Catherine Belling

Commentary: sharper instruments: on defending the humanities in undergraduate medical education.

The study by Ousager and Johannessen in this issue finds a lack of research attempting to measure the long-term effects of incorporating humanities into the undergraduate medical education (UME) curriculum, and warns that more such studies are needed if the humanities are to become integrated into UME. This commentary points to limitations in the studys methodology, suggesting that the value of the humanities in educating new physicians can be defended by demonstrating the need for more complex approaches to knowledge than complete dependence on empirical evidence, and invites those who support inclusion of the humanities in UME to take up three challenges: work together to define the terms and scope of the medical humanities as a coherent (though heterogenous) field, teach reading skills (promote, that is, a nonreductive approach to the interpretation of human objects), and work to establish effective and persuasive alternatives to the blunt tools of outcomes measurement.

The Living Dead: Fiction, Horror, and Bioethics

Popular fiction responds to, and may exacerbate, public anxieties in ways that more highbrow literary texts may not. Robin Cook’s 1977 novel Coma exemplifies the ways in which medical thrillers participate in the public discourse about health care. Written shortly after the medical establishment promoted “irreversible coma,” or brain death, as a new definition of dying, and at a time when the debate over the removal of Karen Ann Quinlan from life support was the subject of popular attention, Coma crystallized public fears over the uses of medical technology. While Cook hoped that Coma would encourage public participation in health-care decision-making, the book may have fueled public concerns about medicine in ways that he did not anticipate. The public engagement that accompanied the rise of bioethics and that led to increased transparency and patient autonomy in medical decision-making had its birth, in part, in the distrust and paranoia reflected in the medical thriller. Because fiction can shape public perceptions of health-care dilemmas and may affect decision-making on bioethical issues, bioethicists need to pay attention to popular fictional accounts of medicine.

Human contexts: Medicine in Society at Stony Brook University School of Medicine.

Humanities teaching was introduced at Stony Brook University School of Medicine by Edmund Pellegrino, the first dean of the Medical School and founder of the Health Sciences Center. Since 1990, “Medicine in Society” has been a substantial presence throughout the curriculum, introducing students to the perspectives of a wide range of humanities disciplines as they apply to health care, and continuing as a sustained presence throughout the four years of training. Medicine in Society serves as a reminder that medicine is a human and communal endeavor, situated in sociocultural contexts, reliant on human values, and articulated most often through narratives. The authors describe the structure and function of the Medicine in Society curriculum and the Institute for Medicine in Contemporary Society, summarize their evaluation of the program, and outline their plans for meeting current and future challenges.

A happy doctor's escape from narrative: reflection in Saturday

The humanities have, in their application to medicine, become almost synonymous with narrative. When medical education turned to ‘reflection’ as a means to nurture coherent and ethical professional identity, interventions tended to take narrative as their primary form. Even while promoting ‘mindfulness’ as complete engagement in the present moment, proponents of reflection sometimes subsume reflection under the category ‘narrative’. The author offers a reading of Ian McEwans novel Saturday, the account of the thoughts of a London surgeon over the course of one day, attending to the novels reflective and lyrical as well as its narrative passages, in order to suggest that, rather than grouping the various forms that constitute ‘literature’ into a single instrumental method for producing more professional and ethical doctors, it might be valuable to attend to the various modes that constitute literary discourse, of which narrative is only one.

Begin with a Text: Teaching the Poetics of Medicine

This paper suggests that the purpose of humanities teaching within medical education should be primarily to teach and promote the informed, attentive, critical, and precise reading of the multiple texts that constitute medicine as a discursive field—in short, a poetics of medicine. This claim is illustrated by reconsidering Margaret Edson’s play Wit, not as it is often used in medical education, as a cautionary tale about unprofessional behavior or as a way to inculcate “humanistic skills,” but as an analysis of the relationships between texts and feelings—or cognition and emotion, or science and art. This reading is illustrated by comparing the poetics of Wit with those of two other texts representing ovarian cancer: a scientific paper in Oncology and a clinical case conference in JAMA.

Microbiography and Resistance in the Human Culture Medium

Perhaps it is not an accident . . . that, in the case of diphtheria,— in the control of which modern bacteriological methods have been most effective since the late [eighteen-]nineties, thus creating interference with normal evolution,—we are just beginning to observe the return of excessively toxic and deadly cases. . . . It is not at all unlikely that the successful control of an epidemic disease through several generations may interfere with the more permanently effective, though far more cruel, processes by which nature gradually immunizes a race. —Hans Zinsser, Rats, Lice and History (1934)1

The President's Glands: Somatic Interiority and the Referents of Biographical Fction in American Adulterer

ABSTRACT In the biographical novel American Adulterer, physician Jed Mercurio recounts President Kennedys life as the story of a sick body. This experiment and its reception expose biofictions conventional assumptions regarding human interiority and reveal alternative, bodily interiors, knowable largely through medical discourse, which work as the biographical novels biological referents.

Dark Zones: The Ebola Body as a Configuration of Horror

Ebola virus disease has a media presence and imaginative traction disproportionate to its statistical probability in most parts of the world. This chapter attributes that rhetorical power to a particular figurative structure, the “Ebola body,” which has the topology of an opaque receptacle subject to rupture. Reading Richard Preston’s The Hot Zone as an influential poetics of the Ebola body, metonymic across scales, from the geomorphic body of an infected patient through the anthropomorphic landscape of the Congo, Belling argues that the Ebola body is a topos locating what, after both Julia Kristeva’s account of the abject and Joseph Conrad’s account of the Congo, we can identify as horror—and that this horror may be endemic to the experience of human embodiment.

How to imagine ourselves

How do we learn to think about what we have inside our bodies? From autopsy, surgery, and dissection, to x-rays and MRIs and CT scans, biomedical imaging technologies allow medical practitioners to study, compare, diagnose, and treat human bodies. But the images generated by medicine have also always broken out of their instrumental contexts to become part of wider culture, showing us how to picture ourselves in ways we cannot do with just a mirror. In the process of escaping from medicine, these representations take on new functions, symbolic, aesthetic, and existential. Outside the clinic, the image of a skeleton is never just a plain descriptive account of bone. It is scary, or funny, or beautiful, a monstrous memento mori, a Halloween costume, or a still life. Imaging/Imagining the Human Body in Anatomical Representation is an unusual three-venue exhibition at the University of Chicago in which representations of human anatomy reveal the interdependence of biomedicine’s imaging technology and art’s creative imaginings. One of the visitor’s first encounters is with a pair of whole-body images of the human vascular system. The first image is from Govard Bidloo’s 1685 anatomical atlas, Anatomia Humani Corporis, a man-shaped map of rivers and their tributaries, or maybe the tracings of leafl ess winter trees feathering out from a central trunk—except that in the centre of the trunk we fi nd a heart. Beside it is a second image, similar yet diff erent: a digital composite generated for the exhibition, made not by the old technologies of eye and pen (and cadaver) but instead data-sourced from CT angiograms. Both are medical representations of the anatomy of the vascular system, yet their context here, reproduced larger than life and hung in a gallery, makes them both also works of art. They are paired so that the viewer must ask not only “what am I looking at?” but also “Why was this image made, and when, and what is it for?” The exhibition’s imaginative curators, physicians Brian Callender and Mindy Schwartz from the