Full transcript
0:04[music]
0:09[music]
0:18Hello everyone. I welcome you to my NPTL
0:20course titled introduction to medical
0:22humanities. This is lecture two and in
0:26this particular lecture I am going to
0:28define what is medical humanities.
0:31Broadly speaking, I am going to look
0:33into the major theoretical debates one
0:37and secondly as to how the discipline of
0:42medical humanities came into existence
0:45globally like who are the theorists who
0:47contributed to it primarily in terms of
0:50its medical trajectory. Before we go
0:53ahead, let me quickly take you through
0:56what the overview is like. In today's
0:58session, we begin by defining medical
1:01humanities in its broader context.
1:03Follow it up with the productive
1:05tensions and its effort to bridge
1:07science and lived experiences. Finally,
1:10we consider its role in professional
1:13formation, institutional critique and
1:15its engagement with moral questions,
1:18justice and postcolonial context. Let us
1:21briefly return to the images that I had
1:23shown you in the introduction slide. Uh
1:26there are three images. You see figure
1:281, figure two, figure three. In figure
1:31one, there is an empty stage. Now this
1:35empty stage depicts a hospital bed
1:38indicating that a patient has recently
1:41died or may be removed. The patient's
1:45body is no longer visible yet the
1:48medical apparatus remain. What does it
1:51indicate? This indicates a prominent
1:53question on the patient's voice in the
1:56surgical or medical outcome.
2:00The second image on your screen is
2:02Sirvalo's tonic in India, an
2:05advertisement that frames as a commodity
2:08within colonial markets. The woman
2:11holding the bottle links health to
2:13domestic and reproductive
2:14responsibility.
2:16The man carrying a crate marked
2:18Cerello's tonic emphasizes distribution
2:21and trade. The image in a sense also
2:24suggest health as purchasable and
2:27positions imported medicine as necessary
2:30within a colonial economy. The third is
2:33an important image quite familiar with
2:36what you know of Shushut uh in India and
2:41he's an old surgeon and this is uh an
2:45image from the history of medicine
2:47collection. [snorts] We can see that
2:50Shushut is preparing to reconstruct an
2:54artificial earlo for a mutilated
2:56patient. a procedure described in
2:59Shushut Sahita, an early Sanskrit
3:01surgical text detailing instruments and
3:04techniques. We read this image as a
3:07reminder that medical history is not
3:10singular. It calls for a return to
3:12plural and regionally grounded histories
3:15of knowledge that predate and exceed
3:18modern western biio medicine. In fact,
3:21uh in subsequent lectures when I will
3:23take up the trajectory of medical
3:25humanities in India and try to map uh it
3:29with the global health, I will discuss
3:32these issues in detail as to how there
3:35was always a component of plurality in
3:39the medical sphere as far as Indian
3:42context is concerned.
3:44Now when we define uh medical humanities
3:48we can just build on these images. We
3:51adopt a very culturally grounded
3:54approach beginning to read medical
3:56humanities as historically produced.
4:00Now within uh the Indian context as we
4:04will see throughout the course cultural
4:06texts including literal, visual and
4:09archival have longedged ethical
4:12questions central to medicine authority
4:15suffering embodiment and care. These
4:18engagements precede the formal
4:20institutionalization of medical
4:22humanities. In terms of method, we move
4:26at two levels. At a macro level, we
4:29engage sociological and institutional
4:31analysis. And at micro level, we read
4:35cultural text and narratives to examine
4:38how medicine is represented,
4:40legitimized, and also contested.
4:44Our postcolonial framings draw on Edward
4:47Sai and Ashish Nandi to question the
4:50assumed neutrality of medical knowledge.
4:53So in uh orientalism s demonstrates that
4:58knowledge about the orient was
5:00constitutive.
5:02On the other hand, Nandi in the intimate
5:05enemy published in 1983
5:08complicates the narrative further by
5:12showing that colonial modernity operated
5:15not only through institutions but
5:17through psychological and cultural
5:19internalization.
5:21Western medicine therefore was not
5:23passively adopted. It was negotiated and
5:26internalized in ways that reshaped both
5:30colonizer and the colonized. Borrowing
5:33from western medical humanities are
5:35acknowledged. However, they are treated
5:38as outcomes of colonial history rather
5:40than as foundational origins. Indian
5:43medical humanities must therefore be
5:45located [snorts] within what we can term
5:48as plural knowledge traditions and
5:51uneven historical exchanges. When we
5:54talk about the origin of the word uh
5:57what is humanities and why does it
6:00matter you will find that uh the word
6:04humanitas
6:06articulated by Cicero means humane
6:10feeling but it also referred to
6:12refinement through education.
6:15Intellectual training and moral
6:17disposition were not separate domains
6:19and therefore this concept parallels the
6:23Greek idea of philanthropia.
6:26The belief that education in the liberal
6:30arts also produces generosity towards
6:32others. In the 14th century, Petrarch
6:36reworked humanitas and he reworked into
6:39three-fold model. What was this
6:41three-fold model on your screen?
6:44um it was humane feeling, intellectual
6:47cultivation and action in the civic
6:50world. This model shaped liberal
6:52education traditions and was
6:54reformulated in the 20th century by
6:57Lionel Trilling as the humanistic
6:59educational ideal. More recently, Martha
7:03Nubam has defended a version of this
7:05ideal, arguing that democratic societies
7:08require citizens trained in critical
7:11thinking and empathy.
7:13So what does humanities combine? Emotion
7:16and intellect, knowledge and virtue,
7:19reflection and action.
7:22Modern academia often separates science
7:24and humanities. Science as objective,
7:27measurable, technical and humanities as
7:30interpretative, moral, subjective. But
7:34historically humanitars did not
7:37recognize this split. Defining the
7:39humanities today is not a simple task.
7:42They can be defined by subject matter,
7:45disciplines or methods. But no final
7:48definition is possible or perhaps even
7:51desirable.
7:53So let us now discuss the origins of the
7:57medical humanities in which we find that
8:00before the late 19th century there were
8:04no major research universities or modern
8:06medical schools in the United States.
8:09Now the physicians trained in Europe
8:11were steeped in classical humanistic
8:14education and medical students in
8:17London, Edinburgh, Paris, Padua and
8:20Vienna were required to read gallon and
8:22hypocrites in Latin. History was central
8:26to professional identity. Medicine in
8:29itself was understood as a part of
8:32learned tradition.
8:34But this model began to shift. Now what
8:37happened over the centuries? The
8:39humanities themselves
8:42became increasingly specialized and
8:44oriented towards pure scholarship. In
8:47the second half of the 19th century,
8:49German research universities accelerated
8:52this shift. The ethos of scientific
8:55dynamism replaced the preservation of
8:57tradition. Knowledge production began to
9:00outweigh moral cultivation. American
9:02physicians trained in German
9:04laboratories brought back a new model.
9:07This model was called medicine as
9:10experimental science. When John Hopkins
9:13Medical School opened in 1893, modeled
9:16on Germany, biomedical science rapidly
9:19displaced older humanistic frameworks as
9:22the model of medical authority. Yet even
9:26at that moment of scientific triumph,
9:29there was concern. concern was about
9:32excessive specialization, reductionist
9:34thinking, commercialism and moral drift.
9:38In short, they were worried about
9:40dehumanization.
9:42Figures such as William Osler and John
9:45Shaw Billings attempted to preserve
9:47medicine's moral center. Osler argued
9:50that medicine was more than an art and a
9:53science, a calling rather than a
9:55business. It required education of the
9:57heart as well as the head.
10:01Now this anxiety uh towards this
10:04dehumanization process started to
10:07intensify in the earlier 20th century
10:10because in 1929
10:13at John Hopkins Harve Kushing declared
10:16and I quote medicine has become so
10:19scattered and subdivided that there is a
10:22crying need for someone to lead it from
10:25the wilderness and bind it together.
10:29Therefore, medicine in its early form
10:32emerged as a response to fragmentation
10:35and history became a tool through which
10:38medicine sought coherence and moral
10:40grounding.
10:42But early medical humanities has limits.
10:45And what is the limit? The limit is that
10:48emphasized
10:49cultivation and elite formation. It was
10:52largely white male upper class. The
10:57whole epistemology relied on great men's
11:00version of history
11:02and therefore it was insufficiently
11:04critical and often nostalgic rather than
11:07analytically rigorous. Medical
11:09humanities thus began not as a critique
11:14but as a restoration an attempt to
11:17prevent science and commerce from taking
11:20out the soul of the medicine. And in
11:23this regard, you will find Pelgrino's
11:26model extremely relevant because he
11:28redefined the field. And there are three
11:31things that we have to
11:34remember on your screen. Clarify ethical
11:37values in clinical practice. Cultivate
11:41critical self-examination.
11:43Educate and not merely train. These were
11:46the three agendas he set in terms of
11:50defining redefining the role of
11:53humanities. Let us go one by one. Now uh
11:57in the first place when he was talking
12:00about clarifying ethical values in
12:03clinical practice, he meant that
12:06clinical decisions always involve
12:08judgment.
12:10Judgment about risk, consent,
12:13responsibility and justice. So, Pelgrino
12:16helped institutionalize this concern
12:19through the development of bioeththics
12:21in the 1980s. A term that we will
12:24discuss in lecture three when we are
12:26discussing the key words. Uh in fact,
12:29bioeththics is the first word we will
12:31begin with. Secondly, uh the humanities
12:34must cultivate critical
12:36self-examination.
12:38This meant that physicians must question
12:41their assumptions, recognize
12:44institutional pressures and examine how
12:47authority operates in practice. The
12:49third was around the training procedure
12:52and it said that humanities must confer
12:55those attitude which distinguish the
12:58educated from the merely trained.
13:01Training produces technical skill. The
13:04education produces discernment.
13:07Pelgrino retained part of the older
13:09humanity's ideal integration of
13:12knowledge, compassion and action, but he
13:14modernized it. He acknowledged that
13:17contemporary medicine cannot just rely
13:20on very scientific cultivation. It
13:23requires structural collaborations with
13:26scholars in ethics, history and
13:29philosophy.
13:31When we discuss uh medical humanities as
13:35a field or discipline,
13:38we use the term
13:40medical humanities but we don't know. So
13:43the field draws from different
13:46disciplines history, literature,
13:50philosophy, religious studies,
13:53anthropology, sociology and the arts.
13:56Now the breath raises an important
13:58question.
14:00Should we understand medical humanities
14:02as a discipline with its own fixed
14:05method and boundaries? A discipline uh
14:09typically claiming to be with
14:11methodological coherence and
14:13institutional autonomy. A field often
14:17operating more flexibly, borrowing tools
14:20and framework from elsewhere.
14:23A related debate concerns whether
14:25medical humanities is multiddisciplinary
14:28or interdicciplinary. We will not
14:30resolve this definitely here but it
14:32seems productive to approach medical
14:34humanities as a field that operate both
14:37ways. Sometimes juxtaposing perspectives
14:41sometimes interrogating them. What may
14:44distinguish medical humanities however
14:47is its practical orientation.
14:50The knowledge it produces does not
14:52remain abstract. It often bears directly
14:56on ethical care, professional formation,
14:59medical education, public health
15:01practice. So rather than giving it a
15:04very fixed kind of a definition,
15:07we can treat medical humanities as a
15:10dynamic field, one that gathers methods
15:14across the humanities and social
15:16sciences domain to examine medicine into
15:20practice, institution and cultural
15:23force.
15:25Now the problem of exclusivity and
15:31hierarchy is pretty much embedded in the
15:35medical humanities
15:37domain. Critics argue that the term can
15:41sound hierarchal
15:43because it may unintentionally center
15:46doctors while marginalizing nurses,
15:48dentists, public health workers and
15:51others. For this reason, several scholar
15:54proposed the term health humanities. A
15:56distinction that I want to kind of begin
16:00and end here. This course is all about
16:03medical humanities. I take up health
16:06issues but I do not deal with health
16:09humanities because that is a more
16:11inclusive term. Health humanities
16:14suggests that it attempts to place all
16:16health professionals on equal conceptual
16:20ground. So we see this impulse in
16:23journal titles such as the Cambridge
16:25quarterly of healthcare ethics which
16:27adopts a broader framing rather than
16:30medical ethics. In recent years figures
16:33such as Paul Crawford has actively
16:36advanced the intellectual and
16:38institutional case for health
16:39humanities. Similarly, Theresa Jones,
16:43Delis Weir, and Lester D. Friedman
16:45titled their 2014 collection, the health
16:49humanities reader, signaling this
16:51broader orientation. At the same time,
16:54some scholars retain the term medical
16:56humanities. Why?
16:59Partly because much of the existing
17:01scholarship still centers on medicine.
17:04Partly because scope matters. A given
17:07text or course may focus primarily on
17:09medicine even while acknowledging public
17:12health and non-alopathic traditions.
17:15Perhaps the more productive stance is
17:17not to treat the terminology as fixed
17:20but to remain alert to its politics. If
17:23we retain medical humanities, we do so
17:26critically aware of power hierarchy and
17:29professional dominance and prepared to
17:31examine these issues within the field
17:34itself. So to clarify the aims of
17:38medical humanities, it helps us to look
17:42at how the field has been
17:44conceptualized. Let us see here in
17:48medicine and the humanities theoretical
17:50and methodological issues. Rhyo Pin,
17:54Michael Leman and Anna Maria Wiljan
17:59identify a major shift in clinical
18:01medicine over the past 50 years. What do
18:04they observe? They observe that the
18:06biological approach alone cannot address
18:09the various human phenomena that
18:12physicians encounter in everyday
18:15practice. Now this marks a movement away
18:18from what you can term as medical
18:21reductionism towards medical holism.
18:25Pients are no longer viewed merely as
18:28diseased bodies. They are understood as
18:30persons embedded in relationships,
18:33histories and context. Several thinkers
18:36shaped this shift. You can see here we
18:41have George Angel who discussed
18:43biocsychosocial model. Eric Castle who
18:47talked about personhood and suffering.
18:49Edmund Pelgro and David Tomasa who
18:52discussed philosophy of medicine. And we
18:55have Christina Puchalski who discussed
18:57spiritual care. So medical humanities at
19:02that point of time started to face
19:04criticism and we find that by the 1960s
19:08students and reformers question the
19:10dominance of strictly biomedical
19:12curriculum. Therefore we will examine
19:14these goals critically and consider
19:17whether a fourth explicitly normal and
19:20political aim must also be acknowledged.
19:24So uh in 1980
19:27uh when George Angel challenged the
19:29operations of uh clinical medicine
19:32within a narrow biomedical frame, he
19:35proposed the biocschosocial framework.
19:39Now this framework uh insisted that
19:42clinical medicine is not only biological
19:45but also psychological and social. when
19:48I analyze the literary and cultural
19:50text, this is the model that I'm going
19:52to employ. So, you must read a little
19:55more uh on this before you
19:59uh come for the analysis say somewhere
20:01around week six or seven.
20:04Now, in his view, health and illness
20:07cannot be understood solely from
20:09laboratory data. They require attention
20:12to lived experiences and social context.
20:15In 1991, Eric Castle extended this move
20:19by distinguishing between pain and
20:21suffering. As he argued, bodies feel
20:24pain but persons suffer. This shift
20:28legitimized forms of data that biio
20:31medicine alone cannot capture and
20:34therefore the distinction between
20:36disease and illness further clarifies
20:38this bridge.
20:40Very suently I will talk about disease
20:43and illness. So disease refers to the
20:47biological pathology and illness refers
20:49to the lived experience. I will go about
20:53these two terms in detail in my lecture
20:56three where I discuss the key words to
20:58understand the medical humanities. Uh
21:02but other practices reinforce this
21:06bridge in which reading illness
21:08narratives and pathographies or watching
21:11films or theatrical representation of
21:14illness or studying visual art that
21:17depicts pain embodiment were seen as a
21:20model of recovery. But a final question
21:23remained open. What is that? Should
21:26medical humanities integrate science and
21:28the humanities into a unified framework
21:31or does it simply add humanities content
21:34onto a large scientific curriculum?
21:38For the time, medical educators assumed
21:42that teaching ethic courses would
21:44naturally strengthen ethical behavior.
21:47That assumption proved fragile. Jack
21:50Kulhan identifies several pressures that
21:53reshaped this conversation. First the
21:56expansion of expensive medical
21:58technologies and you will see that so
22:01many are listed here CT, MRI, high cost
22:05diagnostic and other tools as well. Now
22:10second patients express dissatisfaction
22:13because technology could prolong
22:15biological life while extending
22:17suffering. Third, the rise of
22:19commercialism altered the moral
22:22landscape of medicine. For profit,
22:24hospitals, managed care systems, and
22:27relationships with pharmaceutical and
22:29biotech companies introduced new and
22:31visible conflicts of interest. A
22:34profession, at least in principle, is
22:36grounded in altruism and fiduciary
22:39responsibility. Yet physicians now
22:42operate within institutional and
22:44economic pressures that complicate these
22:47ideals. Medical humanities responds by
22:50cultivating virtues, altruism, empathy,
22:54compassion, and by developing reflective
22:57and critical habits of mind. It also
23:00acknowledges a further dimension.
23:02Educating human physicians includes
23:05creating space for self-care. Without
23:08that compassion may erode under systemic
23:11strain. The question then is not simply
23:14whether the humanities make physician
23:16humane. It is how they help
23:19professionals navigate the modern
23:21complexity of the contemporary medicine.
23:24When we uh think of medical humanities
23:27as a function of moral critique, we find
23:30that recent global discussions on
23:33physician burnout and suicide, including
23:37reflections such as those by Liisa Prior
23:40and epidemiological studies like Abdul
23:43Aziz Aloima Atal expose deep stress
23:48within medical culture. Training demands
23:51near total commitment and yet
23:54institutional structures often fail to
23:56provide adequate psychological or
23:58structural support. A culture that
24:01valorizes perfectionism and grit may
24:04appear admirable but it also can conceal
24:08dysfunction. To become learned, one must
24:11also become critical and self-critical.
24:15medical humanities therefore extends
24:18beyond the cultivation of sympathy or
24:20empathy as some scholars put it. The
24:23field observes moral critique and
24:26political aspiration. Historically,
24:29medical humanities developed alongside
24:32patient rights movement of the 1960s and
24:351970s and remained attentive to how
24:38knowledge is produced, used, and
24:41distributed and whose interest it
24:43serves. In this sense, the field started
24:47by interrogating what is understood by
24:51humanizing medicine.
24:54If we step back, medical humanities can
24:57be described across three broad
25:00overlapping domains. One context, the
25:03other conceptual analysis and third is
25:06formation.
25:08So to study the context is to situate
25:11medicine historically, culturally,
25:14economically and politically. It asks
25:17how medicine is practiced in different
25:19systems. For example, under the National
25:23Health Service in the United Kingdom
25:25versus in the National Medical
25:27Commission in India, how are
25:31the differences? It asks whether the
25:33hypocritic oath
25:36emerged and whose interest it served. It
25:39asked how medieval Christianity shaped
25:42European understanding of disease and
25:44how Buddhist view of suffering inform
25:47ideas of health.
25:49Secondly, when we think of conceptual
25:51and critical analysis, what
25:53distinguishes disease from illness or
25:56curing from healing? What are the goals
25:58of medicine? Conceptual analysis often
26:01exposes instability.
26:04Conditions such as alcoholism or
26:06attention deficit hyperactivity disorder
26:09for instance may shift being framed as
26:11pathology and as forms of normal human
26:14variation. Third, we talk about medical
26:18humanities also becomes pedagogy. How
26:21professionals are shaped. What is now
26:23termed professional identity formation
26:26echoes older traditions of humanitas.
26:29The formation of persons who combine
26:32knowledge, compassion and action.
26:35Medicine in this view is not merely
26:37technical and physicians are not
26:39plumbers of the body. They are witness
26:42to suffering to flourishing and to their
26:45own moral limits.
26:47Finally, we come to the postcolonial
26:50context and how there is a narrative
26:53dislocation. But before that, a caution
26:56and on your screen
26:58as Euro Yangestron warns, medicine risks
27:03regressing to a purely instrumental
27:06biomedical baseline, choking the
27:09potential release of its metaphoric code
27:12as possibility knowledge. The expansion
27:15towards ethical, aesthetic, political
27:18and even transcendental dimensions does
27:21not weaken science.
27:23If we synthesize these strands, medical
27:25humanities emerges not as a decorative
27:28supplement to medicine but as a mode of
27:31inquiry that situates, clarifies,
27:34critiques and forms and in doing so it
27:37continuously asks what medicine is and
27:41what it ought to become. If we end where
27:45we began with narratives, we see that
27:47the person seeking care rarely seeks
27:50biology alone. Literary texts show
27:53individuals pursuing recognition,
27:56dignity, and alignment between treatment
27:58and their own moral worlds. Those worlds
28:01do not always conform to dominant
28:04western ethical standards. They may draw
28:06on practices labeled traditional, local,
28:10or even irrational.
28:12A postcolonial perspectives shifts the
28:15perspective. What does it do? It asks us
28:18to pause before accepting such labels.
28:22It questions who defines the standard,
28:25who decides what counts as legitimate
28:27knowledge, whose practices become
28:30central and whose are relegated to the
28:33margins. Medical humanities when
28:36situated critically asks how medicine
28:38looks when we take seriously multiple
28:41epistemologies, multiple moral
28:43vocabularies and multiple histories in a
28:47postcolonial frames. These strands
28:50converge. Medical humanities becomes a
28:53space where medicine is not only
28:56humanized but destabilized only to be
29:00re-imagined, reconceptualized and
29:03refigured.
29:05Thank you so much. In the next slide, we
29:08begin with the key terms to be used in
29:10medical humanities and follow it up with
29:13key theorists. Uh I'll see you in the
29:16next slide. Thank you so much.