Paul Stepansky writes: Greetings from the wilds of Montclair, New Jersey, a bustling community 12 miles west of New York City. It is a great pleasure to introduce “Medicine, Health, and History” to the CMH community. It is a blog about medical history and its impact on contemporary clinical practice, patient care, and U.S. health policy. It is a blog about the history, present-day challenges, and future prospects of primary care medicine, especially in America and Canada. And it is a blog about medical instruments, medical technologies, and the laying on of hands.
My journey to medical history is a bit circuitous. I trained in European intellectual history at Yale with Peter Gay and Franklin Baumer, with a specialization in the history of psychiatry and psychoanalysis. When I finished my training in the late 70s, the American job market in history bottomed out, so I segued into mental health publishing. Beginning in 1984, I was Managing Director of The Analytic Press, a small firm that published psychodynamically oriented books and journals for psychoanalysts, psychiatrists, clinical psychologists, and clinical social workers. I held this position until 2006, when TAP was acquired by the British conglomerate Taylor & Francis and absorbed into the mental health program of Routledge, another T&F imprint.
My interest in medical history accompanied my odyssey in small professional publishing, not only via an appointment to the history of psychiatry section (now the Dewitt Wallace Institute of the History of Psychiatry) at Weill-Cornell Medical College, but also through a series of publications that sought to illuminate psychoanalytic history and epistemology from the standpoint of history of science and medicine. In Freud’s Shadow: Adler in Context (1983), Freud, Surgery, and the Surgeons (1999), and Psychoanalysis at the Margins (2009) are interdisciplinary studies that chart my movement from history of psychiatry and psychoanalysis to history of medicine.
So behind “Medicine, Health, and History” is training in European intellectual history and a 27-year career in mental health publishing. But behind both these tributaries stands my father, William Stepansky, a remarkable GP of the post-World War II generation, the man from whom I learned about medicine as art, science, craft, and calling. I have written of his extraordinary life and career in a memoir published in 2011, The Last Family Doctor: Remembering My Father’s Medicine. My postings, all of which are brief essays of 1,500 or so words, deal with a range of topics, but my father is always in the background (or, in some cases, in the foreground) of my musings.
A Jewish émigré from Russia, born in Rumania in 1922 during his parents’ flight from the post-World War I Kievan pogroms, he grew up in modest circumstances in the Jewish enclave in South Philadelphia. A surgical tech in a medical battalion attached to Patton’s Third Army, a licensed pharmacist, and a gifted violinist, he began medical training shortly after World War II and set up shop in a small town 30 miles west of Philadelphia in 1953. There he practiced general medicine until his retirement in the early 90s, after which he continued to counsel and comfort his patients until his death in 2008. His career and his example fuel my interest in various aspects of history of medicine, especially the evolution (and devolution) of primary care medicine in America since WWII.
Those interested in humanistic care-giving over the past six decades may enjoy a series of four postings under the general heading, “Primary Care/Primarily Caring.” Here I compare the quality of caring among generalist physicians of my father’s generation with their counterparts today; the role of procedural, hands-on medicine in forging bonds of trust; the rise and fall of psychodynamic psychiatry in general practice since WWII; the rise and fall of George Engel’s biopsychosocial model of illness; and the paradox of contemporary patient- and relationship-centered care. These essays, along with my eulogistic “Hail the House Call,” provide an interesting counterpoint to the role of the GP within the NHS.
Among postings that intersect with medical humanities, let me single out two more. “A Musical Offering” begins with my father, his violin, and his lifelong passion for chamber music and then proceeds to a more general consideration of chamber music playing in relation to narrative medicine. I am especially interested in how the sensibility associated with chamber playing contributes to the narrative competence associated with patient- and relationship-centered care.
“My Doctor, My Friend” probes the different kinds of friendship that doctors and patients may come to enjoy. In an era of patient rights, defensive medicine, and concerns about boundary violations, “real” doctor-patient friendship has for many become a problematic, even a minefield. Better to give way to the diffusion of connective energy fostered by social media and “friend” one’s patients via Facebook, et al. In this piece I voice concern that, among doctors and patients, the kind of nonprofessional, even depersonalized “friending” fostered by social media may be eroding the more singular kind of friendship associated with the medical calling: the physician’s nurturing love of the patient.
I am grateful to Angela Woods for this opportunity to introduce “Medicine, Health, and History.” I greatly enjoy keeping up to date with the wonderfully diverse offerings in medicine and humanities on your side of the pond through the CMH Blog. And I hope in a complementary way that members of the CMH community will find MHH informative of the medical scene over here and stimulating of comparative reflection about the challenge of humanistic caregiving in Britain and America.