If medical humanities is going to live up to the many hopes that are pinned to its name – such as improving clinical practice, understanding and better representing the experience of patients, holding the biomedical sciences to account, and widening the meaning of health and well being – then it must confront the scale and complexity of health issues, that is, it must think and act globally. It was under this theme, ‘the global’, that the tenth annual conference of the Association of Medical Humanities (AMH) was convened. It was the first AMH conference I had attended and, as a newcomer to the field (discipline? educational tool? intellectual milieu? conveniently strategic label?) I had much to learn, absorb and reflect upon. Certainly, it was an opportunity to hear about all the interesting work that was occurring in the name of medical humanities and also a great deal of critical attention on what we, as a group, could do together.
The views aired during the conference reflected the great variety of experience and expertise of the association’s members – clinicians, curators, historians, librarians, anthropologists, literary critics and many more besides – all mixed and communicating what was new in their work. Initial panels, four running in parallel, covered political geographies, histories, narrative and educational issues and encompassing epidemiological, pharmacological, theatrical and psychological work. I participated in a panel entitled, ‘Is the Past Really Another Country?: Medieval and Early Modern Perspectives on Medical Humanities’, in which Alison Williams discussed Rabelais’s medical and botanical knowledge, Durham’s Corinne Saunders presented medieval accounts of voice-hearing and other experiences of vision and hallucination, followed by a talk by Jamie McKinstry which examined the mnemonics and metaphors of depression in the later Middle Ages, returning on the confluence of physical and mental states of heaviness. I’ll put my paper up here in the coming weeks.
In some small measure, these historical perspectives prepared us for the conference’s first plenary, given by Sanjoy Bhattacharya, under the title ‘Humanities and Humanitarianism: An Uneasy Relationship’. Bhattacharya explored the troubling way in which the history of multilateral aid has been constructed to systematically exclude the failures of multilateralism. He took examples from the UNRRA’s role in the Bengal Famine (1943–44) in which some calculate that 6 million people died of starvation. The failure of UNRRA policy and its support for local sectarian groups created the conditions for India’s post-war politics, a fact rarely acknowledged in the history of the WHO or UNICEF, which is sanitised in order to reflect the triumphant history of organisations who promote a certain version of global health provision.
Such histories, argued Bhattacharya, furnished a ideological firing range in which ‘magic bullet’ policies could continue to be supported, often overlooking the complexity of local contexts and leaving corruption at local and global levels relatively untouched. In order to resist the passive repetition of historical falsehoods that serve to bolster the agendas of the powerful, he called for greater international co-operation among medical humanities practitioners, increased inter-lingual dialogue and cautioned against a too-cosy relationship between academics and policy makers.
The next day we heard Kathryn Montgomery discuss the effects of misidentifying of medicine as a ‘science’, based on the model pursued by physicists. The rule of evidence-based biomedicine, argued Montgomery, had drawn medical knowledge towards the mythology of facts rather than emphasing the generative basis of medical understanding in practice. Her plenary drew broadly from her own experience as a philosopher, bioethicist and medical educator and, I think, it was unusual to hear evidence-based medicine so warmly criticised, not only for its failure to adequately account for what Montgomery called ‘outliers’, or those that do not conform to the statistical medians which the norm, but for the damage that a focus on evidence-based medicine did to the status of traditional and complementary forms of medical practice.
This, I think, is where Montgomery’s talk ended where it should, in fact, have begun – on the evidential status of ‘non-traditional’ practice. When asked by Bridget MacDonald, a neurologist based at Croyden University Hospital, how the efficacy of complementary medicine should be demonstrated, Montgomery responded with an interest in but not an explanation of ‘pragmatic trials’. What was left suspended after this talk was whether we are to simply reject the epistemological ethics of evidence-driven medicine outright, or whether we should co-opt aspects of these methods in order to substantiate the claims made in the name of therapies that are currently ‘exiled’ from the mainstream. Such questions raise the rather ancient debate of how we should legislate between medical and non-medical knowledge, one that remains a pressing issue for the medical humanities and its activist agenda – what are the most effective forms of critique, how should we, as researchers and practitioners, ‘lobby’ for alternatives? Montgomery’s insistence on the kind of medical education young people receive on entering medical schools is, of course, important. But a wider set of relations, of the kind that Sanjoy Bhattacharya discussed the previous day, are surely at stake – including governmental, commercial, non-governmental and charitable actors – when attempting to transform what kinds of evidence are seen as legitimate.
Looking back at my conference schedule, I am now struck at all that I missed. Other than live-streaming everything onto an enormous bank of monitors, NASA-style, while conference delegates watch in uniforms of white collars and thick-rimmed glasses, I can’t see any practical measure to do justice to the sheer quantity of work being presented at these larger conferences. So I missed lots of interesting work on literature, narrative and cultural identity, and was instead delighted by Lisetta Lovett’s discussion of Casanova’s medical knowledge, Claire McKechnie on the trans-Atlantic politics of nineteenth-century cancer treatment, Alexandra Lewis’s discussion of the miasmic mood and atmospherics of Emily Bronte, and Aine Larkin’s discussion of Proust, memory and the work of Henri Bergson. I can’t say there was much that kept these papers on a common path, other than their high quality and their refusal to see a single site of cultural analysis as having a particular privilege on their subject matter. This is, of course, the creative advantage and centrifugal frustration of medical and other kinds of interdisciplinary humanities work. I was happy to see such colour in these fireworks.
I suppose it was obvious how John Lwanda (NHS Lanarkshire) was going to answer the question in his title, ‘Is Medical Humanities Only for Developed Countries?’, less easy was to anticipate how he would introduce his work, playing us Malawian music and dancing across the floor of the auditorium. With the tone set, Lwanda’s moved from topic to topic: the high rates of suicide in Malawi; the role of traditional medicine in a country with such grave public health problems; the trade in body parts; the shared importance of ritual and interpretation in modern medicine. In each he demonstrated the significance of the literary and musical arts, and, though there was an elision between those arts and what medical humanities was taken to mean (is every poet a medical humanities practitioner?), Lwanda’s insistence that medical humanities could play an important intermediary role between new and older forms of medical culture was forcefully made.
After this I sat in on a fantastic panel organised by Iain Milne of the Royal College of Physicians, Edinburgh. He was joined by Chris Henry who introduced the anatomical collections held at the Surgeons’ Hall Museum, David Shuttleton and spoke about the Wellcome Trust-funded digitisation project of William Cullen’s diaries and correspondence, and lastly, Simon Chaplin, Head of Wellcome Library, explained the dynamic approach that the Trust were taking towards their resources.
There was a great discussion about the many strategic decisions needed to support the development of new and existing research, as well as make resources more accessible, extending collections beyond bricks and mortar and into formats that could keep apace with the habits of online users. Curators are disciplinary soothsayers in some regard, anticipating both the intellectual and technological environments in which their collections are used. All these papers reflected on how collections must respond to and seek to inform disciplinary boundaries, which was striking since the collections varied widely in their potential audience.
The final panel I attended was an all-Durham affair, focusing on the experience of wonder and its relationship to medical cultures. This resonates with some of my work and I have been meeting with two of the panelists, Martyn Evans and Jan Pedersen, in recent months to discuss the topic. They were joined by Catherine Racine. All three accepted that seeking the extraordinary in the ordinary could challenge a number of philosophical, political and ethical enclosures, but did so with radically different targets in mind. Evans challenged humanistic assumptions about the difference between ‘humans’ and ‘things’, calling attention to the way that experiences of wonder can highlight a ubiquitous materialism. This view sat uncomfortably with the dehumanizing effect of some mental health services which, according to Racine, could objectify and dismiss patients as ‘heartsink’ cases, without hope for a healthy future. Wonder at and with the human condition, it was claimed, can provide a way of keeping us from these dehumanising discourses. Finally, Pedersen argued that the empathy at stake in many experiences of wonder, whether in technology or in the natural world, provided a means to emphasise common ground between different groups of people. Inspiring another lively post-panel discussion, all three identified the transformative potential of wondering at and with the body; an opportunity to revise scales, categories and perspectives.
OK, I’m now realising that this report is growing and growing so I’ll cut to the final day’s plenaries, sparing you the details of both the conference dinner, hosted in Aberdeen’s Town Hall, and the balletic pell-mell that followed. Historian Mark Harrison asked, ‘Is it possible to write a global history of medicine?’, giving an introduction to the various issues at stake when taking up such a project. He cautioned against the tendency to see all local histories as necessarily or straightforwardly ‘global’, as well as resisting the temptation to identify incipient globalisation where there is no evidence for such a teleological history. He gave an example from his own work on the eighteenth-century, Indo-Muslim court at Arcot – a place that was richly cosmopolitan but not easily absorbed into a colonial history of the region. Harrison went on to argue that careful historical attention needed to be paid to differing economic models so that we can better understand differing global resiliences to diseases. The result, he suggested, was a model of global medical history capable of identifying the effects of different ecologies as they developed, independently and in conflict with one another. This led to an interesting though not explicitly stated dialogue with the themes Bhattacharya had introduced on the first day – whose ‘global’ counts? How is medical humanities going ally itself within climate in which ‘global’ reach is rich with political and economic reward? Harrison’s demand that we keep “a critical distance” was well made but do we keep a critical distance together and in solidarity or are we to retreat from making collective interventions on a global stage?
It fell to CMH’s Jane Macnaughton to close a conference that had ranged over land and sea, into the clinical, educational, philosophical, artistic and political aspects of medical culture. She organised her talk around the idea of ‘scaling up’, which seemed appropriate given all the scales of meaning that had been scrutinised, revised and re-presented over the previous days. Macnaughton asked how we were to scale up our research so that we could approach the global health issues that were impacting people’s lives on a daily basis. She argued that we should not do so through a scale or model of action borrowed from elsewhere but through scales of practice that might be unique to the medical humanities, a scale particular to the research collaborations and cross-cultural partnerships that it affords. Far from suggesting a utopia, Macnaughton showed how her new project, ‘The Life of Breath’, on chronic obstructive pulmonary disease (COPD), sought to rectify the current absence of adequate clinical criteria for understanding breathlessness and early onset of COPD. She backed this with another example – the work on auditory-verbal hallucinations being dong by Hearing the Voice. She showed how critical interdisciplinary medical humanities could address global health issues in a way that was both responsive and collaborative. It was by emphasising the strength of these small teams – diverse and creative, full of expertise, organised in order to develop research together – that she could come to Margret Mead and the words that concluded the 10th Association of Medical Humanities conference: “A small group of thoughtful people could change the world. Indeed, it’s the only thing that ever has”.
Having spent so much time at the sort of conferences where a call to collective action would either be politely ignored or gently sniggered at, I found it invigorating to hear of work that was seeking to affect meaningful change at a global scale. I left the conference with the same sense of ambivalence about the medical humanities as a ‘discipline’. I remain especially ambivalent should this ‘discipline’ model itself on the nation state (complete with border controls, penal system, honors list and so on). I’m much more attracted to a version of the medical humanities which operates like an international space station – a collaborative, multipolar network without an ordinary sense of territory; a place for creativity with some stellar perspectives.
Thanks go to Catherine Jones and the rest of her organising committee for such a wonderful conference, and to the Wellcome Trust for their financial support.
 Although these words cannot be located in Margret Mead’s written work they are closely connected to her The Wagon and the Star: A Study of American Community Initiative, see Nancy Lutkehaus, Margaret Mead: The Making of an American Icon (Princeton, NJ: Princeton UP, 2008), p. 261