past pandemics and Covid-19. Student responses indicate enhanced understanding of the scientific and medical aspects of epidemics and also increased appreciation of the insights to be gained from the medical humanities. We discuss co-teaching the class during a real-time, twenty-four-hour-news-cycle pandemic, and the ways in which that experience underlines the value of a "critical medical humanities" approach for undergraduates.

Tales of treatment and new perspectives for global health research on antimicrobial resistance

Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential-in particular, through the field's emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public.We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance.Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and 'lay' sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.

Developing New Academic Programs in the Medical/Health Humanities: A Toolkit to Support Continued Growth

Academic programs in the medical/health humanities have proliferated widely in recent years, and the professional, academic, and cultural drivers of this growth promise sustained new program development. In this article, we present the results of a survey sent to representatives of one hundred twenty-four baccalaureate and ten graduate programs in the medical/health humanities to assess the experiences and needs of existing programs. Survey results confirm the interest in and need for a descriptive toolkit as opposed to a prescriptive manual; indicate what data and materials are most needed to support the successful development of new academic programs in the field; and identify areas for future research. Recognizing a need for program development resources, the Health Humanities Consortium (HHC) has initiated the creation of a comprehensive online toolkit. We discuss survey results and the toolkit in relation to the drivers of new program growth. Finally, we describe resources now available through the HHC's new online program toolkit, including existing programs; sample syllabi; sample curricula templates; program rationale; proposal templates; and graduation data.

Infectious thinking: the pathophysiology of 19th-century pedagogy

Systems for improving public health and organisations for providing national education were two of the great reforming achievements of 19th-century Britain. Despite the overlapping personnel and historical contemporaneity, scholars have rarely considered the two projects in tandem. This essay shows that developments in public health were at the heart of two foundational moments in the rise of 19th-century mass schooling. The originators of the monitorial system, a method of peer-educating working-class children cheaply that dominated British mass schooling at the turn of the 19th century, were deeply invested in the origin and spread of vaccination. Similarly, the first state teacher training system was conceived by a medical doctor in the 1830s, who first rose to prominence investigating cholera in Manchester earlier in the decade. Using archives of school providers, training institutions and the educational state apparatus, I show that medical prophylactic interventions of vaccination and sanitary reform helped galvanise the government into educational reform, by imagining the working class as pathological and providing templates for their palliation. By showing that the roots of the modern school system were deeply imbricated in attempts to combat smallpox and cholera, both in form and in epistemology, this paper argue that critical medical humanists should consider the role of epidemiological thinking in institutions and disciplines which seem, on first sight, removed from the clinic and the lab.

Should eloquence be taught as part of the undergraduate medical curriculum?

This article was migrated. The article was marked as recommended. The integration of the humanities into the medical curriculum over the past two decades has been widely adopted in the stream of communication usually within the realms of doctor-patient relationship. However, its integration within medical curriculum is inconsistent, and may only be present as an optional component in certain selected modules. The study of eloquence within medicine has not been described previously, we propose that its inclusion into the medical curricula will increase equality and diversity in medical training. We aim to debate the roles of medical humanities and the integration of eloquence into the medical curriculum. Integration of eloquence into the medical curriculum with the aim of developing written prose and oration could improve our interprofessional communication and bridge the gap for those from a wider social background accessing medicine.

The Not-So-Strange Case of Dr. Jekyll and Mr. Hyde in Antibiotic Research: An Interdisciplinary Opportunity

Literary-rhetorical devices like figurative language and analogy can help explain concepts that exceed our capacity to grasp intuitively. It is not surprising these devices are used to discuss virulence, pathogenesis, and antibiotics. Allusions to Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde seem to be used with particular frequency in research pertaining to pathogens, especially in studies contemporary with our evolving understanding of antibiotic resistance. More recent references to the text have appeared in research parsing definitions of virulence and acknowledging the role of anti-virulence in future therapeutics. While it is obvious that scientists invoke Stevenson’s story for stylistic purposes, its use could go beyond the stylistic—and might even generate rhetorical and imaginative possibilities for framing research. This perspective discusses the first published allusion to Jekyll and Hyde in reference to virulence and pathogenesis; comments on a select number of specific instances of Jekyll and Hyde in contemporary scientific literature; briefly contextualizes the novel; and concludes with the implications of a more productive engagement with humanistic disciplines in the face of antibiotic resistance.

Psychosocial curating: a theory and practice of exhibition-making at the intersection between health and aesthetics

A recent Manifesto for a Visual Medical Humanities suggested that more in-depth analysis of the contribution of visual art to medical humanities is urgently required. This need perhaps arises because artists and curators experience conflict between the experimental approaches and tacit knowledge that drive their practice and existing audience research methods used in visitor studies or arts marketing. In this paper, I adopt an innovative psychosocial method-uniquely suited to evidencing aesthetic experiences-to examine how an exhibition of my own curation facilitated audiences to undertake psychological processing of complex ideas about mental distress. I consider the curator working in a health context as a creator of care-driven environments where complex affects prompted by aesthetic approaches to illness can be digested and processed. My definition of care is informed by psychosocial studies and object relations psychoanalysis, which allows me to approach my exhibitions as supportive structures that enable a spectrum of affects and emotions to be encountered. The key argument of the paper is that concepts from object relations psychoanalysis can help to rethink the point of entanglement between curating and health as a process of preparing the ground for audiences to do generative psychological work with images and affects. The case study is Group Therapy: Mental Distress in a Digital Age, an exhibition that was iterated at FACT (Foundation for Art and Creative Technology), UK and University of New South Wales Galleries Sydney, with an emphasis on audience response to key artworks such as Madlove-A Designer Asylum (2015) by the vacuum cleaner and Hannah Hull. It is hoped that this paper will help to reaffirm the significance of curating as a cultural platform that supports communities to live with the anxieties prompted by society's most complex medical and social issues.

Making Breath Visible: Reflections on Relations between Bodies, Breath and World in the Critical Medical Humanities

Breath is invisible and yet ever present and vital for living beings. The concept of invisibility in relation to breath operates in concrete and metaphorical ways to extend ideas about breath and breathlessness across disciplines, in clinical spaces and in life experience. Using a critical medical humanities approach, I demonstrate that the poverty of narrative accounts and language for breath outside the health context have had a crucial influence enabling clinically mediated interpretations and accounts to dominate. These third-person accounts are important in the articulation of the 'lived body', but I balance this with a consideration of the subjective sensation of interoception, which has important implications for the visibility of breathlessness in both clinical and lay contexts. This article illustrates the rich potential of the subjects of breath and breathlessness within body studies and this special issue is a key step in making breath such an emergent topic.

Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare

Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed 'entangled' relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.

Perspectives on person-centred care for borderline personality disorder: a critical research agenda

Borderline Personality Disorder (BPD) is a highly contentious psychiatric diagnosis with ongoing tensions over nomenclature, aetiology and treatment recommendations. This article examines a number of these tensions and assesses how greater attention to the voices of people living with BPD may help inform the delivery of new modes of person-centred care. To this end, we present a critical social science research agenda for investigating the experiences, social contexts and support needs of people living with BPD. We canvass issues pertaining to the diagnosis of BPD (including its name), the strongly gendered dimensions of BPD, and the pressing need to improve support for people living with this condition. Throughout our analysis, we indicate how critical interdisciplinary inquiry may drive new responses to these challenges. Our analysis is illustrated with reference to experiences of BPD recounted in two Australia-wide surveys conducted in 2011 and 2017. We argue that greater progress towards person-centred care requires novel forms of evidence grounded in critical social inquiry into experiences of treatment and support among people living with BPD, and the varied social, cultural and political contexts underpinning these experiences.

Prosthesis and the engineered imagination: reading augmentation and disability across cultural theory, representation and product design

This article argues for the value of considering the interaction of literary/cultural studies, disability studies and engineering/design studies in the ongoing development of a critical medical humanities research frame. With a specific focus on prosthesis, but also considerations of embodiment, technology and augmentation as concepts in both cultural/disability theory and engineering/design, we note how the shifting and plastic ideas of 'the prosthetic' as used within cultural studies have never been in conversation with scholars who work on prostheses in engineering design or the processes through which such technologies are produced. Additionally, we show that the increased use of systems engineering in the design and construction of prostheses creates fractured ideas of disabled bodies that frequently ignore both the cultural meaning and lived experience of technology use. In design and engineering, prostheses are literal objects, often made to order for a diverse range of clients and produced across different working platforms; in cultural studies, the word creates multiple resonances around both augmented bodies and non-embodied states increasingly understood in terms of assemblage and supplementarity. Working from this, we outline how questions of metaphor, materiality and systems weave through the different disciplines. The article claims that a critical dialogue between the working methods of literary/cultural studies and engineering/design, for all their obvious differences, possesses the potential to create informed and sophisticated accounts of disability embodiment. Our conclusion brings the strands of the enquiry together and points to the merits of engineering the imagination, and imagining engineering, as both a subject and method in future medical humanities research.

Reading Between the Lines: A Five-Point Narrative Approach to Online Accounts of Illness

The successful delivery of patient-centered care hinges on clinical affiliation for patients' personal needs and experiences. Narrative competence is a mode of thinking and set of actions that widens the clinical gaze beyond logico-scientific cognition. In this article, we investigate a tool that enables clinicians to rehearse their skills in narrative competence. We apply the narrative competence framework developed by the founding practitioners of narrative medicine to personal accounts of illness and patienthood published on the Internet. We describe our use of the five-point framework in the close reading of 214 accounts by people with the life-threatening skin cancer melanoma.

What's in it for the animals? Symbiotically considering 'therapeutic' human-animal relations within spaces and practices of care farming

Human-animal relations are increasingly imbricated, encountered and experienced in the production of medicine and health. Drawing on an empirical study of care farms in the UK, this article uses the language of symbiosis to develop a framework for critically considering the relationships enrolled within interspecies therapeutic practices. Care farming is an emerging paradigm that aims to deploy farming practices as a form of therapeutic intervention, with human-animal relations framed as providing important opportunities for human health. This article moves to attend to multispecies therapeutic interventions and relationships from a more-than-human perspective, drawing attention to the often-troubling anthropocentrism in which such practices are framed and performed. Attempting to perform and realise human imaginations of 'therapeutic' affects, spaces and relationships can rely on processes that reduce animals' own opportunities for flourishing. Yet, the therapeutic use of other species does not have to be forever anthropocentric or utilitarian. The article explores whether relations between humans and animals might result in a level of mutual proliferation of affective capacities, reciprocally beneficial. These human-animal entanglements highlight opportunities to think more critically about how to practice interspecies relationships and practices in ways that are less parasitic, and instead framed more by attempts at producing opportunities for mutualistic flourishing.

Attachment and the archive: barriers and facilitators to the use of historical sociology as complementary developmental science

This article explores historical sociology as a complementary source of knowledge for scientific research, considering barriers and facilitators to this work through reflections on one project. This project began as a study of the emergence and reception of the infant disorganized attachment classification, introduced in the 1980s by Ainsworth's student Mary Main, working with Judith Solomon. Elsewhere I have reported on the findings of collaborative work with attachment researchers, without giving full details of how this came about. Here, I will offer personal reflections arising from the process, and my work in what Hasok Chang has called history as "complementary science."

When bodies think: panpsychism, pluralism, biopolitics

Cultivating a speculative orientation to the medical humanities, the aim of this essay is to explore some dimensions of the recent calls for more participatory forms of medicine and healthcare under the sign of what, after Michel Foucault, I call the 'biopolitical problematic'. That is, the divergent encounter between techniques of biopower that seek to take hold of life and the body, and a plurality of living bodies that persistently respond, challenge and escape its grasp. If critics of 'participatory medicine' have warned that the turn to 'participation' in healthcare functions as a form of biopower that seeks to gain access to bodies, and in so doing take a better hold of life, in this essay, I propose we experiment with the question of what kinds of conceptual tools may be required to make perceptible the ways in which a plurality of participating bodies may become capable of responding, challenging and escaping 'participation's' grasp. After problematising the ontology of participation involved in contemporary debates around participatory medicine, I draw on the work of William James and Alfred North Whitehead, among others, to argue for the need to reclaim a pluralistic panpsychism-in short, the proposition that all things think-as a pragmatic tool to envisage the possibility of a plurality of thinking bodies capable of unruly forms of participation all the way down.

From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account

This paper tells the story of one man's experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient's clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.

Pharmaceuticals and modern statecraft in South Africa: the cases of opium, thalidomide and contraception

This article provides a history of three pharmaceuticals in the making of modern South Africa. Borrowing and adapting Arthur Daemmrich's term 'pharmacopolitics', we examine how forms of pharmaceutical governance became integral to the creation and institutional practices of this state. Through case studies of three medicaments: opium (late 19th to early 20th century), thalidomide (late 1950s to early 1960s) and contraception (1970s to 2010s), we explore the intertwining of pharmaceutical regulation, provision and consumption. Our focus is on the modernist imperative towards the rationalisation of pharmaceutical oversight, as an extension of the state's bureaucratic and ideological objectives, and, importantly, as its obligation. We also explore adaptive and illicit uses of medicines, both by purveyors of pharmaceuticals, and among consumers. The historical sweep of our study allows for an analysis of continuities and changes in pharmaceutical governance. The focus on South Africa highlights how the concept of pharmacopolitics can usefully be extended to transnational-as well as local-medical histories. Through the diversity of our sources, and the breadth of their chronology, we aim to historicise modern pharmaceutical practices in South Africa, from the late colonial era to the Post-Apartheid present.

Walking up hills, through history and in-between disciplines: MHH and Health Sciences Education at the tip of Africa

Celebration, frustration, contestation and imagination all manifest themselves when examining the evolution of the field of Medical and Health Humanities (MHH) at the University of Cape Town (UCT). That this field has been growing at the same time as access to, inclusion in, and social justice issues linked to higher education have come under the spotlight has the potential to shape how we think and plan for the future of the field. Doing this will require treks up hills, journeys through difficult histories and dynamic dances in-between disciplines.This article examines MHH at UCT broadly, referring to projects and programmes that are underway primarily in the humanities and health sciences faculties. From this overview, the article specifically examines the curricula changes introduced in the Faculty of Health Sciences inspired by MHH and the author's interest in historical consciousness. It describes current points of intervention in physiotherapy and MBChB undergraduate curricula; and through short-term special study modules that have allowed those interested in MHH to explore relationships between health and healing and art, music, writing, yoga, PhotoVoice, drama, drawing and complex histories.It discusses some of the challenges of introducing humanities teaching into health sciences curricula; and some of the tensions that result from the meeting of divergent epistemologies and pedagogies. The article considers if, and how, MHH might engage with social (in)justice, and inclusions and exclusions and potentially offer a balm to soothe the bruising effects of oppressive histories and a hegemonically hierarchical present.

Reflections on a field across time and space: the emergent medical and health humanities in South Africa

In this paper, we draw on our own cross-cultural experience of engaging with different incarnations of the medical and health humanities (MHH) in the UK and South Africa to reflect on what is distinct and the same about MHH in these locations. MHH spaces, whether departments, programmes or networks, have espoused a common critique of biomedical dualism and reductionism, a celebration of qualitative evidence and the value of visual and performative arts for their research, therapeutic and transformative social potential. However, there have also been differences, and importantly a different 'identity' among some leading South African scholars and practitioners, who have felt that if MHH were to speak from the South as opposed to the North, they would say something quite different. We seek to contextualise our personal reflections on the development of the field in South Africa over recent years within wider debates about MHH in the context of South African academia and practice, drawing in part on interviews conducted by one of the authors with South African researchers and practitioners and our own reflections as 'Northerners' in the 'South'.

Challenging perceptions of disciplinary divide: an ethnographer's experience of collegiality, collaboration and crisis

Warned by social scientists about 'the disciplinary divide' and the hostility of medical professionals to qualitative research, I was pleasantly surprised by the collegiality I experienced while conducting fieldwork among clinician-researchers in South Africa. This commentary is a challenge to common discourse, historically dominant in a global (north) anthropology, that biomedical practitioners are necessarily antagonistic to the humanities. Drawing on my field experiences, I propose an optimistic outlook for collaboration and inclusivity in developing medical and health humanities in Africa. While conducting anthropological fieldwork among doctors producing medical research, I gained access to elite professional spaces, even presenting anthropological work in medical research forums. I established relationships with leading figures in various clinical departments and research institutes. There were, unsurprisingly, times when I had to rigorously defend my methodology. I had to revise my methodological knowledge including on quantitative methods to explain varying epistemologies to both sympathetic and doubtful medical colleagues. But, I was often treated as a fellow researcher, a colleague. Some clinician-researchers accepted me as having different, valuable expertise to analyse human complexity and proposed opportunities for possible collaboration. I argue that these clinicians appreciated this expertise because of their pervasive perceptions of crisis in healthcare and an awareness of the complexities of biomedicine in an African context of social heterogeneity, medical pluralism and legacies of social injustice. These concerns around crisis and complexity may be points of leverage for expanding interdisciplinary collaboration and facilitating access to research sites and research forums.