Medical humanities:demarcations, dilemmas anddelightsAudrey Shafer

Dark/light, question/answer, teacher/stu-dent, science/art, female/male. Our livesare chock-a-block with categories. It ishuman nature to distinguish pattern,indeed it is life-saving on the savannahor on a city street to differentiate move-ment from stillness. However, we livemostly in the in-between. In the give-and-take between categories, relationshipbecomes paramount and seemingly defi-nitive boundaries blur. What makes lifemessy and uncertain also, after all, makeslife interesting. Furthermore, anythingwith a moral quality, such as good andbad, will have associated quandaries andnuances.

Medical humanities is an area of scho-larship, education and creativity peopledwith those who primarily, secondarily orin no way associate themselves with thefield. Therein lies the first demarcation,dilemma and delight. From my initialexposure to medical humanities, at aweeklong seminar at Hiram College inthe cornfields of Ohio, I knew I was in foran intellectually fascinating ride. In atten-dance and presenting were theologians,nurses, English professors, social workers,physicians, historians, anthropologists,artists, writers, therapists, educators, ethi-cists and of course those who woremultiple hats—what a collection of talentand experience! We had (and continue tohave) engaging, productive interactionsboth in the seminar and off-hours. Cross-fertilisation is the delight, professionalbarriers the dilemma. Language, careerdevelopment priorities, funding sourcesand educational domains vary strikinglybetween groups of professionals.Nonetheless, these people did associatethemselves, to varying degrees, withmedical humanities. Clearly there aremany, many more who work on, writeabout and wrestle with themes and issuesof medical humanities who do not affili-ate themselves with the field. For exam-ple, few filmmakers, writers and artists

whose work is annotated on the New YorkUniversity medical humanities database(http://medhum.med.nyu.edu/) would befamiliar with the term, let alone publiclyassociate themselves with this area.

But, you may protest, writers whosework appears in the canon of literaturecourses do not identify themselves asEnglish professors. Why should the crea-tors of art or research studies (forinstance, a cultural anthropologist study-ing healing practices in Papua NewGuinea) affiliate themselves with medicalhumanities? And therein lies the nextdemarcation, dilemma and delight. Thedelight is the welcome of front-line artistsand interlopers from distant disciplines tothe cause of medical humanities. Thedilemmas include a snubbing of medicalhumanities as a dilute, noncritical mish-mash of applied theory without academicdepth, rigor or demarcation.

Another dilemma is the variable extentto which those who work directly withpatients or in health environments vis-a-vis the arts consider themselves or areconsidered by others to be included underthe medical humanities umbrella. Suchpeople may be poetry, art or musictherapists, hospital art committee mem-bers, or medical-centre-based orchestramusicians. In the USA, medical centresvary greatly, but it is not uncommon forthe hospital-based art therapy programmeand the medical-school-based medicalhumanities programme to have littleinteraction. Similarly, the professionalsocieties, such as the Society for the Artsin Healthcare (http://www.thesah.org)and the American Society for Bioethicsand Humanities (http://www.asbh.org/),have only mustered fledgling interactions.In the UK, the boundaries seem moreporous: the 2008 meeting of the Associationfor Medical Humanities (http://www.gla.ac.uk/departments/amh/) contains thiswelcome note from Sir Kenneth Calman,chancellor of the University of Glasgow:

Perhaps the most important character-istics of medical humanities is that itlinks seemingly disparate disciplines andstimulates collaborations that benefit

patients. In this tradition, the workwhich will be presented here comes frommedical and arts communities, and fromhealthcare as well as academia. It pro-mises to generate discussion and newideas, and stimulate further develop-ment. (p9)1

Indeed, the disciplines encompassed bymedical humanities cross the borderlandsbetween medical school, hospital andother healthcare provider programmes,and also traverse the university. Medicalhumanities programmes can be basedoutside of a medical school, directed atundergraduate or graduate education.They can be bedfellows with ethicsprogrammes, but because of fundingdiscrepancies and variable mandates (suchas a requirement for a hospital ethicscommittee), the partnership can feelunequal and medical humanities may finditself fighting for a corner of the bedsheet.They can be led by faculty with an arrayof different qualifications and degrees.Invariably, the humanities of medical huma-nities subsumes and assumes the arts andsocial sciences, yet universities tradition-ally separate these broad areas by depart-ment and school. Even in interdisciplinaryprogrammes, faculty associates are fre-quently dependent on their ‘‘homedepartment’’ for appointment and promo-tion. The dilemma of comparison (eg, thevaluation of single-author versus multi-author publications) can stifle collabora-tion, since, for instance, a performing artsdepartment will have different theoreticalunderpinnings, methodologies, scholarlyactivities and products from a philosophydepartment.

Medical humanities suffers from anidentity crisis that extends beyond its

Correspondence to: Dr Audrey Shafer, Anesthesia112A VAPAHCS, 3801 Miranda Avenue, Palo Alto,CA 94304, USA; ashafer@stanford.edu

Editorials

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name to include its definition and mis-sion.2 ‘‘Narrative medicine’’, ‘‘arts, huma-nities and medicine’’ and ‘‘medicine insociety’’ are some of the names formedical humanities programmes. Nearlyevery conference includes a discussion ofdefining or redefining medical humanities(see, for example, http://bioethics.north-western.edu/events/b2b_schedule.html).Why, how, when, and by and for whomare questions that plague educators inter-ested in optimising the potential formedical humanities in curricula.3 Even if acore value of the medical humanities is theaspiration to better human relations inmedicine, including acknowledgement ofcomplexity, ambiguity and multiple per-spectives, the proclamation of medicalhumanities as the way to perfect and popout a humanistic, compassionate, com-pleat doctor dooms the endeavour toderision. Even worse, equating a dose of‘‘culture’’, such as an isolated, noncontex-tualised film screening, to doing the workof medical humanities is dangerous.Muddying the terms professionalism andhumanism further confuses the role ofmedical humanities as a means of codifica-tion rather than reflection.4

Yet why is the field of medical huma-nities filled with such a plethora ofdilemmas, including marginalisation, tri-vialisation, identity crises and boundarybumping? And why is it so full of delight—not only the delight of intellectual curios-ity, but also the delight of affirmation? DrTrevor Thompson, now codirector of the

BA in Medical Humanities programme atthe University of Bristol writes, ‘‘Reared inBelfast, I studied in Oxford and Londonfrom where I graduated with a degree ofuncertainty about the completeness of the‘‘biomedical’’ model’’ (p89).1

I believe the reason why medical huma-nities brims with dilemmas and delights isthat its main concern, its raison d’etre, ismeaning-making. And not just any oldmeaning-making, but meaning-makingabout life itself. Medicine is about life,death, health, illness, youth, age, suffering,relief—and everything in between. It isabout the human condition, what it meansto be embodied and what it means to beembodied in your particular body. It isabout relationship and the murky mistwhere relationship is forged. The article‘‘Troubling dimensions of heart transplan-tation’’ by Shildrick and colleagues in thisissue is a striking examination of thecomplexity of corporeality, relationship,medical experience and meaning-making.5

When medical humanities ceases tostruggle with what it encompasses—how to be inclusive yet not amorphous,how to best explore the issues and how toshare these issues with students, collea-gues, patients and the public—then it willcease to be medical humanities.Paramount to the meaning-making aretwo sets of relationships, two types ofborder-crossings: the demarcation, how-ever blurred or distinct, between the onewho is ill and those around the patient,including the healthcare provider; and the

demarcation between the one who is illand the memory, dream, hope or even fearof being well. Poems such as Plath’s Tulips(‘‘a country far away as health’’)6 andHoagland’s Emigration (‘‘the memory ofyour health is like an island/going out ofsight behind you’’)7 are entrees to themeaning-making. Medical humanities isdifficult work. It is frustrating and invi-gorating work. Despite or because of thedemarcations and dilemmas, medicalhumanities is rewarding and replete withdelights. But ultimately, and most impor-tantly, it is vital work.

Competing interests: None declared.

Audrey Shafer is a government employee.

J Med Ethics; Medical Humanities 2009;35:3–4.doi:10.1136/jmh.2008.000869

REFERENCES1. Dominiczak M, ed. Creative space: arts, humanities,

and health care. Book of abstracts. Fifth annual meetingof the Association for Medical Humanities, University ofGlasgow; 8–9 July 2008. http://www.gla.ac.uk/media/media_103894_en.pdf (accessed 11 Apr 2009).

2. Campo R. ‘‘The medical humanities,’’ for lack of abetter term. JAMA 2005;294:1009–11.

3. Shapiro J, Coulehan J, Wear D, et al. Medicalhumanities and their discontents: definitions, critiques,and implications. Acad Med 2009;84:192–8.

4. Goldberg JL. Humanism or professionalism? Thewhite coat ceremony and medical education. AcadMed 2008;83:715–22.

5. Shildrick M, McKeever P, Abbey S, et al. Troublingdimensions of heart transplantation. Med Hum2009;35:35–8.

6. Plath S. Tulips. In: Plath S. Collected poems. NewYork: Harper & Row, 1960:160–2.

7. Hoagland T. Emigration. In: Sweet ruin. Madison,Wisconsin: University of Wisconsin Press, 1992:69–70.

Hearing Australian Aboriginalvoices on neglect andsustainabilityThomas Faunce

In this issue of Medical Humanities, Matharudiscusses four plays about AboriginalAustralians from the 1980s that providean indigenous perspective on the protractedprocess of official neglect that has had adisastrous impact on the health of theirrace.1 Matharu points out, ‘‘Within anAboriginal context, acting represents anintegral part of educating others on

important cultural traditions and rituals.’’He cites as an example those song and danceperformances under then recently enactedland claim legislation that were critical toeventually establishing indigenous legalownership over large sections of northernAustralia. Matharu notes that the dramaticworks chosen for analysis are the productsof this watershed moment in indigenousAustralian history. ‘‘During this period’’, henotes, ‘‘issues of identity and sovereigntybecame more prominent with the right tovote and participate in government affairsafter a long period of suppression.’’

Matharu highlights how in Jack Davis’sThe Dreamers (1980), the death of theAboriginal elder Worru becomes symbolic

Correspondence to: Professor Thomas Faunce, Collegeof Law and Medical School, Faculty of Law, Building 5,Canberra ACT 0200, Australia; Thomas.Faunce@anu.edu.au

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and delightsMedical humanities: demarcations, dilemmas

Audrey Shafer

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