Medical Humanities @ Swansea University Dr Andrew Hull Department of Philosophy, History and Law School of Human and Health Sciences Swansea University

MeSH - BSc Medical Sciences and Humanities BV95 (3 yrs f/t) Exploring the scientific and human sides of Medicine & Healthcare since 1999 http://www.swansea.ac.uk/health_science/Undergraduate/MedicalSciencesHumanities/ This innovative, interdisciplinary degree reflects contemporary medicine’s patient-centred and bio-psycho-social understanding of health, illness, and healthcare interventions . It has been developed in conjunction with the University’s School of Medicine and allows you to study the broad spectrum of subjects that encompass the science and art of medicine.

The Course Ethos ‘It is more important to know what sort of person has a disease than to know what sort of disease a person has.’ (Hippocrates).  ‘My aim is not to make a system or to see patients as systems, but to picture a world, a variety of worlds – the landscapes of being where these patients reside.’ (Oliver Sacks, Awakenings New York, Harper, 1990). Bringing together information related to biophysical, psychological, and social factors - a more holistic approach that focuses on the whole patient and not just the specific disease, condition, injury, or symptom. To challenge received concepts of health, disease, well-being, human flourishing.

Scientific and Human Something has gone wrong with Medicine needs to be more patient-centred and this needs to entail substantive changes to theory and practice of Medicine and healthcare. Medicine is an Art as well as a Science (practical art – techne?) The Art comes in that making by and applying of science to individual human beings – Analyse knowledge making and application Transferable skills.

History: Evolution of the Biomedical Paradigm Founded on Jewson’s (flawed but useful for UG teaching!) stage model of development of Biomedical Paradigm (intellectual/social) and that backlash against mature lab/techno medicine that Jewson’s 1976 article was part of. Question Can we re-integrate the seemingly incommensurable discourses of doctor and patient to create a new common conetxt synthesiss o- a ‘Romantic Science’ which attends to both scietific and experiential ‘facts’

Each year - two modules in six distinct areas of study:  Biological Sciences explores how knowledge of biological systems at the molecular, cellular and organismal levels underpins clinical medicine.  Clinical Sciences key study and learning skills of medicine and healthcare: esp.essential critical information analysis of evidence-based-medicine; the issues surrounding implementation of public health interventions; and the integration of theoretical and practical knowledge in patient interactions, via reflective clinical observation.

Philosophy of Medicine –explores ethical and conceptual issues that shape the nature and goals of medicine, interrogating problems of life and death, genetic ethics, multiple personality disorder, and conceptions of mental illness. Social Sciences and Medicine – comprises the economic, psychological, and sociological dimensions that inform the experience of medicine and health care, and also issues of costing and provision across the lifespan.

   History of Medicine provides a critical view of the interaction of intellectual and social factors in the making of medical theory, practice, and professionalisation, and the overall role of medicine in the creation of modern society since 1500.   Literature and Medicine contrasts doctors’ and patients [Lynsey there is no dash there] views of disease by examining literary narratives of health care and illness. Literature – illness narrative – empathy – but what for – simply better communication between Doctor and Patient?

Narrative Beyond Empathy: Oliver Sacks Romantic Science: both scientific and human facts needed Medical problem not just physical lesion but lesion of the soul/self - in linked: Disruption in the story of the self (narrative identity) Disruption to fundamental sense of self – BODY-IMAGE Health = adaptability/new normality (Canguiheim) Doctor’s role: facilitating this remaking of the physical/mental/idea of self Literature gives us access to... Frank/Kleinmann/Bury. Auto-Pathography = a substantive way of validating subjective experience in Medicine

Bio-psycho- SOCIAL model ‘Medicine is a social science, and politics nothing but medicine on a grand scale.’ (R. Virchow, Die Medicinische Reform, 1848) Don’t mention to the UGs that Foucault attacks just this political ambition as part of the imperial medical Enlightenment power/knowledge project, but rather we say: Human element is important in another way – since as Virchow said – medicine IS politics –all government decisions have health impacts and the health of the nation is a political issue since health = national wealth. So it is important to understand – the social, political, economic and legal contexts and impacts of medicine and healthcare. However, we also suggest that these insights into the broader nature, purpose and scope of medicine and healthcare and the meanings of health, disease and well-being as containing socio-economic and subjective elements, is not simply a recent preoccupation; but has a long-history – which pre-dates but also coexisted with the high-point of the laboratory revolution in medicine...

Holism in Medicine The patient is not merely the addition of circulatory, respiratory and excretory symptoms – a sort of heart-lung-kidney preparation – but a human being with all the desires and emotions, hopes and fears of humanity. Whereas the physiologist and pharmacologist can more or less isolate the object of investigation, the patient, like other living organisms, cannot be disassociated from this environment. One merges with the other with mutual action and interaction. (Noah Morris, ‘Prolegomena to the Study of Therapeutics’, Glasgow Medical Journal, 1937, 7th series, 10, No. 4, p. 148).

MeSH Spectrum Explores Medicine and Healthcare in the various contexts that we experience them as a society: Technical Knowledge (Medical Sciences) Human Sciences Perspective (Psychology, Sociology, Economics, Law etc) Humanities Perspective (Philosophy [Medical Ethics, Autonomy, Identity etc]; History (science of knowledge change); Literature)

The B.Sc. Year 1 Human Anatomy and Physiology Applied Human Biology Maths and Physics for Physiological Measurement Systems Study Skills and Health Informatics Sociology of Health and Illness Health Law Philosophy of Medicine Psychology and Medicine History of Medicine Medicine and Literature

The B.Sc. Year 2 Human Anatomy and Physiology 2 Pathophysiology Research Methods & Statistics Health and Economics Health Law and Practice Health Disease and Illness People Populations and Medical Care Psychology, Health, Illness & Medicine Medicine and Society Genetics*

The B.Sc. Year 3 Applying Information in Medicine* Systems Physiology and Common Pathologies Public Health Medicine and Epidemiology Persons and Illness Sociology of Health and Illness Applied Psychology & Health Genetics* Hospitals in History Dissertation

PG: MA in Medical Humanities (2001-) David Greaves and Martyn Evans in 2001 http://mh.bmj.com/content/27/1/51.full Philosophical element still central, but more strongly supplemented now by Historical, Literary and Visual Art perspectives History as a Medical Humanity: current research focus – ‘cultural history’ and bio-power formations Target of Teaching/Research: How to re-frame conflicted role of MH is Medical/pre-medical curricula

Evolution of the Biomedical Paradigm? I mentioned that Jewson was flawed How does change happen – accommodation, resistances, hybrid types of worker... Ironically Jewson embodies a triumphalist or Whiggish teleological account of the rise of the BP and the D of the Sick Man that has warped two succeeding generations of HOM...

MH can only = bolt-on, not be integrated Impact of Standard Historiography of BP on Role of MH: Something is missing from Medicine Constructs role as bringing subjective experiential human facts as counterweight to reductionist objective scientific medical facts . MH can only = bolt-on, not be integrated Assumes universal objectivity and reductionism as intention and result of Scientific Medical Project/Professional Entity House Built on sand: This leaves MH vulnerable to Positivist Backlash: non-core activity: MH is easily labelled as non-core because it hasn't justified its role as core/penetrated the core definitions of Medicine 3. Or at least - believes the hype – under-interrogates a scientistic rhetorical position that was not universal/maybe never existed in clinical medicine. What did exist were accommodations/resistances and hybrid types of medical worker How do we know this: HOM! 4. Like Nursing and other emerging experiential knowledge types when faced with the power of Medicine – everything becomes expressed in the language of the dominant discourse for fear of exclusion or sidelining. But this specifically devalues the special and different subjectivities that other forms of experiential knowledge alone can bring. What we need to do is to historically deconstruct the evidence-base and return it to what its founders wanted it to be: a broad and deep church.

Modernism/Postmodernism: HOM and the Postmodernist Critique Critique of MH very similar to postmodernist critiques of History Structure vs. agency; objectivity versus subjectivity; material vs. ideal Modernist concern with subjectivities to be bolted on to existing epistemological framework. Revision not abandonment of En project. Scientific medicine – plus subjectivities (Med Hum) HOM (medico-centric – knowledge/practice) – plus subjectivities (patients)   Postmodernist focus on process – everything is constructed – nothing is solid – all is always emerging from social processes (including concepts of social processes!) ‘History’ is historical construct like ‘Science’, ‘Progress’ etc Our analyses must reflect this and not assume objectivity and thus reify outmoded discourses of positivistic science At the moment, both HOM and MH appear stuck in a modernist paradigm which still reifies positivistic knowledge and existing knowledge hierarchies. This is what fatally limits the role of MH. The sensitivities which shaped the terminological move away from ‘wellbeing’ and towards ‘human flourishing’ are a response to this problem: ‘well-being’ was felt to retain a strong taint of medicalization. BUT we must be careful of throwing the baby out with the bathwater. If we seek a non-medicalized Medcial Humanities then don't we give up out claim to a discrete and specific identity and purpose? Shouldn’t just call ourselves ‘Humanities' – because surely if we claim any closer relevance to Medicine we are in danger of being epistemologically contaminated by proximity to biomedical hegemony? How do we get out of this bind? If we embrace the postmodernist critiques of knowledge – and present the meeting of Medicine and Medical Humanities as the symbiotic relationship between two, historically shaped, constellations of subjectivities which can learn from one another then we might make some progress towards radically redefining Medicine, and everything else that we are interested in. Only a sociologically informed SHOM can do this (!) – it involves, as Roger Cooter has recently argued, a much deeper understanding and use of Foucault’s idea about power/knowledge and its formations and operations and the analyses of constellations of bio-power – from which all of us here are constructed!

Role of Medical Discourses of Disability? Disability and Industrialization: A Comparative Cultural History of British Coalfields, c.1700-1948. What discourse of work injury/disability play around the coalfield industries and communities? Role of Medical Discourses of Disability? How are they themselves constructed? What part do they play in individual or group discourses of debilitating injury/illness? Inputs from self-help groups, Trades Unions, insurance companies, religious groups, local authorities, national policy-makers, doctors (GPs, consultants, Public Health, Industrial Health) etc etc To this end – our major new project – currently seeking Wellcome funding – seeks to foreground the relevance of SHOM to a Medical Humanities agenda by examining constructions of disability - ‘Cultural History’?

Role of Medical Discourses of Disability? Disability and Industrialization: A Comparative Cultural History of British Coalfields, c.1700-1948. What discourse of work injury/disability play around the coalfield industries and communities? Role of Medical Discourses of Disability? How are they themselves constructed? What part do they play in individual or group discourses of debilitating injury/illness? Inputs from self-help groups, Trades Unions, insurance companies, religious groups, local authorities, national policy-makers, doctors (GPs, consultants, Public Health, Industrial Health) etc etc ‘Cultural History’?