Full transcript
0:04[music]
0:09[music]
0:20>> Hello everyone. I hope you're doing
0:22well. I welcome you to my course
0:24introduction to medical humanities.
0:26In the last unit we tried to map the
0:31historical trajectory of how we can
0:33divide the Indian health care
0:36alongside
0:38global health care and we looked into
0:41how the division can be made into four
0:44ways.
0:45We categorized it as indigenous, which
0:48is pre-colonial. We moved on to colonial
0:50followed by post-colonial and then the
0:53very recent COVID-19 pandemic as
0:56important timeline markers that decided
1:00or made
1:01the significant point in the health care
1:05practices of
1:06India. Now in this particular lecture,
1:09which is
1:10the
1:12last of the theoretical units I can say
1:15after which we will move to four units
1:18that will specifically talk about the
1:20literary and cinematic texts. What we
1:23are going to do is we are going to
1:25discuss
1:26the research methodology part of
1:29analysis. If you can see on your screen,
1:32my lecture 11 is titled analyzing data
1:35and its implications, methods and
1:38methodology. In the case of medical
1:40humanities, most of the time the data is
1:44qualitative.
1:46Unless sometimes you try to map it with
1:50the data that is already available. In
1:52fact, if you look at my research, you
1:55will find that in order to authenticate
1:59sometimes or map it sometimes with the
2:03original data that is available or
2:05anthropological data that is available,
2:07I have tried using or utilizing someone
2:12else's research which is empirical in
2:14nature along with what I have done which
2:17is very theoretical.
2:19Before I move on, I will quickly also
2:22talk about what I what you mean by
2:24methods and methodology. So methodology
2:27usually is a very broad term,
2:30the broader framework, the theoretical
2:32framework and methods are considered to
2:34be the tools and techniques which you
2:37use to
2:39uh
2:40align with the theoretical framework
2:42that you are talking about. Now in this
2:45case, the first lecture which is today's
2:47lecture, I will go ahead with the method
2:49part more and then follow it up with
2:52four lectures, one discussing
2:55reproductive justice, the other
2:57discussing ableism, the third talking
2:59about mental health, and then follow it
3:03up finally with something which is
3:05related to a kind of a mixed area. So
3:09this is precisely what I am going to do
3:12in
3:13this particular unit. Before I begin, uh
3:16let me take you through the overview of
3:19the slide which is here. I straight away
3:22move to what I want to say in terms of
3:25the introduction to this particular
3:27lecture.
3:28So
3:29the first question that we begin with in
3:33this particular unit which talks about
3:36how to analyze data and what are the
3:38implications of analyzing the data which
3:41is so qualitative in nature. In our
3:43case, it is literary and cinematic
3:45narratives, what is it that we will do?
3:48Now when you think of why narrative
3:51matters, we have been discussing this
3:54that there is socio-cultural economic
3:58context that shapes the biomedicine. And
4:01therefore, what narrative does to
4:03medical humanities is that it provides
4:06it with a context. It provides it with a
4:10thematic
4:12comprehension of the issue that we are
4:14dealing with.
4:15So, the first of the points that we can
4:18make here is that of how biomedicine
4:22prioritizes biological mechanisms and
4:25predictability, but what does humanities
4:28do? Humanities foregrounds culture,
4:32inequality, and belief. So, in this
4:34sense, without this broader perspective,
4:38the patients risk being reduced to what
4:40happens as the irrational or disordered
4:43other.
4:45Concepts such as reflective practice and
4:47self-awareness are connected to the idea
4:50of narrative medicine.
4:52Now,
4:53these
4:54concepts, these ideas, promote what has
4:57been called the narrative competence,
4:59and I have earlier mentioned also about
5:03narrative competence, which is ability
5:05to interpret patient stories.
5:07There was one experiment that happened
5:09in 1971. It's called the Stanford Prison
5:12Experiment, and in this particular
5:16experiment, ordinary individuals could
5:19adopt harmful behavior when placed in
5:22positions of authority within an
5:24institutional setting was assigned. What
5:26happened that participants were assigned
5:29the role of prison guards
5:31who began to mistreat those assigned as
5:33prisoners, even though the entire
5:36situation was simulated. Simulated as in
5:39imagined.
5:41Literature, philosophy, and cinema
5:43allows us to imagine scenarios that
5:46cannot easily be tested in scientific
5:48research. Finally, what is the main
5:51claim that you know, narrative examines
5:54questions of life extension and meaning.
5:57What does this mean that
5:59there is a narrative and they are
6:02designed to construct, explore, and
6:05reflect on human narratives with broader
6:09dimensions that you can think about in
6:11the field of medical humanities.
6:14At some point of time, I spoke about
6:17interdisciplinary and I spoke about deep
6:19entanglement. I combine both here
6:22because like I mentioned in the
6:24introduction of this lecture that uh
6:26sometimes while you are analyzing the
6:29qualitative data, which is uh the short
6:31stories or the novels or the memoirs or
6:35media, uh any form of case study that
6:38you are choosing, there is a possibility
6:41that you make it interdisciplinary by
6:45fusing it with
6:47data that is available in different
6:49other fields. So, while your theme
6:52remains the same and it's all catering
6:54to the theoretical framework you have
6:56adopted to and the content that you are
6:59kind of analyzing, but at the same time,
7:02this kind of interdisciplinary edge
7:05gives your research or gives your
7:07reading a more vantage point. So, if you
7:10look at the uh I mean, important debate
7:14in medical humanities, it concerns how
7:17different disciplines should actually
7:19work together.
7:21Scholars such as Evans H. Martin and
7:24Jane Macnaughton argued that
7:27interdisciplinary should imply that
7:29scholars move beyond their disciplinary
7:31frameworks and build perspectives that
7:34combines methods and insights from
7:37different fields. And it is also
7:39necessary because illness cannot be
7:42separated into biological,
7:44psychological, and social parts. Now, if
7:48you look at your screen, it I have made
7:50a kind of a chart to show you why
7:52interdisciplinary is necessary because
7:54even if we think in terms of illness or
7:57we think of it as a patient concerned
8:00matter, we will find that patients also
8:03exist within emotional, cultural, and
8:06social networks. So, combining these two
8:09parts perspectives become important in
8:12the case of medical humanities because
8:15there has to be an integration that
8:18should happen. The term assumes
8:21disciplines are stable separate units,
8:23and therefore, when you look at the
8:27narratives, you have to think of it in
8:30one combination or the other.
8:33Additionally, when you look at the
8:36problem of interdisciplinarity,
8:39scholars began using concept of
8:41entanglement.
8:43In an essay titled Living in a
8:45post-humanist material world, Karen
8:47Barad explains entanglement using a
8:50famous thought experiment from quantum
8:53physics. It's called Schrödinger's cat.
8:56In this experiment, what happens is that
8:58a cat is placed and cat is placed inside
9:02a sealed box. You can see it here.
9:04And then, what happens is that the box
9:07also contains a radioactive atom that
9:10has 50% chance of decaying within 1
9:13hour.
9:14If the atom decays, a mechanism breaks a
9:16flask of poison, which kills the cat. If
9:19it does not decay, the cat remains
9:21alive. Until the box is opened, however,
9:24we cannot know the outcome. Now, quantum
9:26theory suggests something unusual here.
9:29The cat cannot simply be described as
9:31alive or dead before observation.
9:34Instead, the system is described by an
9:36equation that combines both possibility.
9:39Therefore, the
9:41situation of cat is actually
9:44indeterminate. What will happen? We just
9:46do not know. So, what you see as
9:49something which is clearly bounded
9:53entity, which is a cat, for instance,
9:55does not exist independently of the
9:58process that defines and measure it. The
10:00boundaries that allows us to say this is
10:02the cat, this is its life state, only
10:05emerges through specific interactions or
10:08intra-action. What does this mean? That
10:11entities become distinct through
10:12relations that constitute them. That you
10:15are a product of the system that you are
10:19coming from.
10:20So, in the case of this cat experiment
10:23also, you cannot just be very sure of
10:26what is going to happen. Similarly, the
10:29implication of this experiment in
10:32medical humanities is that when we talk
10:34about either patients, disease, body,
10:37life, they are not very stable objects.
10:40In fact, they define and decide their
10:43position. They find their position,
10:45rather, in terms of different other,
10:49you know, the way in which the
10:51incubation is kind of taking place. They
10:53emerge within technologies,
10:55institutions, language, and culture
10:58broadly, but then there are more aspects
11:01that we can talk about.
11:04The first reading method that I can talk
11:07about in medical humanities while you're
11:09dealing with either the literary text or
11:12the cinematic text or maybe an
11:14advertisement,
11:15uh,
11:16any form of, uh,
11:19method that you have chosen to analyze,
11:21you will find close reading as the most
11:24useful form of reading. Now, in close
11:28reading, what do you do? It is a core
11:31method of literary studies, often
11:34described as the central method of
11:37literary analysis. What happens in
11:39close? So, close is close, you know? So,
11:42though it's as physically close, but
11:44what you have to do is you have to read
11:47the text minutely. What does this mean?
11:49I will come to it. Now, before I come to
11:52what close reading means, let me quickly
11:54talk about where it originated and what
11:57it is like. So, the origins are in new
12:00criticism or some of the famous
12:02theorists who discussed close reading
12:05methods are John Crowe Ransom, Cleanth
12:08Brooks, Robert Penn Warren. Most of the
12:10people who are either from the
12:12discipline of linguistics or language or
12:14ELT or literature or maybe any of these,
12:17I mean, disciplines that require you to
12:19read text from literary and cinematic
12:22narratives will know this method. But,
12:25for others also, it's a very useful
12:27method of examination and analysis. So,
12:31in close reading, what do you analyze?
12:34You not only look at You must have read
12:37of the phrase in between lines. So,
12:39close reading is also like that. It is
12:41like reading in between lines, but in a
12:44very structured kind of a way where you
12:47have language, structure, imagery, tone,
12:52irony, rhythm. And when you take into
12:55account one or the other or more,
12:59there is a meaning that emerges from the
13:01textual detail. So, something which you
13:03have read just on the basis of
13:05superficial language might appear to you
13:08something else, but when you start
13:10looking into the imagery or anything
13:13else, you find more meaning. Like when I
13:16was reading
13:18a particular novel called Jhumpa
13:19Lahiri's The Namesake, the detailing of
13:22the kitchen stayed in my mind, you know?
13:24She talks about blue cupboard. So,
13:27Jhumpa Lahiri in her novel Namesake
13:29talks about a blue cupboard in the
13:31kitchen. And somehow, even when the
13:33novel was complete, I thought of that
13:37particular
13:38uh cupboard. So, you know,
13:40these little detailings that you come
13:43across uh especially in the field of
13:45medical humanities becomes important
13:47because image speaks for the person as
13:51well. Speaks for the narrative. Speaks
13:53for the context. Hence, when you come
13:56across uh the cases of
13:59analysis, there is a productive
14:02attentiveness to language that is
14:03required because it is where the
14:06interplay of saying and meaning is
14:09happening.
14:10Not necessarily what is written is what
14:12is meant. I will give you some examples
14:14in subsequent slides. Why it is uh
14:17important? Because in medical ideas,
14:20they are circulated through novels,
14:22memoirs, narratives, films. And all of
14:26them represent the one that we analyze,
14:29represent illness, bodies, doctors, and
14:32care in a broader context. And
14:34therefore, close reading is a
14:36appropriate method of analysis in
14:38humanities.
14:41The second uh is
14:44how we look for close reading. I'll just
14:48give you some more examples. One example
14:51from Armadale by Wilkie Collins. And
14:54also talk about what is the analytical
14:56process.
14:58Now, I spoke about methodology and
15:01methods. So, this is now how do you go
15:03about it? The method of uh close
15:06reading. So, you have to read the
15:09passage multiple times.
15:11Identify what are your keywords and
15:14phrases.
15:15Examine denotation. Denotation is the
15:18literal meaning. What is the
15:20literal meaning, actual meaning of the
15:22word given.
15:24But you also think about connotations,
15:28the cultural associations. Like when
15:30somebody says a particular word,
15:33you know that there can be more meaning
15:35to that, just as you it happens in our
15:38day-to-day life. In close reading too,
15:41we have to look we have to understand
15:43beyond what language says. And connect
15:46it to larger cultural meanings. What
15:49does this mean? This mean two things.
15:52Our understanding of a particular word
15:56depends on the culture we belong to,
15:59number one.
16:01And the second, each culture will assign
16:04a different kind of meaning to a
16:06particular kind of language set. So,
16:09these two things we have to keep in
16:11mind, and that is why even in the case
16:14of India, some words you will think of
16:17in different language and find them
16:19funny. In your own language, maybe it's
16:21very serious. So, there can be huge
16:23amount, and that is one big area in
16:25translation studies even now. But
16:28those are things that you have to keep
16:30in mind while you are reading a text in
16:32the case of medical humanities, because
16:35it is about disease, illness. It runs
16:37the risk of being misjudged. So, you
16:39have to be very careful.
16:42Let us take this example, Armadale.
16:45What happens in this particular
16:47novel? You will find that
16:50cabinet of poisons used in medicine. So,
16:53it says "Rows of little shabby bottles
16:56containing the poisons used in
16:58medicine."
16:59In this,
17:00it reveals the broader tension. What is
17:03poison? Poison is medicine. And you will
17:06find its references in Victorian
17:08culture. Why does it matter? It matters
17:11because it links language to social
17:13ideas about medicine. So, you see, when
17:17we discussed language as metaphor, you
17:19find that it's the poison is also
17:23connoting something else, which is
17:25medicine.
17:26It explores themes of trust, risk,
17:29professional authority.
17:31What is the limitation of this
17:33understanding? That in earlier,
17:36uh you know, new criticism, they ignored
17:38the historical context. And like I said,
17:41when we are moving towards human rights
17:43model, where health is a human right, we
17:46have to encompass also the historical
17:49trajectory. And that is why when I took
17:52up the last unit, I mentioned very
17:56clearly that we are going towards
17:58right-based model, which is a major
18:00shift in the understanding of how
18:02humanities or humanities has made an
18:04impact on the medical science.
18:07In that sense, uh medical humanities
18:10combines close reading with historical
18:12and cultural analysis, something that we
18:14have emphasizing on over a period of
18:17time now.
18:19Now, uh
18:20how does
18:22language then becomes important? We have
18:25We will discuss it all the more, but
18:26here I take a couple of examples. If you
18:29look at metaphors, which is dependent on
18:32language mostly, it shapes medical
18:34meaning. Why? Because it's not just a
18:37language, but ethical interpretation and
18:40communication.
18:42It talks more than what is represented.
18:45And it also gives a
18:48theoretical insight. Why? Because
18:50sometimes when these metaphors are
18:53there, there is a gap sometimes that
18:55language can create. These metaphors
18:58fill that gap. I'll explain you quickly
19:01when I'm giving you the example. Why
19:03does it matter? Because there are
19:06metaphors influencing clinical
19:08decisions, ethics, and power relations
19:11between doctors and families. Let us
19:13take this example. It is an example from
19:16Sheryl Mattingly's uh research uh and
19:19the case study is NICU ethnography.
19:22Now, in this particular case, what
19:24happened uh that there is a infant,
19:27Darlena, and she is having spina bifida,
19:31and many surgeries have happened, and
19:34the infant is not in a good state to
19:37survive. And therefore, there is a
19:39debate that is happening between the
19:42doctors whether they should take a DNR
19:45decision. So, uh when the nurse comes to
19:49the family uh and says this to the
19:51mother, and I quote, "Your daughter will
19:54be a vegetable."
19:56So, what does this mean? The vegetable
19:58here means that she will be in a
20:01vegetative state. Now, this is a
20:03metaphor which is recurrently used in
20:05medicine. This means that the person
20:07will not be in a state of conscious
20:09cognition.
20:11The mother, on the other hand,
20:13when, you know, the nurse tells that uh
20:16the daughter will be a vegetable, she
20:18responds, "We will be her garden. She
20:21will grow."
20:22Now,
20:24the same metaphor, the same
20:27interpretation,
20:28which in the mind of the nurse or in the
20:32field of biomedicine is a state of no
20:36life, in the case of mother, it becomes
20:39a symbol of life. So, there is two
20:41contrasting image that we have to think
20:43about, and
20:45there is where the the cultural context
20:48also comes into play. So, they the nurse
20:51was speaking from a point of view in
20:53which the clinical space is used this
20:56metaphor, but for the mother, the moment
20:58she came to know that it's a vegetable,
21:01and she thinks of it as having life, and
21:04how she can nurture her daughter, and
21:06she'll grow is what she thinks of.
21:09How does this metaphor analysis
21:10framework work? Two things. A familiar
21:13concept
21:15is the source domain where the there are
21:17plants, the target domain is human
21:19condition, illness. So, the vegetable is
21:23the source of reflecting a human
21:26condition. A conceptual metaphor could
21:29be people are plants. And therefore, if
21:32you think of it in the interpretative
21:34insight, you find the same metaphor with
21:37different meaning. So, you see the
21:39vegetable at the same time signified,
21:43you know, life. And in other metaphor,
21:45it did not. So, if you have read at some
21:48point of time deconstruction theory, you
21:51will find the whole importance of what
21:54signifies the signifier and the
21:56signified method also. I think maybe you
21:58can just
22:00search for these terms. You will find
22:02more meaning out of the signifier
22:04signified. Clinical view is that there
22:06is lack of cognition, and parental view
22:09is of growth and care. So, so the same
22:11kind of metaphor finds different meaning
22:15for two parties is what we come across
22:17here.
22:19Why is metaphor analysis important in
22:21medical humanities? Because they can
22:22explain complex medical and biomedical
22:25process.
22:27There are very common examples like
22:29mitochondria is energy factory, cancer
22:32is battle, drugs as magic bullets. So,
22:35you know, there are quite a few metaphor
22:38that you can think of. In fact, what why
22:40don't you do one thing? After this class
22:43is over, maybe you can jot down 25 words
22:47that are used in medical science, but
22:50they they are written differently, but
22:52they mean differently. So, I give you
22:54three examples here. Maybe you can have
22:56more.
22:57Now, what do they do? They shape patient
22:59and societal understanding of illness
23:02and treatment. So, you know, any day if
23:05somebody has died, it is easier for us
23:08to say he's passed away or she's passed
23:10away than saying that the person is
23:13dead. So, you know, you you
23:16around disease, you use many words that
23:18are there.
23:21Now, when you think of uh clinical
23:23communication and medical training,
23:26these words become handy and they reveal
23:28embedded assumptions. Uh say for
23:31example, gendered language in biology
23:33textbooks. Now, this is a quick metaphor
23:37uh usage table I can think of. Uh pretty
23:41much self-explanatory. You identify the
23:43metaphor. You map the source and target
23:46domains. You examine the entailments,
23:49which means the implications. You
23:51investigate the cultural context. You
23:54interpret the metaphor within its
23:56broader narrative meaning. And what does
23:57it do? It develops a critical reading.
24:01Now, uh when you think of limits and
24:04challenges of metaphor analysis, I speak
24:07about quite a few things here that
24:09metaphors are context-dependent, which
24:11means that a context is required. There
24:14is no universal rule for language
24:17because it can depend on different kind
24:20of language sets, the source language
24:22set.
24:23The interpretations can be provisional,
24:25so which means that even within one
24:27culture, you can find different set of
24:29meanings
24:31of the same word and
24:34depending on their disciplines. And
24:37the cultural and historical framework is
24:39also to be taken care of when you are
24:42interpreting a meaning. Like say for
24:44example, uh social distancing uh was not
24:47a word in our dictionary before the
24:49COVID-19 pandemic hit. Now,
24:52most of us know about it. Uh and of
24:54course, in all this, inclusivity plays a
24:57very vital role. Why stories matter in
25:00moral decision-making, you will find
25:02that there is
25:04a gap between traditional bioethics and
25:06narrative ethics.
25:07What does traditional bioethics do? It
25:10talks about what decision. Broadly
25:13speaking, it it discusses what is the
25:16decision to be made, which means what is
25:18right and what is wrong. However, in the
25:21narrative ethics, the shift is not
25:24towards what decision should be made. It
25:26is like how did you arrive at this
25:28decision?
25:29This means that the moral problems are
25:33embedded within lived stories, not
25:35abstract principles, and therefore you
25:38think of
25:40the dilemmas of this decision-making
25:43through family history, illness
25:45trajectory, institutional pressures,
25:48emotions. And all this
25:51kind of move the narrative or move the
25:54decision towards what is ethical and
25:57what is not. So, sometimes it can happen
25:59that this is ethical for someone, but
26:01the same situation for somebody else
26:03might be non-ethical.
26:06How narrative ethics work? There are
26:08four points that you have to take into
26:10consideration here,
26:12which are also four key elements of
26:14storytelling. I will not go much into
26:16the detail because I will eventually
26:18take it up in the next unit.
26:21You talk about voice, you talk about
26:24character, you discuss plot, and finally
26:26what is going to happen in terms of
26:28resolution.
26:30Quickly, life writing is extremely
26:34important in medical humanities because
26:37you identify the corpus of life writing
26:39text. Now, life writing texts
26:42claim certain kind of authenticity. So,
26:45you must understand that when you
26:47formulate research questions on illness
26:50identity or practice, you have to review
26:52the existing scholarship as well. You
26:55select and closely read passages,
26:57analyze patterns, themes, compare
26:58multiple narrative, and apply any
27:01theoretical lens that you talk about. In
27:03life writing, an important concept is
27:06pathography that you must understand.
27:08What does pathography do? It is
27:10autobiographical narratives of illness,
27:13treatment, and death. And just by
27:16narrating if I can if I can talk about
27:18it in simple terms, what happens? By
27:21writing, there is a
27:24sense of therapy that is happening. That
27:27is what pathography primarily in an easy
27:30language means. It draws on cultural
27:33metaphors and shared storytelling form.
27:35There is a sense of sharing that
27:37happens, and that is what primarily
27:39happens. And that is why you will see
27:41that many of the life writing texts are
27:45used in medical humanities. In fact,
27:46when I move on to my unit four to unit
27:50eight, I will analyze quite a few
27:52memoirs to explicate what I am trying to
27:55say within the scope of medical
27:57humanities.
27:59Films I'm analyzing quite a few films in
28:03the later course of this particular
28:05course.
28:06So, films become important because when
28:09you talk about
28:11medicine, they operate within visual
28:13culture, and film captures and shapes
28:17this. So, what does film do? It allows
28:20you
28:21to see how a particular culture reflects
28:25that particular medicine. And how
28:28medicine looks at patients. So, these
28:30two, the medical gaze is given
28:32importance, and in this perspective,
28:35cinema constructs ways of
28:38seeing a particular disease via camera
28:41angles, framing, editing perspectives,
28:44analyzing these film or
28:48these health scapes
28:50is an intersection of medical knowledge,
28:52technology, media, and public anxiety.
28:55So, all this comes together when we
28:57think of how films become a tool to
29:01analyze the culture of medicine.
29:05You have to think of
29:07when you read a film, you have to think
29:09of analyzing the language, which means
29:12the formal elements of the film. You
29:14have narrative, you have cinematography,
29:17you have mise-en-scène, you have editing
29:19and sound.
29:21You have a five-step framework where you
29:23annotate scenes.
29:25Again, you know, annotation I spoke the
29:28literary meaning.
29:30The definition of the research focus,
29:32which means what is going to be your
29:34theoretical framework. The close reading
29:36of scenes, you pick up scenes that are
29:38important to your narrative. The big
29:40picture analysis, broader overarching
29:42narrative. And then, of course,
29:45the contextual interpretation.
29:48That is where I will end, and I think I
29:51will take it up
29:53the themes that we will be analyzing in
29:55the next class. Thank you.