Learning Empathy through Chekhov

July 26, 2016 at 3:26 pm

Guy Glass, MD, MFA, Clinical Assistant Professor
Center for Medical Humanities, Compassionate Care and Bioethics
Stony Brook School of Medicine

I am a psychiatrist who writes plays and has several professional productions and published plays to my credit. Having recently earned an MFA in theater from Stony Brook University, I am now affiliated with the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University School of Medicine. At both Stony Brook, and starting this fall at Drexel, I teach an elective entitled "Theater and the Experience of Illness" in which medical students both read plays and write their own dramatic monologues.

I dedicated my master's thesis to finding ways that plays might be used in medical education. This involved creating dramatic adaptations of two of Chekhov's "doctor" short stories, including "A Doctor's Visit." In April 2016, I was invited to bring "A Doctor's Visit" to the Arts and Health Humanities Conference in Cleveland. There, I was fortunate to have the opportunity to create a piece of theater with five medical students who happen to be very fine actors and who contributed the blog post below. I'm delighted to see that the exercise gave the students insight into what the arts can contribute to medical training. Moving forward, I hope to find other institutions that will allow me to bring this program to their students.

Reflections on the Importance of Dramatic Arts in Medical School Curricula

Alicia Stallings, DaShawn Hickman, and Nick Szoko

clevelandclinicIntroduction

As a part of the Medical Humanities conference held at the Cleveland Clinic on April 9th, 2016, we were asked to perform a dramatic reading of an adapted short story by Anton Chekhov entitled, "A Doctor's Visit." The piece, thoughtfully developed by Guy Glass, MD, MFA, takes place in a factory town outside of Moscow in the 1890s. It features a diverse group of characters: Dr. Korolyov, a middle-aged physician working to jumpstart his struggling practice; Boris, his eager apprentice; Christina Dmitryevna, a caricaturized spinster; Liza, a seemingly spoiled heiress; and Madame Lyalikov, Liza's frenetic and overbearing mother. The story centers on the encounter between Dr. Korolyov/Boris and the inhabitants of the Lyalikov mansion. Dr. Korolyov is called upon to tend to the needs of Liza. Motivated by the prospect of compensation, Dr. Korolyov and Boris make their way to a gritty industrial town outside of Moscow where the gaudy mansion is situated. They arrive to find a hysterical young woman, Liza, nearly bed-bound for no apparent reason. Initially, Dr. Korolyov operates in a detached, business-like manner when examining and interacting with Liza. He is eager to perform his duties and exit, having excluded any true disease process; however, when Madame Lyalikov invites Korolyov and Boris to spend the night at the mansion, Dr. Korolyov achieves a moment of profound insight when he stands in the property's garden and gazes at the glowing factory lights beyond. In this setting, Korolyov recognizes his lack of compassion and revisits Liza in her room, finally able to connect with the young woman and "cure" her by acknowledging and validating her unique narrative. In reading, rehearsing, and performing this work, we extracted three important themes: empathy, justice, and professionalism.

 

hickmanJustice, as told from the perspective of Boris (DaShawn)
Case Western Reserve University School of Medicine

At the start of the play, Boris attempts to wake the doctor, but we quickly learn that Korolyov would rather the student learn more of the basic science and medicine on his own. He is told to "memorize all the books on my bookshelf, dissect all the rats and frogs you can find. And come back at noon." As outrageous as this sounds coming from the doctor, many schools have taken to this self-directed learning style. Students are spending more time reading and learning on their own or in groups than with professors during their first two years of medical school. The play also makes it abundantly clear that although students need patients to learn from, patients are not always as willing to allow students to learn from them. One of the characters in the play, Christina Dmitryevna, bans Boris from seeing the patient with his teacher. She expresses how she is displeased to be "running a medical school." Being able to act in this role allowed me appreciate all the time I am able to spend with patients during my formative years as a student doctor.

Although the doctor doesn't appear interested in directly teaching Boris basic sciences, he does take the time to teach him about communication skills, history, and society, all topics that will have an impact on the quality of doctor that Boris will become. A theme that emerges from interactions between Dr. Korolyov and Boris is justice. As the doctor and Boris travel away from Moscow to the industrial town, the socioeconomic disparities become more pronounced. The doctor teaches Boris how poor and hard-working the factory workers are. He tells Boris that even though they are poor like the factory workers, because they are doctors, and thus in a higher social class, "[the factory workers] will always hate us."

The town is covered in soot from the factory, and so many people have health problems, including the limited life expectancy of 35. Despite this, the doctor lectures, "it is a pampered rich girl we have been asked to care for." Dr. Martin Luther King, Jr. summed up his teachings nicely when he stated "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." The doctor not only points these injustices out to the student but challenges them in front of the student. He asks about the well-being of the factory workers and implies that it is subpar to the wealthy he has come to visit. These are bold actions that not only teach Boris to recognize injustices but to confront and work to dismantle them.

Without future doctors being taught these lessons the injustices that exist today will continue to permeate our healthcare system, stifling advancements in this realm for the betterment of mankind overall.

 

Professionalism, as told from the perspective of Madame Lyalikov (Alicia)
Cleveland Clinic Lerner College of Medicine

In the reading, I portrayed Madame Lyalikov, the mother of the patient in the play. In this role, I found that many principles of professionalism were highlighted during the preparation and enactment of the dramatic reading. One component that stands out was the principle of responsibility to colleagues. During my preparation for the role, it gradually became clear to me how different I was from the character. I could not relate to her in her stage of life (I am not a mother), nor her walk of life (I am not wealthy), nor her personality/disposition (I am neither of the anxious variety nor passive). Yet, despite my lack of similarity to this character, for the sake of the audience, to learn from the play, and for the sake of my fellow student-actors, so that they could also portray their characters well, I needed to work to understand this characteraher perspective and her mindsetato meet my responsibility to the group.

Principles of professionalism specific to the practice of medicine were also highlighted in the play. Most notably, the issue of bias was an important theme, which was illustrated by Dr. Korolyov's negative comments to the student about the patient and her mother. In my role as Madame Lyalkiov, I had an interesting vantage point, being both privy to Dr. Korolyov's bias, as an actor, as well as the object of his prejudice, as the character. In this unique position, I found myself reflecting: is Korolyov aware of his prejudice towards her and her daughter? Can she feel how he feels about them? Does she feel that his prejudice is impacting his care of her daughter? Is his prejudice hurtful to her? It was very interesting to reflect on these questions from the vantage point of a future healthcare professional. One likes to think that her attitude towards others can be isolated from how she treats them, and that one can even hide their prejudice, so that the other party is not aware. However, is this true? Are we as medical professionals, and as people in society at large, able to separate how we feel about others from how we treat them? And perhaps more importantly, if how we feel about them is based in prejudice (as in the case of Dr. Korolyov), is it acceptable to continue to harbor these biases, even if we think we can separate them from how we treat patients? These are important questions for students to consider as move forward in their development as medical professionals. My role as Madame Lyalikov brought these questions to the forefront, and gave me much to reflect on with regards to professionalism in interacting with and caring for patients.

 

Empathy, as told from the perspective of Dr. Korolyov (Nick)
Cleveland Clinic Lerner College of Medicine

"You will learn, if you are to be a doctor, you do not always have to do a thing." As Dr. Korolyov prepares to depart from his visit at the lavish Lyalikov mansion, he offers these reflections to his young assistant, Boris. As medical students, the words of Dr. Korolyov surely resonate with us. We embrace ignorance, thrive in discomfort, and accept inaction. We feel dually limited and protected by our positions as trainees. We are told that the greatest gifts we can give our patients are not medical expertise or surgical acumen, but rather our time, humility, and empathy. So what happens when these fail?

It is no secret that the ability of medical professionals to empathize declines over time. We are cautioned from the first day of medical school regarding this well-cited trend. When we examine Korolyov, we see the familiar vices of the burned out physician. His initial motivation to visit the Lyalikovs is financial. He forms a prejudgement of his patient based on socioeconomic class and lets this guide his diagnostics. There is an unspoken aroma of efficiency and industriousness that hovers over the encounter. As medical students, we face a similar climate. Our attitude towards learning and career choice is tinted by the haze of student debt. We train in tertiary care centers that venerate evidence-based medicine and cost-conscious care. We aim for concision and efficiency in our interviews and presentations. Amidst this, we strive to temper our own arrogance so as not to become hardened to the pain of those around us. With each day we spend on the wards, we are tempted to limit our vulnerability and minimize our emotional presence so as not to compound physical exhaustion with psychological. We ask ourselves, "Am I becoming a professional?" or, "Am I losing my humanity?" We become less of Boris and more of Korolyov.

For Korolyov, it takes a revelation, an "Aha!" moment to arrive at the proper diagnosis. Indeed, it is not until his liminal experience in the garden that Korolyov finally overcomes his psychological barriers to connect with his patient, recognize his biases, and act as a healer. Romanticizing such transformative moments is not unfamiliar in our profession. Our attendings often recall patient encounters that made them stop, reflect, and even reform. As medical students, we remember our first patient death, the first child we delivered, or our first "thank you." These moments, though rare, do more than just provide subtext for television dramas or ignition for research funding campaigns. In some ways, these instances and the act of recounting them eternally bind us to the humanism of our craft while allowing us to mature in our profession. Storytelling, whether it by play, article, or interview, remains powerful, not only for those who listen, but also for those who share. In reliving these experiences, we evoke our emotional self, and this is often done from a place of greater experience and wisdom. The value of this exercise cannot be understated, because beyond connecting us to the ethereal concept of "emotion," it allows us to reflect, critically and honestly, about how this experience and others like it have shaped our practice today. By participating in a dramatic reading of "A Doctor's Visit," I told a story that, over time, became my own. This opportunity offered a space for vulnerability and introspection, and I am thankful that I could engage in this dialogue alongside my colleagues.

Conclusions

For many students entering medical school, it has likely been years since they have taken part in a traditional stage play. Although many may have participated in variety shows or other short dramatic works in college, these dramatic engagements are notably different from traditional plays. The content of variety shows is written by the students themselves, and therefore generally presents contemporary issues from contemporary lens using contemporary language (most of which are shared by and native to the students). Other works of drama present the opportunity to explore diverse settings, subject matter, and perspectives. Utilization of selected plays and short scripts as teaching tools for individual students as well as groups of students has great potential. Indeed, for many medical students, there is great power in silencing our own voice to fully walk in the shoes of another and experiencing the world from their eyes. Script readings can offer students an opportunity to do so again, while providing a reminder why it is important to do so in life as well.

Other members include:
Anne Runkle and Megan Morisada, Cleveland Clinic Lerner College of Medicine.

The Patient Experience Book Club at NYU Langone Medical Center

March 2, 2016 at 1:41 pm

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When an AP reporter called to tell Erika Goldman, publisher of the Bellevue Literary Press, that its novel, Tinkers, by Paul Harding, won the 2010 Pulitzer Prize for fiction, "it was akin to receiving a blow to the head," she said. "It was concussive." For the first time since 1981, a book published by a small press won the award.

Ms. Goldman told this story to the members of the Patient Experience Book Club at NYU Langone Medical Center, a group that includes physicians, nurses, administrators, analysts and social workers among others. On a recent Friday afternoon, the group met to discuss Tinkers.

Tinkers recounts the last days of George Crosby. Lying in a hospital bed in the middle of his living room, surrounded by the members of his extended family, George's thoughts drift between the scene around him and memories of his boyhood. His father, Howard, a peddler of home goods in rural Maine, had epilepsy. Faced with the possibility that he would be committed to a psychiatric hospital Howard Crosby abandons the family leaving George, his mother and siblings to fend for themselves.

Time is a thematic thread running through the novel (George repairs clocks) as the narrative flows between memories of his childhood and his adult life. Harding describes his book as unlineated poetry. Its rich, descriptive language requires readers to settle into the prose, avoid distractions, and allow themselves the space to fully experience the story.

After a brief introduction by Ms. Goldman about how the Pulitzer Prize process works, the group turned to a discussion of the text. Their interpretations were filtered through their individual experiences working with patients and families. A social worker compared some "not so great" deaths she has witnessed to George's death at home with his family. A neurology administrator pointed out that the stigma attached to epilepsy remains a problem for some of the patients she encounters. Tinkers draws attention to the silence surrounding illness, another commented.

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The Patient Experience Book Club was started by Dr. Katherine Hochman in 2012. She came up with the idea after attending a conference on patient experience that was organized by the Institute for Healthcare Improvement in Boston: "What I took away from that was in order to have an engaged patient, we need to have an engaged staff." She decided to hold meetings every two months to discuss books that related, even tangentially, to patient care. A small grant funds box lunches and copies of the selections. The books are made available in advance of the meeting. Sessions typically draw from 10-30 people from all areas of the medical center. For many, it's a chance to meet co-workers who they do not interact with in their normal daily routines.

Locksley Dyce, a hospital administrator, loves to read and is a regular attendee: "It affords me the opportunity to meet in a multi-disciplinary group and exchange thoughts with healthcare professionals whom I probably would not meet otherwise."

The Club invites a faculty or staff member with expertise in a particular area to lead the sessions. Dr. Joseph Lowy from the palliative care service led the discussion of Being Mortal by Atul Gawande. David Oshinsky discussed his book Polio. And during the Ebola scare, the novel Blindness prompted a discussion of what it would be like for a whole society to be affected by an illness. During that session, Hochman and the group wore blindfolds to experience blindness for themselves.

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Mr. Dyce finds the sessions particularly thought-provoking. "We try to apply the material from the book to healthcare - especially patient care - and the individual roles that we play in it," he said.

As the session on Tinkers drew to a close, and the members prepared to go back to work, ordering tests, analyzing metrics and attending to their patients, they reflect on the issues brought up in the meeting and acknowledge the importance of taking time to connect with their patients.

The group meets next in April to discuss When Breath Becomes Air by Paul Kalanithi.

Biocultures: Take 2

February 11, 2008 at 2:27 pm

Designer babies, Rowena Dugdale, Wellcome Library, London
Commentary by Bernice L. Hausman, Ph.D.,Department of English, and coordinator of the undergraduate minor in Medicine and Society, Virginia Tech.

On December 29, I acted as respondent to a panel on biocultures at the Modern Language Association meeting. The panel, "Biocultures: An Emerging Paradigm," was organized and chaired by Lennard Davis, who read from the manifesto (written with David Morris) introducing the recent issue of New Literary History (vol. 38, no. 3, 2007) discussed by Brad Lewis in his August entry to this blog. Jonathan Metzl gave a paper on "Protest Psychosis: Race, Stigma, and Schizophrenia," while Jay Clayton spoke on "Victorian Epigenesis: Inherited Behavior without Genetics." This blog entry is an edited version of my remarks.

Data and truth

Every year I lecture to the Careers in Medicine class at Virginia Tech on the social contexts of medical practice. This fall's lecture was "Against Health," inspired by a conference put on by Jonathan Metzl at the University of Michigan in 2006. Based in a Foucaultian paradigm to explicate the normalizing effects of biopower, the lecture challenged the idea that "health" is an unalterable good based in the truth of scientific evidence. I had focused on the problem in making "health" the goal of life a not a means to a good life, but a substitute for life altogether, such that working for health has become a major preoccupation for many people and is now a measure of goodness, morality, and righteous living. Since "science," through what is now called "evidence-based medicine," provides the ballast for concepts like "health," "health" is unassailable. "Health" cannot be challenged because it is based in the truth of scientific study. But that is only through a very narrow framework for analysis a the same kind of framework that suggests that one's eating habits should be determined by the results of a blood cholesterol test rather than cultural traditions or the local availability of various foodstuffs. I was trying to dislodge this narrow framework by suggesting its stresspoints and problems, by highlighting the historical particularity of lifestyles framed by scientific studies and medical prognostications.

At the end of the lecture, one frustrated premedical student asked me, "what's your data?"

As Lennard Davis points out in the manifesto, "data" is a point of contention between the sciences and the humanities, despite decades of excellent research in science studies. Indeed, we still operate with the understanding that in the humanities we have "critical thinking (i.e., no data) while in the sciences there is strong data, usually conveyed in numerical form. Having no data is tantamount to having no truth. In the cynical view, "critical thinking" might be figured as that activity one engages in the absence of any clear truth, the intellectual game one plays with no data. "Critical thinking" is what the humanities offers the world, but only because the field is perceived to lack true data and the valuable facts that emerge from it.

Why we need biocultures

Any biocultural synthesis thus faces the degraded profile of the humanities in public culture and the hegemony of "science" over "truth." Even in arenas where humanistic knowledge might be especially helpful, it is absent or denied. At the 2006 International AIDS conference in Toronto, the social sciences made it into the program, but the humanities were completely absent. One session I attended addressed "controversies around prevention strategies for sex workers and injecting drug users, showing how politics and ideologies are pitted against "good science"." At this session I was struck by two assertions a 1st, that good science is as an antidote to politics and ideology, and 2nd, that scientists are equipped to identify and overcome ideology. I suggested, in keeping with Len's claims, that in addressing these issues, "scientists should look to . . . humanists and interpretive social scientists who think about the work of ideology and its sociocultural effects."

This is precisely the kind of intervention that Jonathan Metzl is making in his research on the racialized meanings of schizophrenia in the twentieth century. His claim does not merely concern the social determinants of disease categories and understanding, but addresses how the diagnostic process itself is racialized. He argued that schizophrenia actively functions to "enable mainstream America to grapple with" effects of the Civil Rights movement on the meaning of America; this claim demonstrates how biocultural analysis understands diseases as "disease entities," in Len's words. Jonathan's project moves us closer to Len's suggestion that "experiments using 'race' [would] be better a produce more reliable facts a if they employed a biocultural notion of what race in fact means." Feminists have connected mental illness diagnoses to normalized and heavily gendered cultural scripts; it is time to determine how race figures in the construction of mental states and disease entities.

But how do we keep biocultures from being another form of enhancing science's own projects, especially ones that misrecognize the existing and potential contributions of humanistic inquiry?

This is the problematic addressed by Jay Clayton in his paper on the new Neolamarckian epigenetics; he suggests that in policy contexts, "our (that is, humanists') absence from the room skews the resulting image of culture." The time is ripe, he argues (although without cliche), to move into the policy arena through the specific study of literature and an understanding of its historical embeddedness. This deep understanding, as opposed to the vague gesture toward literature as the repository of timeless values, allows literary humanists to engage knowledgeably in the important ethical and policy debates surrounding new technologies, practices, and aspirations in the biosciences. We must enter into what Jay calls the "semi-autonomous realm of policy" a the institutional context that, in his words, "gives critique at least a chance of having real consequences."

Revitalizing the humanities: biocultures in the contact zone

The biocultures initiative asks us to get into the scrum and tangle with the significant scientific and medical issues of the day. This endeavor stands to revitalize the humanities. It does so not only by insisting on putting scientific endeavors in context, but also by rethinking humanistic inquiry itself, particularly how its findings are unique and potentially useful to those who are not by profession nor inclination humanists. Significantly, Jay argues that we must do this by coming forward "as experts in our own fields," not through a flattening of our interpretive acumen or a repackaging of our ideas to "the people." Policy contexts are, indeed, a good match for the kind of analyses we develop in literary and cultural study a attentive to detail and consequence, broadly descriptive but at the same time focused, our interpretive practices tend to take an example, develop an understanding of context, and make broader conclusions with suggestions for caution and specificity. These seem ideally suited to public policy.

In the case study example that Jay provides, current epigeneticists are confident that their support for directed evolution and the inheritance of acquired characteristics, based in "strong" data, will avoid eugenic tendencies and arguments for intelligent design, both construed as ideological overlays on scientific findings. These arguments seem to replicate the "good science" over "bad ideology" claims made in Toronto that I alluded to earlier. Literary analysis allows us to see the mutual and inevitable imbrication of science and ideology, such that the good and bad cannot be disaggregated from the mix so easily and assigned a stable meaning. As Jay points out, culture mediates the meaning of scientific findings in ways that scientists rarely control. The difficulty of separating science from ideology, beliefs grounded in "data" from utopian longings, is captured in Charlotte Perkins Gilman's Herland, another Neolamarckian text devoted to eugenics and presenting a feminist utopia simultaneously enabled and marred by its racist science. The modern history of biology is haunted by the "race problem" because it remains culturally unsolved, and vice versa a the modern history of culture is haunted by the "race problem" because race remains a biological puzzle, seemingly evident somatically but nonexistent in a genetic sense.

Finally, the biocultures paradigm suggests that the answer to "What's your data?" is neither the social construction of knowledge nor the idea of the text. Data is the selective information that we interpret as findings. All disciplines engage in this exercise, as Len suggests in the manifesto. The data themselves are facts, but they are not in themselves significant without interpretation. In literary analysis, reading produces data analyzed through the varied frameworks of criticism. Our expertise is in identifying, selecting, and interpreting the data of textual and discursive contexts, and linking these to broad cultural patterns, both historically and contemporaneously, as well as developing rich understandings of the complexity of linguistic significations.

In the language of my institution's former tag line a "putting [this] knowledge to work" a or, in its new brand a using it to "invent the future" a I want to advocate the serious challenge this expertise represents, especially to status quo humanities. Revitalizing the humanities through biocultures will only happen when we begin to believe that speaking beyond our own kind, and presenting our evidence for others, matters. Because we so often speak in forms of discourse meant only for our own kind (that is, decipherable only by other literature professors), I can only deduce that we do not think our contributions to knowledge make a difference outside our own, relatively enclosed, worlds of practice. As Jay made clear, the answer is not a dumbed down humanism but a willingness to engage with that expertise a its data, its interpretations, and its knowledge in the strongest sense a in the contact zone of public science policy.

Editor’s note: Those who don’t have access on-line to New Literary History will find a similar version of the biocultures manifesto at the biocultures website:
http://www.biocultures.org/index2.php?page=links

Toward a New Aesthetic of the Body

October 21, 2007 at 6:34 pm

Stretching Figure with Vertebral Scoliosis

Commentary by Laura Ferguson, Artist working in New York City

Can a deformed body be beautiful? Yes, through an artist's eyes - and I believe art can help medicine to broaden its vision, and embrace a new aesthetic of the body.

I'm an artist and for the past twenty years I've been using my own body, inside and out, as the subject of my work. My anatomy is an unusual one because of scoliosis, a curvature of the spine, and I found intriguing visual possibilities in the image of a body that was beautiful yet flawed. My drawings are quite intimate and personal, and at the same time strongly based on science, on an understanding of anatomy and physiology, and specifically on medical images of my own skeleton that were made for this purpose.

To help me deal with pain and physical frailty, I turned to movement practices like yoga, Alexander Technique, and neuromuscular training. I learned how to compensate for muscle and joint imbalances and make subtle postural adjustments. I came to know and feel my body from the inside out, becoming more sensitive to its proprioceptive, inner body sensors and signals. I felt more symmetrical, whole, centered, and three-dimensional in my physical being - and better able to convey that sense of myself through the images I made.

I came to understand scoliosis as having a complex rotational dynamic, arising out of a growth process, albeit one that has gone awry. That allowed me to visualize my curving spine as a manifestation of flowing energy: in my drawings it's a graceful and sinuous shape that helps me to endow a still figure with movement.

The most powerful response to my work has come from people who have unusual anatomies themselves, and have never before seen such bodies portrayed as beautiful. I'll let a few of these viewers speak in their own moving and eloquent words:

I have to tell you how deeply exciting and beautiful I find your work. My right arm and leg were amputated two years ago, and I'm just now developing a friendly relationship with my body. You have helped me feel beautiful.

Your pictures have helped me to become more accepting of my body… Your drawings reflect a very whole person, not just a body. The figure is lovely, expressive, open and explorative…. This has had a greater impact than my friends trying to convince me that I can be crooked and desireable both! Well, your work proves that.

Somewhat to my surprise, many doctors and medical professionals also respond strongly to this work. It gives them insights into what it feels like to inhabit such a body, they tell me, and allows them to see beyond the deformed spine to the beauty, humanity, and individuality of the person. Still, almost all the orthopedists who tell me they love my work also try to convince me I should have more surgery - whether or not I've asked them for medical advice. Ultimately, it seems they can't help but see an unusual anatomy as a problem to be fixed.

As an artist, I understand that fixing, healing, transforming an abnormal body into a more normal one, is what gives doctors satisfaction, a sense of accomplishment - that it is their form of creative expression. But the result is that there is no alternative paradigm offered to patients, no acknowledgment that an unusual body might be okay the way it is - that there doesn't have to be a 'fix.'

I realize that the idea of deformity having its own beauty, without the need of fixing or altering, is a radical one. But I believe in an alternative vision of aesthetics in medicine, one that gives more value to process, to empathetic connection, than to fixing or curing. Art is a good place to look for an alternative aesthetic: a place where the less-than-perfect body can be shown to have its own kind of beauty, grace, sensuality, originality.

What is Biocultures?

August 24, 2007 at 8:54 pm

Designer babies, Rowena Dugdale, Wellcome Library, London

Commentary by Bradley Lewis, M.D., Ph.D., Gallatin School of Individualized Study, New York University

In my first contribution to this new blog (which I am very happy to see developing), I would like to tell the medical humanities community about an emerging approach to interdisciplinary work at the interface of biology, medicine, humanities, and culture that many of us are calling "biocultures." (www.biocultures.org)

One of the most challenging problems of contemporary scholarship involves the deep segregation of the academy: between the humanities and social sciences on the one hand and biology and the natural sciences on the other hand. This "two culture" divide has long been lamented for the biases and distortions it creates in knowledge and for the increasing risks associated with disconnecting bioscience capacities from the wisdom of history, culture, and philosophy. But, despite the seriousness of these issues, no one seems to have found a solution to the problem. The two sides of campus are so irretrievably divided that the reorganization of inquiry has seemed impossible.

Yet even as many of us have lamented this situation, a grassroots movement of academic research has gradually emerged that effectively integrates the two cultures. Certainly traditional medical humanities and bioethics are part of this grassroots movement, but more recently they have been joined by scholars in areas like disability studies, cultural studies of the body, gay and lesbian studies, gender studies, Africana studies, Asian-American studies, Latino-Latina studies, science studies, literature and science, public health, medical anthropology, medical sociology, and medical education (particularly professors of medicine and society). These scholars not only intermingle facts and values from the two cultures in their work, many of them break down the "fact/value" distinction all togetheraasking pressing questions about what are the values associated with various research agendas (the making of facts) in the first place.

The main thing missing from this grassroots movement is a common identity. This is why Lennard Davis and David Morris are proposing the term "biocultures" as an umbrella term for this group of scholarship. Davis and Morris define biocultures as a new and "counter-intuitive (but perhaps destined to be commonplace) proposal: that culture and history must be rethought with an understanding of their inextricable, if highly variable, relation to biology" (Davis and Morris, forthcoming). By providing an over arching name to these many scholarships, biocultures consolidates and strengthens this terrain. "For example, before disability studies became a common term, those working in a variety of allied fields and with a variety of impairments did not necessarily see any commonality in their various approaches. But with the advent of an umbrella term, a new and exciting synergy has come to pass. Likewise with nanotechnology, feminist studies, or critical race theory. We are not necessarily nominalists, but we do believe in the power of a name" (Davis and Morris, forthcoming).

To learn more about the emerging biocultures movement you can check out the upcoming special issue of New Literary History that is edited by Davis and Morris devoted to biocultures. Davis and Morris kick off the issue with their "Biocultures Manifesto" which will send chills down the spine of any of you in the medical humanities world who have felt that you are all alone (or almost all alone) in your university. If the biocultures movement appeals to you, please play your own part in its growth. Start using "biocultures" in your writings and courses, make lunch dates with your colleagues down the hall or across campus in similar areas, and set up biocultures reading groups and symposiums. The next thing you know, the two cultures divide will be a thing of the past and the world will be a better place!

Davis, L, and Morris, D. Forthcoming. Biocultures Manifesto. New Literary History.

See web site of biocultures project: www.biocultures.org.