Begin with a Text: Teaching the Poetics of Medicine

This paper suggests that the purpose of humanities teaching within medical education should be primarily to teach and promote the informed, attentive, critical, and precise reading of the multiple texts that constitute medicine as a discursive field—in short, a poetics of medicine. This claim is illustrated by reconsidering Margaret Edson’s play Wit, not as it is often used in medical education, as a cautionary tale about unprofessional behavior or as a way to inculcate “humanistic skills,” but as an analysis of the relationships between texts and feelings—or cognition and emotion, or science and art. This reading is illustrated by comparing the poetics of Wit with those of two other texts representing ovarian cancer: a scientific paper in Oncology and a clinical case conference in JAMA.     

See me,hear me: Using film in health-care classes

This essay argues that film deserves a place within the medical humanities curriculum and demonstrates effective strategies for employing it within medical ethics and humanities classrooms. Part One of the article emphasizes how and why medical ethics teachers can utilize documentary and fictional films, such as “Thomas Szasz and the Myth of Mental Illness,” “The Deadly Deception,”Whose Life Is It Anyway? and “Voices From the Front” in their courses. Such films encourage students to move beyond abstract debates and confront the human pain inherent in all ethical dilemmas. Part Two focuses on documentary and fiction film in the medical humanities classroom. In this section, the author details how to incorporates films, such asThe Doctor, The Waterdance andHospital, into the humanities classroom, juxtaposing them with various literary works, such asOther Women's Children, Borrowed Time, andCeremony. Part Three of the essay presents a detailed discussion ofThe Elephant Man andFrankenstein, illustrating how visual and literary texts compliment each other within the humanities classroom. Overall, the author demonstrates how films function as engaging and complex visual texts providing unique insights in the particularities of American health care and, as such, can become valuable components within medical ethics and humanities classrooms.     

“Getting the Knowledge Right”: Patient Communication,Agency, and Knowledge

In 2013, in accordance with a provision in the Patient Protection and Affordable Care Act (2010), the U.S. government began fining hospitals with “excessive” patient readmission rates. Those working to respond to this issue have identified discharge communication with patients as a critical component. In response to this exigency and to contribute to the conversation in the medical humanities about the field’s purview and orientation, this article analyzes studies of and texts about communication in health and medicine, ultimately arguing that the on-going circulation of compliance rhetoric and assumptions has limited efforts to improve patient communication. The article, furthermore, considers that humanist ideals of agentic action, the patient-centered care movement’s emphasis on the patient, and biomedicine’s tendency to treat evidence-based knowledge as fixed and given may have combined to support a rationale for using patient adherence to treatment guidelines as metrics in measurement studies designed to identify effective communication strategies. Finally, the article proposes that those working in the medical humanities consider the value of interdisciplinary posthumanist scholarship—specifically, its treatment of agency and knowledge as emergent, distributed, and contingent—and its potential to transform or extend in productive ways the conversation about what constitutes effective communication with patients.     

Innovation Through Tradition: Rediscovering the “Humanist” in the Medical Humanities

Throughout its fifty-year history, the role of the medical humanist and even the name “medical humanities” has remained raw, dynamic and contested. What do we mean when we call ourselves “humanists” and our practice “medical humanities?” To address these questions, we turn to the concept of origin narratives. After explaining the value of these stories, we focus on one particularly rich origin narrative of the medical humanities by telling the story of how a group of educators, ethicists, and scholars struggling to define their relatively new field rediscovered the studia humanitatis, a Renaissance curriculum for learning and teaching. Our origin narrative is composed of two intertwined stories—the history of the studia humanitatis itself and the story of the scholars who rediscovered it. We argue that as an origin narrative the studia humanitatis grounds the medical humanities as both an engaged moral practice and pedagogical project. In the latter part of the paper, we use this origin narrative to show how medical humanists working in translational science can use their understanding of their historical roots to do meaningful work in the world.     

Accidental Communities: Race,Emergency Medicine,and the Problem of PolyHeme®

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a “community” within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between “autonomy” and “community.” The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part II examines a clinical trial for the blood substitute PolyHeme^® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of “community.” The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment.     

Artificial Intelligence and Medical Humanities

The use of artificial intelligence in healthcare has led to debates about the role of human clinicians in the increasingly technological contexts of medicine. Some researchers have argued that AI will augment the capacities of physicians and increase their availability to provide empathy and other uniquely human forms of care to their patients. The human vulnerabilities experienced in the healthcare context raise the stakes of new technologies such as AI, and the human dimensions of AI in healthcare have particular significance for research in the humanities. This article explains four key areas of concern relating to AI and the role that medical/health humanities research can play in addressing them: definition and regulation of “medical” versus “health” data and apps; social determinants of health; narrative medicine; and technological mediation of care. Issues include data privacy and trust, flawed datasets and algorithmic bias, racial discrimination, and the rhetoric of humanism and disability. Through a discussion of potential humanities contributions to these emerging intersections with AI, this article will suggest future scholarly directions for the field.

     

The Epidemiology of “Regrettable Kinship”: Gender, Epidemic, and Community in Todd Haynes' [Safe] and Richard Powers' Gain

In “The Epidemiology of ‘Regrettable Kinship’: Gender, Epidemic, and Community in Todd Haynes' [Safe] and Richard Powers' Gain,” the author analyzes two contemporary cultural texts about women and environmentally-linked illnesses to rethink commonplace understandings of the relationship between gender, disease, and community formation. By reading these narratives side by side, Lynch is able to address difficult issues about gendered subjectivity and the fragile construction of collective political identity. While the female protagonists in the texts Lynch examines relate differently to their illnesses, both portray the ways in which women negotiate the potential and limitations of “illness communities.”     

The Bhakta and the Sage: An Intertextual Dialogue

Comparing the Bhagavad Gītā and the Buddhist essay “Prajñā is Not-knowing” (Panruo Wuzhi 般若無知) yields interesting insights. The texts have similar dialogical structures and discuss complex philosophical matters. Rhetorically, both texts weave together quotations and allusions from other texts, make liberal use of paradox, and have decidedly spiritual intentions. Their differences, though, remain striking. They emerge from distinct circumstances and their original languages (Sanskrit, Chinese) differ markedly. Stylistically, “Prajñā” is more intellectual and less devotional, espousing a distinctly “this worldly” ideal; by contrast, the Gītā is more dramatic. While espousing “this worldly” ideals, the Gītā is more inclusive and thus more accessible to a broad audience; on the contrary, “Prajñā” has a subtler effect, its “dark” qualities appealing to a more select group. Therefore, while these texts are not “the same,” reading across their convergences and divergences can lead to a deeper understanding of mysticism and cross-cultural spirituality.     

The gastroenterologist and his endoscope: The embodiment of technology and the necessity for a medical ethics

The purpose of this essay is to argue for the necessity of an ethics of the practice of the specialist-technologist in medicine. In the first part I sketch three stages of medical ethics, each with a particular viewpoint regarding the technology of medicine. I focus on Brody's consideration of the “physician's power” as a example of contemporary medical ethics which explicitly excludes the specialist-technologist as a locus of development of medical ethics. Next, the philosophy of Heidegger is examined to suggest an approach to the problem, and, finally, some of Levinas' contributions regarding the “other” are introduced to suggest a preliminary approach to a medical ethics of the specialist-technologist.     

Husserl’s hyletic data and phenomenal consciousness

In the Logical Investigations, Ideas I and many other texts, Husserl maintains that perceptual consciousness involves the intentional “animation” or interpretation of sensory data or hyle, e.g., “color-data,” “tone-data,” and algedonic data. These data are not intrinsically representational nor are they normally themselves objects of representation, though we can attend to them in reflection. These data are “immanent” in consciousness; they survive the phenomenological reduction. They partly ground the intuitive or “in-the-flesh” aspect of perception, and they have a determinacy of character that we do not create but can only discover. This determinate, non-representational stratum of perceptual consciousness also serves as a bridge between consciousness and the world beyond it. I articulate and defend this conception of perceptual consciousness. I locate the view in the space of contemporary positions on phenomenal character and argue for its superiority. I close by briefly arguing that the Husserlian account is perfectly compatible with physicalism (this involves disarming the Grain Problem).     

ON MAKING A CULTURAL TURN IN RELIGIOUS ETHICS

This essay critically explores resources and reasons for the study of culture in religious ethics, paying special attention to rhetorics and genres that provide an ethics of ordinary life. I begin by exploring a work in cultural anthropology that poses important questions for comparative and cultural inquiry in an age alert to “otherness,” asymmetries of power, the end of value‐neutrality in the humanities, and the formation of identity. I deepen my argument by making a foundational case for the importance of culture as a topic of normative analysis through a discussion of the emotions as cultural artifacts. To illustrate how cultural analysis can inform religious ethics, I turn to works by Wayne Meeks, Margaret Trawick, and Charles Taylor. I conclude by sketching some implications of a “cultural turn” for future work in religious ethics.     

Rules as the Impetus of Cultural Evolution

In this paper I put forward a thesis regarding the anatomy of “cultural evolution”, in particular the way the “cultural” transmission of behavioral patterns came to piggyback, through us humans, on the transmission effected by genetic evolution. I claim that what grounds and supports this new kind of transmission is a complex behavioral “meta-pattern” that makes it possible to grasp a pattern as something that “ought to be”, i.e. that transforms the pattern into what we can call a rule. (Here I draw especially on the philosophical insights of Wilfrid Sellars.) In this way I interlink empirical research done in evolution theory with some more speculative philosophical theories, thus shedding new light on the former and adding an empirical footing to the latter.     

Putting Religion Back Into Religious Ethics

This essay on Richard Miller’s Friends and Other Strangers (2016) locates its arguments in the context of how the practice of religious ethics bears upon debates about normativity in the study of religion and the cultural turn in the humanities. After reviewing its main claims about identity and otherness, I focus on three areas. First, while commending Miller’s effort to analogize virtuous empathy with Augustine’s ethics of rightly ordered love, I raise questions about his use of Augustine and his distinctive formulation of Augustinian “iconic realism.” Second, I suggest his discussion of public reason is at odds with the dialogical spirit of the book and may distract from the democratic solidarity required by our political moment. Third, more briefly, I highlight the practical implications of Miller’s vision for higher education at both the graduate and undergraduate level.     

BETWEEN TRANSLATION AND COMMENTARY

Translation played an important role in the history of Old Yiddish literature. To highlight the problems posed by translation, I have chosen to analyse an ethical-mystical bilingual text, the Kav ha-Yosher by Tsvi Hirsh Koidanover (Frankfurt, 1705 and 1709). This text demonstrates the popularization of Kabbalah in Jewish Ashkenazi culture (seventeenth to eighteenth centuries). I analyse the discrepancies between the Hebrew and the Yiddish texts. The vernacular text is a midrashic commentary, which intertwines the literal adaptation of the original Hebrew text and interpretative extensions. I study the discursive structures, the changes due to the shifts of readership and the differences in cultural tradition between “lay” and “learned” tradition, especially concerning magic, demonology, social criticism, tales, legends and censorship. The Kav ha-Yosher is a remarkable laboratory for an understanding of the nature of translation in vernacular Jewish literature.     

The role of culture in early Soviet models of governance

The article draws attention to the exceptional importance of the concept of culture in the development of early Soviet models of governance. It proposes an analysis of party cadres’ conceptualization of culture that provided the basis for the creation of the state monopoly on cultural production of the young Soviet regime in the early 1920s. Particular attention is given to Lenin’s differentiation between “bureaucratic” and “cultural” motivations to labour that, after the October Revolution of 1917, allowed to substantiate the shift in the point of view on socialism from a political to a cultural one. The building of the new Soviet statehood required a moderate depoliticization, the renunciation of the radical revolutionary rhetoric of class struggle in internal policy and the reinterpretation of class, social and cultural contradictions. Attention is drawn to the importance of cultural debates for the creation of the unique Soviet mechanism of governance that separated the principal ideological role of the party from the operative administration of the state machinery. At the centre of the analysis there will be no “theories” of culture or doctrinal diversity of Marxist-Leninist approaches but there will be the modes of culture’s problematization within the sphere that was defined by Michel Foucault as gouvernementalité. A group of specific texts is analyzed, in which governmental rationality and problematization of cultural policy were directly presented. This refers to verbatim reports and party congresses’ materials.     

Three stages of medical dialogue

The negative consequences of physicians' failure to establish and maintain personal relationships with patients are at the heart of the “humanistic crisis” in medicine. To resolve this crisis, a new model of doctor-patient interaction is proposed, based on the ideas of Martin Buber's philosophy of dialogue. This model shows how the physican may successfully combine the personal (I-Thou) and impersonal (I-It) aspects of medicine in three stages. These “Three Stages of Medical Dialogue” include:

1. An Initial Personal Meeting stage, which initiates the doctor-patient relationship and involves mutual confirmation;
2. An Examination stage, which requires a shift from a personal to an impersonal style of interaction;
3. An Integration Through Dialogue or “Healing Through Meeting’ Stage, which involves the integration of the impersonal medical data into the ongoing dialogue between doctor and patient, as a basis for shared decision-making.

The use of the model, as well as common failures of doctor-patient dialogue are discussed.     

Playing the fool: Activists' performances of emotion in policy making spaces

This paper draws upon dramaturgical concepts from performance studies scholarship to examine how situated performance and context enmesh with the emotional content of the practices of policy making. Drawing on sociological dramaturgical perspectives, the cultural and literary criticism that inspired them, and in particular Bahktin's concepts of the grotesque and heteroglossia, I investigate the subversive use of humour in policy work as a way of revealing “emotional knowledge” about the issues under discussion. First I set out the way “emotion” was understood by participants in an NGO's programme of policy activities as a mode of knowing the world, and how emotion and rationality were embodied in the forums by activists and civil servants respectively. I take as a case study activists “playing the Fool” within a programme of policy work in which I conducted ethnographic research. These performances, once set within a mise-en-scène that includes furniture, smells, lighting and the physicality of the people involved, create complex, unsettling and intersecting networks of meaning about power and knowledge in policy work. I argue that such a dramaturgical approach to interpreting the work of making policy challenges scholars to accurately represent the multiplicity of meanings of “emotion” at play in any context.     

Calibrating Study and Learning as Hermeneutic Principles Through Greco-Christian Seeing,Rabbinic Hearing,and Chinese Yijing Observing

Study is recently re-invoked as an alternative educational formation to disrupt the learning trap and trope. This paper calibrates study and learning as two hermeneutic principles and correlates them with seeing, hearing, and observing as three onto-epistemic modes that respectively underpin Greco-Christian, Rabbinic, and ancient Chinese exegetical traditions. Linking study and learning with the hermeneutic issues of language, text, meaning, and reality, my calibration unfolds in four steps. First, I introduce an epistemic aporia encountered in interpreting some Chinese educational “wind” texts, exposing our naturalized reasoning of learning along a representational enclosure. Second, turning to Susan Handelman’s writing, I trace this learning-as-representation enclosure as being conditioned upon the Greco-Christian exegetical mode of seeing, meanwhile correlating study back with the Rabbinic hearing hermeneutic. Third, I move on to explicate an onto-cosmological Yijing observing, proffering a study hermeneutic as a movement of observing, following, and attuning to wendao, literally put, “a crisscrossing pattern that (re-)turns with dao.” Finally, I re-observe and study the crisscrossing Chinese educational “wind” texts, evoking a Chinese “wind-teaching” sensibility so far rarely discerned through representational thinking and learning.