Understanding Convergence: Comprehending Medical Humanities as a Literary Genre

Dr. Deepesh Kumar Thakur
Understanding Convergence: Comprehending Medical Humanities as a Literary Genre

ABSTRACT: -
Discourses concerned with human health and well-being are emerging in the domain of literary studies. The field is generally termed as 'Medical Humanities'. Medical Humanities is an interesting field of study which takes into consideration the humanities, social sciences, art, literature, creative writing, music, philosophy, etc. in order to study and understand ideas related to medical science. Literature and medical science is an interesting branch of study which not only incorporates the ideas of medical science in literature but also promotes many interdisciplinary genres. This field is emerging as a new genre in literature which is now considered to be a seminal discourse. Rather than merely speaking about the notions of disease and illness with a medical jargon, Medical Humanities takes within its ambit a wider socio-cultural perspective on health and disease, moral compass of the patient-doctor relationship and experiences thereby making the readers aware of the complexities, and promoting empathy in the mind of readers. This approach put forward by Medical Humanities bolsters the reader's ability to understand the plight of people undergoing the crisis. Most importantly, it enables the reader to suspend his notion of reality and enter into the reality of other characters, thereby promoting moral sensibilities. The main objective of this paper is to understand how medicine and literature confluences together to form a hybrid genre. This paper shall take into account and deal with some important aspects of Medical Humanities taking reference from literary texts.

Keywords: Humanities, Interdisciplinary, Literature, Medical, Medicine.

Introduction:
The status of literature and literary studies are changing day by day. With the advent of literary theories and inclusion of various ideas of the society within the spectrum of literary texts, a slow but sure paradigmatic shift is observed in the literary scenario. Particularly with the rise of ideas such as 'postmodernism', 'post-structuralism' and 'post-humanism', literature is now trying to encompass many facets of life within the canvas of literature. Since literature and literary departments are a part of the 'Humanities' department at large, any and every aspect of the 'humanity' finds a way in the literary texts. This dominance of the 'post' in academia has abilities to give rise to the notion of 'post-literature' in the literary scenario. Post-literature as a concept and theory which is yet to spread its wings in the academic domains is already undergoing germination at the present times. Interdisciplinary and multidisciplinary approaches in the field of academics have the solid potential to give rise to this new branch of academic studies. As the cliche goes on, "Literature mirrors the society" or "Literature reflects society, social actions and behavior", therefore it soaks ideas from sociology, psychology, medical sciences, technology, environmental sciences, physical and chemical sciences, life sciences, so on and so forth. However, literature has a way to deal with such issues in a rather succinct manner. The portrayal of such matters are different from the portrayal in their absolute fields of study. However, the matter of fact cannot be denied that literature is now all encompassing. It was C.P. Snow who in 'The Two Cultures' (during 1959 Rede Lecture) made some interesting observations on two cultures- science and humanities, indicating the increasing friction between the two and the importance of bridging them for the progress of the society. Snow, who was a scientist as well as a literary enthusiast, saw the importance of bringing these two fields together for the cause of advancement of both. Keeping this in view, literature in the contemporary scenario has produced works which try to bridge the gap between the sciences and the humanities. The Science fiction- Sci-fi for example is an interesting take in this field. Sci-fi presents the readers a world where aliens, non-human characters and extraterrestrial creatures are a part of the narrative. Though the setting of these works may be an alternative world, but the plot centers on science and technology to a large extent. They are inspired by the natural sciences like physics, chemistry and astronomy or take its ideas from psychology, anthropology and medical sciences. Most importantly, sci-fi brings together ideas from science and incorporates them in the literary narratives.
Discussion:
Discourses concerned with human health and well-being are emerging in the domain of literary studies. The field is generally termed as 'Medical Humanities'. Medical Humanities is an interesting field of study which takes into consideration the humanities, social sciences, art, literature, creative writing, music, philosophy, etc. in order to study and understand ideas related to medical science. Literature and medical science is an interesting branch of study which not only incorporates the ideas of medical science in literature but also promotes the following:
- Heightens awareness by bringing issues of medical science in focus.
- Brings stories of patients undergoing severe crisis and writing about their experience.
- Creates critical thinking and promote empathetic awareness about various moral issues in relation to medical practice.
The term Medical Humanities was coined by historian George Sarton and Frances Seigel in their obituary of science historian Edmund Andrews which was published in 1948. Medical Humanities is a highly interdisciplinary branch of study and field that encompasses and embraces the study of medicine through the lens of literature, history, philosophy and other social sciences and subjects of the humanities field. It takes an account of medicine, health, well-being, applied medicine and bioethics. Medical Humanities as a method was primarily deployed by practitioners of medical sciences to teach their students and train them regarding the subjective experiences of patients within the objective world and scientific world of medicine. The main and original aim of Medical Humanities is therefore to instill humanistic values in medical practioners by relying on the ethics of humanity. As Bleakley observes, "medical humanities attempt the democratizing of medicine shifting medical practices from an authority-led hierarchy that is doctor-centered to patient-centered and interprofessional clinical testing process (Bleakley 2).
'Medical Humanities' as Douglas Robinson mentions in his book Translationality: Essays in the Translation-Medical Humanities (2017) is an act of 'translationality'. For the scholars dealing with 'translation' in general, translation is the art of transferring textual features from one form to another. But in general sense, translationally can be considered as any form of transformation, transference and conveyance from one place to another. Translationality is the process by which things and events change in a due course of time, the process of evolution of old regimes and systems along with the inclusion of new set of laws and principles, the incorporation of something new in the existing norm and the emergence of a newer concept. Thus, translationality includes the old and the new, which gives rise to novel and innovative designs, bringing in newer forms of knowledge in the existing system. The incorporation of something new in the system is the transition and change occurring in the existing pattern.
Translation is not just the art of changing one form of language to another and expressing what has already been expressed. It extends beyond the general idea of change of language groups and narrating something in some different languages. The Merriam-Webster Dictionary observes 'translation' as "a change to a different substance, form or appearance" and also states that translation is "a transformation in which new axes are parallel to the old ones." Translationality in the existing corpus of study therefore is the inclusion of psychology and psychological analysis of characters and patients within the existing spectrum of literary studies. This is how Medical Humanities work which brings together aspects of literature and medical studies together on a same plane. In this way, translation gives a new form and appearance by changing the existing form of study. Literature and Psychology is the form of study which draws from psychology into literature and incorporates medical sciences into the humanities thus forming a branch of Medical Humanities (MH) as a field of study. Translationality is thus a change, a force and an impact of one form of study influencing the other. There have been various attempts to bridge the gap between medical science, health care and humanities because of which many other disciplines are merging together in the same platform, giving it an interdisciplinary form and coming up with new areas of study.
Medical Humanities is thus an interdisciplinary and multidisciplinary field that deals with concepts drawn from the medical sciences finding a way to literature. Cole and Carson observes, "Medical Humanities is an inter- and multidisciplinary field that explores contexts, experiences and critical conceptual issues in medicine and health care, while supporting professional identity." Klugman also observes in this regard, "Medical Humanities is an interdisciplinary field concerned with understanding the human condition of health and illness in order to create knowledgeable and sensitive health care providers, patients and family caregivers."
The interdisciplinary study of Medical Humanities is variously defined. Brian Dolan in his book Humanitas: Readings in the Development of the Medical Humanities (2015) states the importance of Medical Humanities in medical education. For Dolan, "everyone teaching Medical Humanities in medical schools needs to answer repeatedly" (Dolan, x). In other words, Medical Humanities are a primary part of medical education in every medical school. Every future medical professional needs to be 'humanized'- that is, taught to engage humanistically not only with patients but also with themselves as a whole. And when it comes to Medical Humanities as curricula keeping in mind the translational aspect of the study, it takes into purview medicine in literature, narrative medicine, disability studies, illness narratives and so on coupled with the humanities and social sciences background. Rather than merely speaking about the notions of disease and illness with a medical jargon, Medical Humanities takes within its ambit a wider socio-cultural perspective on health and disease, moral compass of the patient-doctor relationship and experiences thereby making the readers aware of the complexities, and promoting empathy in the mind of readers. This approach put forward by Medical Humanities bolsters the reader's ability to understand the plight of people undergoing the crisis. Most importantly, it enables the reader to suspend his notion of reality and enter into the reality of other characters, thereby promoting moral sensibilities. The discipline of humanities- in this case, literature- promotes knowledge of the medical sciences through narratives. Rita Charon in Narrative Medicine: Honouring the Stories of Illness (2006) states about narrative medicine:
If narratives are stories that have a teller, a listener, a time course, a plot, and a point, then narrative knowledge is what we naturally use to make sense of them. Narrative knowledge provides one person with a rich, resonant grasp of another person's situation as it unfolds in time, whether in such texts as novels, newspaper stories and movies, and scripture or in such life settings as courtrooms, battlefields, marriages, and illness (Charon 9).
Charon observes how narratives of this kind provide a rich knowledge and lucid understanding of complex matters through various narratives, such as, the novel, newspaper stories, movies and other forms of literary and visual narrative.
Charon's view on the necessity and importance of illness narratives promotes C.P. Snow's vision of bringing the two cultures together to promote living by generating awareness in the minds of the readers. Therese Jones, Delese Wear and Lester D. Friedman in the Introduction to Health Humanities Reader (2014) states the importance of promoting subjects like that of the health humanities in today's world. The practice of carrying out an interdisciplinary approach like that of the health humanities is important because of the following reasons:
-Medical Humanities makes critical concepts of the medical sciences accessible and available to a wider audience. Concepts which were previously available solely among medical practitioners have now been incorporated into the humanities.
-By using plot, character and setting, Medical Humanities demonstrate how multidisciplinary perspectives can be adopted in exploring complex issues like disease, illness, health, disability, patient-doctor relationship and so on.
-Medical Humanities is thus a touchstone for both medical professionals and literary scholars since it ultimately aims at bridging the gap between the two fields of study.
-Ultimately, Medical Humanities aims at disseminating knowledge about concepts related to science and medicine by using various modes of narration, thereby promoting accessibility and empathy in the minds of the readers or audience.
Arthur W. Frank in the article titled 'Being a Good Story: The Humanities as Therapeutic Practice' published in The Health Humanities Reader (2014) state how the humanities have immense potential to bring forth the notions of abnormalities of the body through stories. Firstly, Medical Humanities have immense potential to tell good stories. This takes us to the next point. Medical Humanities not only help ill people to narrate stories about themselves but by telling stories about themselves, they also tell stories to their physicians, their loved ones and these stories become a part of the society. Medical Humanities thus looks into aspects of illness and disease by placing the affected individual at the center. But it does not neglect the people that remain associated with the person who is affected. The study of Medical Humanities thus takes a larger canvas in consideration. Arthur W. Frank observes that "stories are good because they are interesting. Illness can be an interesting story" (Frank 32). Frank also brings in an important aspect of understanding wherein he tries to establish the meaning of two words- 'Illness' and 'disease'- which forms an important base of this study. Illness as Frank states is an 'experience' whereas disease is a 'condition of the body'. Where disease can be reduced to biochemistry, illness includes biography and takes into consideration not only the affected individual but multiple relationships as well as institutions. This brings into consideration the involvement of 'others' in the scenario when it comes to managing illness and disease.
The study of Medical Humanities also foregrounds two matters-- the tension between the provision of treatment, and the offering of care. Frank states, "Treatment is provided as service; care is offered as a gift. Treatment can be expressed in monetary value; one can buy more attentive treatment but not true care" (Frank 34). 'Treatment' of a disease is thus more impersonal, more professional, more profit oriented. But, 'care' provided to overcome illness is not always professional. Further differences between treatment and care are outlined thus by Frank:
-Treatment is one dimensional. It is provided by one who has an insight in the field of medicine. Care on the other hand does not require medical insight. It can be provided by anyone and everyone. Care giving involves emotion as well.
-The treatment provider uses the body of the patient as an instrument to be operated upon. The caregiver on the other hand feels the suffering of the one who is cared for.
-Treatment providing has a subject-object demarcation. Providing treatment clearly demarcates the one who is providing treatment and the one who is treated upon. The patient can become the object of treatment in the hands of doctors or specialists. This is not same with that of the care givers. The boundary between the care giver and the patient gets dissolved because here, care givers and patients are both subjects since the care giver is also emotionally attached to the patient's dilemma.
-In providing treatment, there is a power dynamic that works throughout the structure. Here, one party gains autonomy and exercises its power over the other. Whereas, on the other hand, care giving is endlessly sensitive and is asymmetrical to power dynamics. Here, both the patient and caregiver become one in undergoing loss and overcoming the same.
The human mind is one of the most complex substances in nature. The mind shapes not only the behaviour of an individual but also affects the society as a whole and thus, the human mind can be defined as the most complex circuit in the human body. Moreover, the human mind, even in the present era of scientific development remains largely unexplored, and medical science and psychiatry are working relentlessly to explore various facets of the mind. The National Institute of Mental Health (NIMH) estimates that almost 28.47% of the human population has issues when it comes to mental health as compared to other health-related problems. The WHO is of the same opinion that mental health issues surpass other chronic diseases such as cardiovascular disease or cancer. Mental disorders are a part of the human condition. For over a century, psychologists have studied these conditions in terms of 'abnormal psychology'; while others have used the term 'psychopathology'. Abnormal psychology studies the disorders related to the mind, mostly in the clinical context which takes into consideration a wide range of psychological disorders like depression, personality disorders, mood disorders, bipolar disorders, Obsessive Compulsive Disorders (OCD) to name a few. Abnormal psychology looks into the atypical or unusual way the mind works or the factors which leads to the improper workings of the mind. Psychopathology on the other hand also takes into consideration the abnormal and improper workings of the mind. Like pathology which studies the nature of disease in the human body-causes, outcomes and the ways to deal with these shortcomings, psychopathology too studies the same in relation to the human mind. Although both 'abnormal psychology' and 'psychopathology' has the same function and meaning, psychopathology is more sensitive and less stigmatizing term. Both the terms takes into consideration the three components, generally known as the 3Ds:
-Dysfunction: It takes into consideration how the thought processes of human being are not at tune with reality and what are the factors that lead to this dysfunctionality. This dysfunction may be related to the breakdown of cognition, emotion or behavior of an individual.
-Distress or Impairment: Distress is the result of excessive suffering. Both abnormal psychology and psychopathology takes into consideration how prolonged stress can create a negative impact in the mind of the bearer. Excessive distress leads to impairment where an individual loses the capacity to perform in real life and undergoes a disabling condition in personal or social occupation.
-Deviance: The word 'abnormal' itself brings into focus the idea of deviance. This relates to the idea that something is deviated from the 'normal' standard. Though the idea of the word 'normal' in itself is elusive, yet abnormal psychology and psychopathology studies how an individual undergoing mental illness deviates from the norm because of dysfunctionality, distress and impairment.
-Dangerousness: The DSM-V has come up with a fourth D in relation to the 3D's of abnormality. According to many psychologists and psychiatrists, patients undergoing abnormalities in the mind, can often show dangerous behavior which can come as a threat to the safety of others. This extends the notion that mental illness is confined only to the person undergoing the duress. It can hamper people in various degrees who are in relation to the one suffering.
What is generally termed as 'madness' has been present in the human society since times immemorial. However, throughout history the reception of madness has undergone various changes. Though madness presents abnormality of thought and action, the idea of 'abnormal' is permeable and contested. Since there are no parameters to judge the 'normal' therefore establishing what constitutes the abnormal is elusive. Like other diseases of the body, science cannot measure the degree of madness that an individual has. Andrew Scull in Madness: A Very Short Introduction (2011) observes that contemporary psychiatry and biochemistry can only state that parts of the brain are disfigured or there is "an excess or deficiency of certain neurotransmitters" (Scull 4) in the brain but arriving at a consensus on the actual range of abnormality is not possible. Scull states that there exist no PET scans or X-Rays or any laboratory tests to determine the status of 'being mad' within individuals. Though this dissertation relies heavily on Diagnostic and Statistical Manual (DSM-V) of the American Psychiatric Association, which is considered the Bible of psychiatric practice all across the world, even it has failed to define what constitutes the 'normal' and how the 'abnormal' deviates from the normal.
Over the years, people related to this field have also tried to figure out the idea whether madness is 'mental' or a 'physical' disability. Andrew Scull notes that two centuries ago William Lawrence, a renowned Bedlam doctor associated madness to problems in the brain. Like other diseases of the body which are related to specific organs, for instance indigestion and heartburn are related to the abdomen, cough and asthma to lungs, madness finds its relation to the brain. It is the brain and its dysfunctionalities that bring out madness. However, in the nineteenth century, it was argued that the aspect of madness is not only related to the brain but also to the overall composition of the body. The brain gets dysfunctional due to certain hereditary factors which are spread across the body, leading to an inferior and deformed brain, to madness and insanity. The twentieth century's research into madness claimed that it is not only associated with internal dysfunctionality within the body, but is equally affected by the external environment. This dissertation therefore takes note of such factors-mental illness manifesting the body not only because of hereditary factors, but also because of the external environment.
Andrew Scull brings out an important observation when it comes to the diagnosis of mental illness and madness. He states that despite the advancements of psychiatric sciences, cognitive neuroscience and medical sciences in recent years, till date no breakthrough technology or inventions have come about, which could address these mental issues. Though medicines are known to provide temporary relief to existing conditions, madness and mental illness continues to persist in "multitude of forms" (Scull 6). This aspect of mental illness is evident in the novels undertaken for study of this dissertation. Though the characters exhibit abnormal symptoms, and in some cases, have to depend upon medical supervision, the abnormality persists, manifesting in sporadic bursts in various forms.
The notion of mental illness was evidently divine during ancient times. From the Greeks, down to the Romans and the beginning of Christianity, it was the general assumption that individuals became mad because they were possessed by the Devil or were cursed by God. Madness became a major trope in the Hebrew Bible as well as in the New Testament. Stories in the Hebrew Bible and the New Testament are replete with images and ideas of madness and insanity. However, Hippocrates and Galen of Pergamum pointed out the humanistic turn in this field. A paradigmatic shift was seen when both Hippocrates and Galen mentioned that the root of mental illness lies within the body and no supernatural forces have its control over the same. At the core of their findings was the theory that the human body is a composition of various elements, known as fluids which were constantly in interaction with each other and the misbalances in these fluids lead to various effect on the body and the mind.
Conclusion:
The human body, according to Galen was comprised of four basic elements: blood, phlegm, yellow bile and the black bile. Though every individual has a composition of all these four elements within the system, the proportions of these elements vary across people, which in turn give rise to different temperaments. And the key to good health is to maintain equilibrium among these body fluids. When an individual fell ill, it was the task of the medical practitioner to figure out which body fluid had become disproportionate and then use various therapies at his disposal to restore the balance of the fluids. It was Hippocrates and Galen who emphasized that the body is affected by the external environment in which an individual is situated. Though they emphasized on seasonal variations affecting the mind of an individual, they also focused on the role of the environment in maintaining a healthy life state.
Besides science and psychology, literature is one such field which has constantly been dealing with the problem of abnormal psychology since times immemorial. From the pages of Shakespeare to motion pictures, themes ranging from insanity, lunacy, psychosis to mental illness have been dealt with. Madness is something that frightens and fascinates everybody. Michel Foucault in Madness and Civilization: A History of Insanity in the Age of Reason (1961) mentions, "On all sides, madness fascinates man" (Foucault 20). However, despite madness arresting our attention to its reality, mental illness is still not an acceptable term to use in polite company. The primary aim of this paper was to analyze the idea of Medical Humanities and forms of mental illness, abnormal psychology and symptoms of mental ill-health, as projected in literature. In the changing world order, it becomes crucial to update the knowledge base. Therefore, the need of the hour is to bring a change in the existing knowledge system. This can be done by relying on interdisciplinary and multidisciplinary ideas. Medical Humanities- the branch and its study opens up new grounds not only for research in academia but also helps readers to understand the complex medical ecosystem in a lucid manner.

References:
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