Two conceptions of medical humanities

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The biomedical model was predominant in Westernmedicine and largely went unchallenged for thehundred years from the middle of the nineteenthcentury to the middle of the twentieth century. In the1960s a number of factors led to a sustained question-ing of the model and this has resulted in some sig-nificant developments in subsequent years. Thesechallenges came from both within medicine, e.g. theantipsychiatry movement, and from society more gen-erally, e.g. the demand for greater personal autonomy.One outcome has been the establishment of a range ofnewly professionalized medical subdisciplines relatingto the social sciences and ethics, and as a consequencean enlargement of the medical curriculum.These sub-disciplines include, most notably, medical sociology,medical anthropology, social history of medicine,health economics, politics of health, medical law andmedical ethics or bioethics.

This development has been aimed, on the whole, atredressing the scientific bias of traditional biomedi-cine, with the purpose of providing a more balancedapproach to medical theory and practice. What it haslargely failed to confront is the compartmentalismassociated with reductionism, and in spawning newdiscrete subdisciplines has if anything reinforced this tendency. Nor has it explicitly dealt with the place of the arts and their relationship with science inmedicine.

Medical humanities also began to gain recognitionin the United States in the late 1960s, although it hasonly recently begun to be acknowledged in Britain,and the reasons for its development are broadlysimilar to those identified in relation to the social sci-

270 © Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 270–271

ences and ethics. Of particular relevance to medicalhumanities though, is the scrutiny of two biomedicalpresuppositions, which as indicated have not gener-ally been taken on board by these new subdisciplines:

1 The division of medical knowledge into arts andsciences, and the parallel division of medical practiceinto humanistic and technical components, with priority being given to the scientific and technicalaspects.2 The reductionism of medical knowledge into subdisciplines, and medical practice into related specialties.

Within the medical humanities, however, therehave been two patterns of response to these issues,which we have referred to elsewhere as the ‘additive’and ‘integrated’ conceptions (although as far as par-ticular initiatives are concerned they are not neces-sarily kept separate or clearly distinguished; Evans &Greaves, 1999). Broadly the former only deals withthe first of these presuppositions, whilst the lattertakes account of the second as well, and they will nowbe considered in more detail.

The additive conception of medical humanitiesinvolves a series of discrete subdisciplines relating to medicine and the arts, e.g. medicine and litera-ture, which when viewed collectively constitute themedical humanities. Thus it is consonant with thedevelopments of medicine and social sciences sub-disciplines, and represents a further extension beyondtraditional biomedical sciences to incorporate thearts. Not surprisingly then, its aims are in general anextension of those that apply to these subdisciplines

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critical reflection capable of providing both analysisand synthesis.4 The overall objective then becomes a re-examination of the nature and goals of medicine and health care, and entails not just an extension ofmedical knowledge and practice as with the additiveconception, but their reconfiguration.

When viewed as a whole these features of the inte-grated conception of medical humanities can be seenas presenting a second generational challenge to bio-medicine, following on from the earlier challenge thatbegan in the 1960s, and of which the additive con-ception can be seen to be a part. In contrast with theadditive conception, which aimed to complement the biomedical sciences and humanize health carers,the integrated conception seeks to humanize thewhole of medicine, a central requirement of whichinvolves an engagement between the arts, social sci-ences and natural sciences. In order to distinguishthese two approaches there might be merit in refer-ring to the additive conception as the medical arts, orthe arts in medicine, and to reserve the term medicalhumanities for the integrated conception.

David GreavesUniversity of Wales Swansea

Reference

Evans M. & Greaves D. (1999) Exploring the medicalhumanities. British Medical Journal, 319, 1216.

© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 270–271

viz to provide a more comprehensive counterbalanceto medical science, with the expectation that anappropriately balanced curriculum will also human-ize practitioners (although this does not necessarilyfollow automatically as is often assumed). So theadditive conception of medical humanities providesan augmentation to a more general challenge to bio-medicine, rather than a different response, and thusalso embodies its limitations.

The second approach to medical humanities, theintegrated conception, aims to go beyond this andprovide a more radical response to biomedicine’sassumptions. Several features can be identified thatdifferentiate it from the additive conception:

1 In order to overcome the divide between arts andscience, the focus is on the human in medical human-ities rather than simply the role of the arts. This can then be applied to aspects of the natural sciencesand the social sciences as well as the arts, allowing for linkages and insights across these traditionaldivides.2 Medical humanities then becomes viewed not as anew subdiscipline, or series of subdisciplines as withthe additive conception, but as a perspective that per-meates and has application to all aspects of medicalknowledge and practice. Hence it is interdisciplinaryrather than multidisciplinary, and provides the pos-sibility of enabling synergy between disciplines.3 It requires a degree of unity in its methodology toachieve this interdisciplinary vantage, which involves