1. Using Literature to Teach Social Justice and Activism Martin Donohoe

2. William Butler Yeats “Education is not filling a bucket, but lighting a fire”

3. Stories

4. Perspectives Tumbling in the Hay Oliver St John Gogarty An Old Horse William J Kornrich

5. Background/Rationale Social, economic and cultural contributors to health of individuals and populations under- emphasized in health professions curricula Social, economic and cultural contributors to health of individuals and populations under- emphasized in health professions curricula Schism between medicine and public health Schism between medicine and public health Students idealistic/motivated, but grow increasingly cynical and develop negative/defeatist attitudes as training progresses Students idealistic/motivated, but grow increasingly cynical and develop negative/defeatist attitudes as training progresses

6. Harvey Cushing “A physician is obligated to consider more than a diseased organ, more even than the whole man. He must view the man in his world.”

7. The Role of Literature Vicarious experience Vicarious experience Explore diverse philosophies Explore diverse philosophies Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge Encourages creative thinking Encourages creative thinking Allows for group discussion/debate Allows for group discussion/debate

8. Why Use Literature Encourage appreciation of non-medical literature Encourage appreciation of non-medical literature Develop reading, analytical, speaking and writing skills Develop reading, analytical, speaking and writing skills Promote ethical thinking (narrative ethics) Promote ethical thinking (narrative ethics) Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams) Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams) Enjoyable Enjoyable

9. Margaret Sanger Books have been to me what gold is to the miser, what new fields are to the explorer.

10. Rudolph Virchow “You can soon become so engrossed in study, then professional cares, in getting and spending…that you find too late with hearts given away that there is no place in your habit- stricken souls for those gentler influences that make life worth living”

11. Uses of Literature Pedagogy Pedagogy Therapy Therapy Psychoanalysis Psychoanalysis Promote communication Promote communication

12. Goals Educate students and practitioners about social justice issues Educate students and practitioners about social justice issues Highly motivated Highly motivated Counter negative attitudinal changes and cynicism of trainees Counter negative attitudinal changes and cynicism of trainees Provoke thoughtful discussion about ethical and policy issues related to social justice Provoke thoughtful discussion about ethical and policy issues related to social justice

13. Goals Promote activist-oriented research and writing Promote activist-oriented research and writing Translate knowledge into practice through volunteerism and service Translate knowledge into practice through volunteerism and service Encourage lifelong, interdisciplinary learning and collegial practice Encourage lifelong, interdisciplinary learning and collegial practice

14. Issues Access to care Access to care Racial, sexual and SES discrepancies in outcomes Racial, sexual and SES discrepancies in outcomes The effects of poverty on health The effects of poverty on health

15. Issues Violence against women Violence against women Human subject experimentation Human subject experimentation Environmental degradation Environmental degradation War, peace and human rights War, peace and human rights

16. Issues Homelessness Homelessness Substance abuse Substance abuse Tobacco industry Tobacco industry Privacy: Privacy: Genetic testing Genetic testing Drug testing Drug testing

17. Issues Corporatization of academic and clinical medicine Corporatization of academic and clinical medicine The pharmaceutical and tobacco industries The pharmaceutical and tobacco industries Conflicts of interest / Role responsibilities Conflicts of interest / Role responsibilities

18. Where and When to Teach Elective courses Elective courses Incorporation into existing curricula Incorporation into existing curricula Service learning; community-based teaching Service learning; community-based teaching Ethics and Humanities Grand Rounds Ethics and Humanities Grand Rounds Interdisciplinary seminars Interdisciplinary seminars

19. Where and When to Teach Clinical teaching rounds Clinical teaching rounds Including at the bedside Including at the bedside Reading groups Reading groups Summer research/service stipends Summer research/service stipends Faculty development Faculty development

20. Stigmatization John Updike “From the Journal of a Leper.” Am J Dermatopathol 1982;4(2):137-42

21. Homelessness Doris Lessing “An Old Woman and Her Cat” From the Doris Lessing Reader (New York: Knopf, 1988)

22. Human Subject Experimentation / Human Rights Abuses Shusaku Endo The Sea and Poison (New York: Taplinger Publishing Co., 1972)

23. Poverty Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233. Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233. Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 1890. In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982. Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 1890. In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982. Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993. Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993.

24. Chekhov on Sakhalin “Sakhalin is a place of unbearable sufferings…[W]e have let millions of people rot in prison, destroying them carelessly, thoughtlessly, barbarously”

25. Chekhov on Sakhalin “A woman on Sakhalin is not exactly a human being…and not exactly a creature even lower than a domestic animal, but somewhere between the two.” “[A]ll of us [are to blame]”

26. Fyodor Dostoevsky “A society should be judged not by how it treats its outstanding citizens but by how it treats its criminals”

27. Race and Access to Care Ernest J Gaines “The Sky is Gray” in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

28. Mental Illness Anton Chekhov Ward Number Six in Chekhov A. Seven short novels (New York: Bantam, 1976)

29. Conflicting Responsibilities of Physicians Pearl S. Buck “The Enemy” In Far and Near: Stories of Japan, China, and America (New York: The John Day Company, 1934)

30. Domestic Violence Michael LaCombe “Playing God” In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Physicians, 1994

31. Single Motherhood / The Welfare System Grace Paley “An Interest in Life” In We are the Stories We Tell: The Best Short Stories by North American Women since 1945, Wendy Martin, ed. (New York: Pantheon Books, 1990)

32. The Humanities and Social Sciences Literature Literature Art Art History History Law Law Philosophy Philosophy Photography Photography e.g., Margaret Sanger, W Eugene Smith e.g., Margaret Sanger, W Eugene Smith Others Others

33. “Activist” Journals American Journal of Public Health American Journal of Public Health Public Citizen’s Health Letter Public Citizen’s Health Letter PNHP Newsletter PNHP Newsletter Mother Jones Mother Jones Harpers Harpers Z Magazine, The Progressive, In These Times Z Magazine, The Progressive, In These Times Dollars and Sense Dollars and Sense

34. “Activist” Journals Rachel’s Environmental Weekly Rachel’s Environmental Weekly Bulletin of Atomic Scientists Bulletin of Atomic Scientists Multinational Monitor Multinational Monitor Hightower Lowdown Hightower Lowdown Some articles in NEJM, JAMA, JGIM, SSM, Policy, Politics, and Nurs Prac, others Some articles in NEJM, JAMA, JGIM, SSM, Policy, Politics, and Nurs Prac, others

35. Additional Resources NYU Literature and Medicine On-line Database NYU Literature and Medicine On-line Database http://endeavor.med.nyu.edu/lit-med/lit-med- db/topview.html http://endeavor.med.nyu.edu/lit-med/lit-med- db/topview.html Public Citizen’s Health Research Group – Activist- oriented courses Public Citizen’s Health Research Group – Activist- oriented courses http://www.citizen.org/hrg/activistcour/index.cf m http://www.citizen.org/hrg/activistcour/index.cf m On-line syllabus exchange projects – e.g., ASBH On-line syllabus exchange projects – e.g., ASBH Syllabi, reading lists available from MD Syllabi, reading lists available from MD

36. Rudolph Virchow Father of pathology Father of pathology Established cell doctrine, elucidated pathology of thrombosis, PE, leukocytosis, and leukemia Established cell doctrine, elucidated pathology of thrombosis, PE, leukocytosis, and leukemia Member of Prussian state and local government for over 30 years Member of Prussian state and local government for over 30 years Founded Journal “Medical Reform” Founded Journal “Medical Reform”

37. Rudolph Virchow Advocated Advocated Public provision of medical care for indigent Public provision of medical care for indigent Prohibition of child labor Prohibition of child labor Universal education Universal education Free and unlimited democracy Free and unlimited democracy

38. Rudolph Virchow Instituted programs for Instituted programs for Improved sanitation Improved sanitation Stricter food inspection Stricter food inspection Revamping ineffective hospital policies Revamping ineffective hospital policies Enhanced nursing education Enhanced nursing education

39. Rudolph Virchow “Typhus, cholera, tuberculosis, scurvy, some mental diseases, and cretinism [are among] those maladies that result from the unequal distribution of civilization’s advantages”

40. Rudolph Virchow “Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

41. Günter Grass “The first job of a citizen is to keep your mouth open.”

42. First They Came for the Jews Pastor Niemoller

43. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org