Full transcript
0:04[music]
0:09[music]
0:18Hello everyone. I welcome you to my NPTL
0:21course introduction to medical
0:22humanities. We have come a long way. We
0:25are almost in the final lectures of our
0:29course and today uh is lecture 36 in
0:33which I am going to talk about
0:35humanizing the medical discourse. Now
0:37the word humanizing is not something
0:39which is unfamiliar to the current
0:42generation. You must have been reading
0:44about humanizing in the context of AI
0:48very often. But what happens when the
0:51discourse of humanizing penetrates
0:53within the medical humanities discourse?
0:55How does it function? I take up one
0:58short story to analyze. But before that
1:00let me introduce you to what I am going
1:02to talk about today. So I will set up
1:05the context and background and discuss
1:07what is medical discourse. Follow it up
1:10with the title short story of
1:13Jumpalahiri's interpreter of malades and
1:16take up the key character Mr. Kapasi who
1:19works as an interpreter for analyzing
1:22the discourse of medical in the context
1:24of India. I take up silence. I take up
1:27the space of diaspora. I talk about
1:30guilt and pain and I follow it up with
1:33the doctor patient relationship and then
1:36the conclusion.
1:38Now before I begin with
1:43analyzing the interpreter of malades
1:45which is the title short story of
1:46Jupalahari's collection published in
1:491999.
1:51It's important that we discuss a little
1:53bit about her because she is one of the
1:56diasporic writers I have chosen for the
1:59analysis. Now the issue with diaspora is
2:05that it looks
2:07at a gaze which is in between space. So
2:13uh if you look at Lahiri who was born in
2:161967
2:18raised in Rhode Island, USA and she her
2:21parents were Bengali and her debut
2:23collection was interpreter of malades in
2:2599. It won her two awards pulitzer and
2:29pen. her very famous novel the namesake
2:33dealing with the issues of two or more
2:36names in the context of India and how
2:40this gets problematic in the context of
2:42the west where there is only one first
2:44name and uh and a last name how naming
2:49becomes a politicized identity it's a
2:52very beautiful very interesting uh novel
2:54that you can read or there is a film by
2:57mira based on the book you can also see
2:59that and we unaccustomed. But let me
3:02come to what is my primary uh discussion
3:05today uh which is on the interpreter of
3:08malades and decode what is important in
3:13the writings of leri that we should take
3:15up. So first and foremost, like I said
3:18earlier, her space is in between the
3:22native world and the world that she has
3:25inhabited.
3:27Despite being born in America,
3:30there was so much of India that was
3:32present in her home. And
3:36while it was present in her home, it
3:38also occupied her mind. And therefore
3:41when we read her writings you will find
3:45her
3:46focusing on Indian themes. This is one
3:49such theme. This particular short story
3:52addresses that kind of a gap.
3:55So like I mentioned earlier she lives
3:57between languages between cultural
4:00expectations between medical and folk
4:03understandings of the body. considering
4:06that body is an important contributor to
4:09the making of the identity and that
4:13identity gets constituted by language,
4:16culture, tradition, many other things.
4:19So she delves into those in in between
4:23spaces
4:26in terms of what is medical discourse.
4:29There are two points that I want to make
4:31here.
4:33Medical discourse primarily talks about
4:36how do we restore the speaking subject
4:40and
4:41how does the hierarchy of patient
4:47doctor relationship work. So when we
4:51talk about the discourse
4:53the setup of patient doctor relationship
4:57is central to how the hierarchy takes
5:00place. Now when you think about that
5:03setup,
5:05the language of the clinic is
5:09like diagnosis, symptom, prognosis,
5:13very structured, very scientific and
5:16therefore there is nothing neutral,
5:20nothing customizing, nothing personal
5:24or let me put it that way, nothing
5:26subjective about the discourse that's
5:29happening.
5:32The physician speaks, the patient is
5:35spoken about and in this process the
5:40words of the physician or the doctor
5:44becomes more powerful.
5:47Now in the medical discourse this
5:50hierarchy is deconstructed
5:53and reconstructed to find the subject of
5:59the patient who speaking
6:03also at the center.
6:06So you find that the position
6:10is
6:12deconstructed
6:14to make a more meaningful discourse out
6:17of that medical setup.
6:20So there is a clinical language
6:23for all kinds of metaphors, silence,
6:26cultural idom, grief, guilt, all those
6:30things. So when a patient
6:33narrates
6:34the story of his or her illness or their
6:39illness,
6:41they may not be in the clinical language
6:44and they can be in terms of all these
6:47things that I talked about.
6:50While words are important sometimes just
6:53the silence. So if you remember yourself
6:57maybe uh a pain abdomen, you just shrunk
7:03with that pain abdomen. It doesn't have
7:05words possibly, but that shrinking is
7:08the language. So when you curl up with
7:11pain abdomen on your bed,
7:14even in the absence of words, you have
7:17communicated that your pain is enormous.
7:21So in the discourse of medical or what
7:25you term as medical discourse you find
7:28there are more ways of telling
7:31than just what clinicians can say and
7:35that's what we analyze through the
7:39interpreter of malades.
7:42Now when I had read this short story
7:45long long back,
7:48I think when it came, I had not imagined
7:51that 26 years later I will be taking up
7:55in a medical humanities class. But even
7:58when I had read it 26 years back, I knew
8:01there was something more about this
8:03short story, this had something more to
8:07tell. I did not know about the scope and
8:11the area and the field of medical
8:13humanities then. But over a course of
8:16time when I started teaching medical
8:18humanities, when I started researching
8:20in medical humanities, I found that I
8:23was going back to this short story again
8:26and again whenever the Indian context
8:29came into my mind. And therefore I
8:32thought in week eight discussing this
8:34short story with a very customized
8:38Indian socioultural background would be
8:42a good idea for the matter. Let me begin
8:44then with the title itself. Now the
8:47title is called interpreter.
8:50So who is an interpreter? It's a very
8:52professional
8:54kind of a designation. An interpreter
8:57translates languages.
9:00In India, it's very important. We have
9:04so many languages, so many dialects. And
9:09to build empathy,
9:12linguistic knowledge is must. And
9:15therefore sometimes
9:18when the doctor is unaware of the
9:22language in which
9:25they are placed
9:26or knows little about it, there is an
9:30interpretator required.
9:32Mr. Kapasi who is who the protagonist of
9:35this short story is an interpretator and
9:39he interprets malades.
9:42Now when we think of maladies they are
9:46usually stories of illness and suffering
9:50mostly embedded with feelings of grief,
9:55loneliness, guilt and dislocation.
10:01So
10:03what it means is that it interprets
10:07suffering, loneliness, guilt,
10:11dislocation and many such issues.
10:15This means that in the absence of formal
10:19medicine being devoid of
10:23a metaphor that can reflect all these
10:27emotions.
10:29How do you go about I have chosen an
10:32exerpt from the short story that reflect
10:34this phenomena. It says he found nothing
10:39noble in interpreting people's maladies.
10:42Aciduously translating the symptoms of
10:45so many swollen bones, countless cramps
10:48of bellies and bowels, spots on people's
10:51palm that changed color, shape or size.
10:55So,
10:57Lahi writes that there was nothing very
11:00significant about his job because he was
11:04just interpreting
11:06whatever the malades of the people were
11:10and they could be anything. It could be
11:12a symptom, it could be a feeling, it
11:15could be a changed color. So he would
11:20basically interpret
11:22the melodies in terms of its linguistic
11:27aspect.
11:29But there is more to the short story.
11:32But before that let us focus on these
11:34three characters. There is Mr. Das, Mrs.
11:36Das and Mr. Kapasi.
11:39Now the short story
11:42has a plot in which Mr. and Mrs. Das an
11:46American couple have come to India and
11:48they have hired Mr. Kapasi
11:51as their taxi driver or and a tourist
11:54guide and they are going to Sun Temple
11:57in Kon Odisha.
12:00Now on their way
12:03Mrs. Das gets interested in knowing as
12:08to what Mr. Kapasi does just to strike a
12:11conversation. She asks him what is what
12:13does he do and he tells her that he's an
12:18interpreter of malades.
12:20Basically he goes on to describe
12:24but Mrs. Das
12:27thinks of this job as very fascinating
12:30because this is in literal translation.
12:34This is interpreter of malades.
12:37Whereas if you look at more symbolic
12:40aspect of it, you will find that it is
12:43just an so interpretation of the
12:44language of the malades and not the
12:46malades.
12:48So
12:50Mrs. Das in that moment confides that
12:54the third child she has is not of Mr.
12:58Das
13:00and she tells him to find probably a
13:06cure for the guilt she has been with and
13:12that is the whole story about how does
13:15as to what Mr. Kapasi perceives as his
13:18job to what Mrs. Das interprets it to
13:22be. The gap between that is what this
13:25short story is about.
13:28Let us take how
13:31this interpretation
13:34gets problematic or how Lahari
13:37problematizes this interpretation.
13:40I take an excerpt when Mrs. Das talks to
13:43him to detail upon
13:47what his job is. This is what he says.
13:50The other day, a man came with a pain in
13:52his throat. He complained that he felt
13:56as if there were long pieces of straw
13:59stuck in his throat. When I told the
14:02doctor, he was able to prescribe the
14:05proper medication.
14:08Look at the
14:11metaphor here. Long pieces of straw.
14:16Now in clinical space
14:20this long pieces of straw stuck in the
14:23throat
14:26has no meaning.
14:29But in metaphorical understanding of it
14:32it does. So how does that work? Metaphor
14:37becomes the diagnosis. So when the
14:41patient says that there is straw stuck
14:43in the throat, Mr. Kapasi is quick
14:47enough to understand that it is perhaps
14:52a sore throat or a fngitis something
14:55like that. So what he does is he
14:57translate embodied metaphor into medical
15:00language a practice narrative medicine
15:03calls close listening. So if you listen
15:08to the word said there is more that than
15:12you can interpret. So when you say
15:16or not feeling well
15:20in all languages you have
15:24a phrase which which can be like this
15:29and it can ultimately lead to anything.
15:33But only a person in that clinical
15:37setup, if that person employs close
15:41listening, can decode what these phrases
15:45can mean in different context for
15:48different people through their
15:50narration. For Mr. Kapasi, it was also a
15:54responsibility
15:56to bridge that gap between the patient
15:59and the doctor. Here he was the
16:02interpreter of the language but also the
16:06interpreter of the malades.
16:09Now when I was discussing in the last
16:12week about doctor patient relationship
16:14if you remember I spoke about trust
16:17empathy of trust and I said the entire
16:20system
16:23will collapse if there is no trust
16:25building exercise because doctor patient
16:29relationship is primarily about the leap
16:33of faith you give.
16:36So in the absence of that trust
16:40one can't be vulnerable enough to
16:43discuss the maladies of the body if I
16:46can use that word here. So Mrs. Daz
16:49notes and I quote you could tell the
16:53doctor that the pain felt like a burning
16:56not straw. The patient would never know
16:59what you had told the doctor and the
17:02doctor wouldn't know that you had told
17:04the wrong thing. It's a big
17:07responsibility.
17:09So while for Mr. Kapasi this is a
17:13regular job in fact a job which he
17:16doesn't even appreciate getting such
17:18kind of a validation in which his
17:22profession is
17:24romanticized to the extent where it's a
17:27big responsibility he he doesn't know
17:30how to kind of go about it and you can
17:33clearly see how Lahari chooses the words
17:37in the short story to explain the
17:43satisfaction he's having through the
17:45validation that is coming for his job
17:49and finally the language that gaps as
17:54illness. So
17:57you must be knowing that unlike many
17:59other jobs in the profession of a doctor
18:03placement is prioritized in the
18:05cultural, linguistic and social context
18:09they are familiar with.
18:13So in case of this setup the doctor
18:17cannot speak Gujarati
18:19and the patients can't speak the
18:22doctor's language.
18:24And therefore language barrier is itself
18:28a pathology that kabasi must heal.
18:32In my communication class at IIT Patna,
18:36when some students ask me as to how they
18:41can improve on their English language, I
18:44often emphasize the fact that in case of
18:47not only English language but any
18:50language if you want to learn, you have
18:52to forget that you know any other
18:54language but then that
18:57is the basic premise from where you have
19:00to begin And
19:05that happens also in the medical
19:07discourse. So here you will find that
19:11Mr. Kapasi has huge responsibility
19:15of interpreting
19:17what is the symptoms of the patients
19:20because there is a language barrier that
19:23exists between the doctor and the
19:25patient and hence his role becomes
19:29critical. He's not just anyone. He's the
19:33clinical agent because he's interpreting
19:36what is said by the patients.
19:40So there is uh this confession scene
19:42like I said Mrs. Das tells him
19:46Mr. capaci the third child is not her
19:50husband's and that scene is
19:55basically the focus point of the entire
19:57short story the interpreter of malades
20:01and I quote from the text for 8 years on
20:04your screen everyone for 8 years I
20:08haven't been able to express this to
20:10anybody I was hoping you could tell me
20:14feel better say the right thing suggest
20:18some kind of remedy. So
20:22when Laheri
20:25puts word into the mouth of Mrs. Das you
20:31feel that there is certain kind of
20:33urgency there is certain kind of guilt
20:37there is certain kind of a mixed emotion
20:42that is not just about the day she meets
20:44Mr. Kapazi
20:46and it is also not about the child
20:50completely.
20:51It's about many moments that she has
20:54lived with Mr. Das earlier.
20:57How she has
20:59thought about her marriage, her family,
21:03her children. So there are many things
21:05into that which you can read and
21:08simulate through this lines.
21:12She's looking for
21:14a remedy,
21:17a clinical term. But what happens?
21:22The question that Mr. Kapasi
21:27does in return
21:31is not what she's expecting because
21:32she's expecting a remedy. But in the
21:35diet of patient doctor relationship
21:40kapasi is not trained for that. So he
21:43asks is it really pain you feel Mrs. Das
21:46or is it guilt?
21:49And then Mrs. Das just doesn't say
21:52anything. Some certain knowledge seemed
21:54to pass before her eyes and she stopped.
21:58In that moment in which Mr. Kapasi asks
22:02Mrs. is asked this question. She knows
22:05there is something a miss. She just
22:09you know couldn't
22:12give in more. She holds back
22:15and that is where
22:20the conversation which was
22:22so much more than what Mr. Kapasi was
22:26interpreting
22:28dilutes itself
22:31because if you look at how trajectory
22:33takes place,
22:35Mrs. Das is treating Mr. Kapasi like a
22:38physician
22:40expecting some kind of diagnosis, some
22:43kind of remedy, some kind of cure.
22:46But that doesn't happen because
22:51narratives of illness
22:54serve several functions
22:56in this case
22:58because Mr. Kapasi is just an
23:01interpreter
23:03and not the physician or not the
23:06clinician or somebody who's not trained
23:09to understand
23:11the issue that she's trying to raise may
23:14not
23:16respond the way she wanted.
23:19I had discussed the narratives of
23:21illness earlier as well but here I
23:24thought it would be appropriate to
23:27recapitulate it once again where
23:30narratives function as restitution
23:34in this case Mrs. Das wants to restitute
23:38her
23:39previous
23:41space where there was no guilt perhaps
23:46no uh feeling of loss or
23:50whatever she was she's trying to say
23:53there are chaos narratives
23:56so when you talk about those gaps in
23:59between
24:01the patient Mr. Capaci interpreting and
24:04the doctor when you imagine that those
24:06set up that's a chaos narrative and then
24:09there are quest narratives where when
24:12you narrate you they are meaning making
24:15process for yourself nobody else Arthur
24:18Frank in the wounded storyteller talks
24:20about it that how these narratives are
24:23not just narratives alone they are meant
24:28for something they have a purpose and
24:31that is
24:32when Mr. Kapasi questions that
24:37this particular question is it really
24:39pain you feel Mrs. Das or is it guilt
24:42that question
24:46fails because there is no therapeutic
24:48relationship which has been established
24:51between Mr. Kapasi and Mrs. us. There is
24:54no
24:56relationship over there. There is no
24:58empathy of trust. If you remember what I
25:01discussed in the last week and therefore
25:06even the interpretation
25:09both of them have towards the profession
25:12has gap.
25:15In case of uh interpreter of maladies,
25:18we also find silence playing a larger
25:21role as language. And how? Because Mr.
25:26Kapasi's wife never asked him about the
25:29patients. She was
25:32according to the short story not
25:34interested. But this doesn't mean like
25:37that. Perhaps she was not interested
25:41in the way
25:43Mrs. Das was thinking of that profession
25:47because of the different cultural setups
25:49they came from. They were interpreting
25:52the role of an interpretator
25:55in differently.
25:57So
25:59I take up an excerpt from the text. It
26:01says if ever she referred to his
26:04position, she used the phrase doctor's
26:08assistant as if the process of
26:11interpretation were equal to taking
26:13someone's temperature or changing a
26:15bedpan. And this is where you find the
26:18cultural customization
26:21important to the discourse of medical.
26:23Mrs. Das is speaking from the cultural
26:26space she is familiar with. She's come
26:29from America.
26:31But
26:33Mrs. Kapasi is interpreting the job of
26:36an interpretator from the lived
26:39experience of people in India.
26:44And therefore in the meaning or in also
26:48visualizing the profession you find two
26:51different ways in which they go about.
26:55Therefore, a literary atlas of idioms of
26:59distress. It maps the way in which
27:02people use the lack of language of a
27:04dominant culture express what ails them.
27:08So different culture like I said will
27:11have different kind of vocabulary of
27:14ailment, healing, medicine,
27:18care,
27:20disease, illness, grief, so many that I
27:24can just go on and on.
27:28Uh I talked about in between spaces and
27:31diaspora is one such space. uh and
27:35therefore you find the untransatable
27:38symptom. You just don't know what Mrs.
27:40Daz is feeling. So before that this Mr.
27:45Kapasi hasn't heard of this experience
27:48where a woman would come and say this
27:50third child that I have is not my
27:54husband's child. He doesn't know. This
27:57is an unheard malady for Mr. capaci and
28:01therefore he cannot gorge the issue
28:05behind that confession.
28:09Gujarati patients usually came and
28:12described pain in metaphors which the
28:15doctor did not understand and because
28:18they were culturally loaded and they had
28:22to be medically coded by the clinician
28:28Mr. Kapasi only interpreted he just
28:31translated in some ways. Therefore
28:35when you look at this story you
28:37understand that there is the need for
28:41cultural competence which we discussed
28:44or when we were theorizing defining
28:46medical humanities.
28:48This becomes an uncompromising
28:52condition in India all the more because
28:56every
28:57few miles or every state has a different
29:02culture or a group of state have
29:04different culture to
29:07showcase.
29:09So there has to be a willing to inhabit
29:12the space in between to be genuinely
29:14bilingual in the deepest sense which
29:17means bicultural. So language in India
29:21different languages rather in India they
29:24are not just languages
29:27and at all point of time most of us are
29:32at least bilingual
29:35and bicultural at the same time.
29:39So for
29:41clinical competence, this cultural
29:44competence where you are familiar with
29:48the language
29:50or let me say linguistic landscape where
29:53the social, cultural, traditional all
29:57other elements also
30:00map the mental and emotional makeup of
30:06that place. becomes seminal.
30:11So uh quickly I will come to how
30:14interpreter of malades talks about
30:17in terms of language you have the type
30:20of malady as Mrs. Da's guilt which has
30:23come out of infidelity. The response of
30:26the language is confession to a
30:28stranger. She doesn't know Mr. Kapasi
30:31but she just opens up.
30:34When you think of it in a clinical
30:36sense, you find a term called moral
30:39injury, a term used in contemporary
30:43psychology mostly and
30:47gets equated with depression also
30:49sometimes but I will stick to this term
30:53in psychology which is moral injury.
30:57the resolution it can't be done anything
31:02it's the diagnosis is not there
31:04clinically at least so there is no cure
31:06so Mr. Kapasi also couldn't respond,
31:09couldn't uh fathom the situation. And
31:13when you look at any of the language
31:18present, you will find that
31:21despite coding
31:23most of the emotions,
31:27there is no language that can be
31:30uniformly discussing the pain and
31:32suffering or disease and illness of
31:35people because that gets customized.
31:39And when we talk about humanizing the
31:41medical discourse, we talk about this
31:44customization.
31:45We talk about the aspect of medicine,
31:49community, confession, body, suffering
31:53and many other aspects that are held in
31:57the narratives to be coming together to
32:01find the meaning
32:03and therefore one has to humanize the
32:08perspective. I think uh one of the
32:10things atcom models talk about it I'll
32:13discuss I think uh quickly so the doctor
32:17patient relationship is reimagined where
32:19we have the biomedical model and
32:21narrative model which I think I
32:23discussed it in great detail where
32:26broadly speaking I will not go much into
32:29detail here I have already explained it
32:31in great detail but let me just quickly
32:33recapitulate the biomedical model
32:35emphasizes on the body the narrative
32:38model emphasizes on the experience of
32:40the patients. So in biomedical it is the
32:43clinician's diagnosis that is primary.
32:46It's clinician's gaze that is primary.
32:49The person is at the center of the
32:51narration. But in narrative model it is
32:54the lived experience of the patient that
32:57holds the narrative together.
33:00So other aspects mean the culture and
33:04emotion are to be minimized. Here in
33:07narrative model, emotional pain is
33:10important.
33:12Language is just a tool. Here it's just
33:16an expression of the human condition,
33:19the patient's subjective experience.
33:22Finally, when we think of medical
33:24discourse in medical humanities, we find
33:28the role of interpreter
33:32extremely crucial to how we understand
33:35the short story because Mr. Kapasi shows
33:39that interpreters are not just
33:41translators of the language. They are
33:44clinical agents. In that sense, they are
33:46not tools. They are methodology.
33:51Medical ethics accounts for translation
33:53as a site of care and power where the
33:56translator is not just translating
34:01even in the you know in the language
34:03that is familiar to you. You are not
34:04just translating the language
34:07you are translating more than that. So
34:11you have to honor the whosoever it is
34:13interpreter.
34:15Listen for silence. Like I said, you
34:18being curled up in your bed without even
34:21a word speaks volumes about your pain
34:24abdomen. So you have to work on the
34:27semiotics of silence. Also validate
34:30cultural idioms and distress like in the
34:33straw in the throat. Who would have
34:35known? How do you know what it is unless
34:38you know the cultural context and locate
34:42the malady in relationship which is Mrs.
34:45Da's malady is relational. It's not just
34:49very individual because there is so much
34:52of past
34:54involved in in in that. Lahari insists
34:58that the clinic expand its unit of
35:00analysis from body to relationship to
35:03community. Which means that the cultural
35:05and social factors also are
35:08uh adding to the meaning of the
35:12therapeutic
35:16relationship that will be shared in the
35:18clinical space. Finally to conclude I
35:20can say that uh when we think of medical
35:24humanities discourse body speaks in
35:28languages metaphor silence ritual
35:31cultural idioms and not just that.
35:35Additionally when you think of
35:37humanizing the discourse this does not
35:39mean that clinical science has to be
35:42replaced. What it means is that there
35:45has to be an added value of the
35:47sentiment that gets
35:51added at the point of time when the
35:53discussion is taking place when the
35:55person is expressing the narrative that
36:00one has.
36:01It means also inclusion and expansion
36:06and not a myopic gaze around the
36:09clinical vocabulary. And finally, it's
36:13about training
36:15the clinicians to attend, represent and
36:19affiliate with the complex, irreducible
36:24human being in front of them.
36:28And finally, I want to leave you at the
36:32thought in which you feel when was the
36:36last time you truly heard in a clinical
36:39encounter. I want you to hold that
36:42thought till we go to the next lecture
36:44where I discuss the crucial and
36:48foundational aspect of medical
36:50humanities bioeththics in great detail.
36:54See you soon. Thank you.