Medicine, Health and Being Human, 1st Edition
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This volume is dedicated to Dr Des McGuckin, a doctor who
understood and relished both the humanness of life and the
precision of medicine
Contents
List of figures x
Notes on contributors xi
Foreword: medicine, health and being human xvi
I an F ra z er
Acknowledgements xvii
Introduction: medicine and modernity 1
L esa S choll
PART I
Situating the soul, self and mind 13
1 Physicians and the soul: medicine and spirituality in
seventeenth-century England 15
M ichelle P feffer
2 Hearing differently: medical, modern and medieval
approaches to sound 29
B onnie M illar
3 Sensing the self in the wandering mind 42
H a z el M orrison
4 Soul searching: psychiatry’s influence on selfhood 60
P atric k S eniu k
5 Faith in healing: evidence-based medicine, the placebo effect
and Afro-Brazilian healing rituals 75
H annah L esshafft
viii Contents
PART II
Socio-medical narratives 89
6 Voices in medicine: ethics, human rights and medical
experimentation 91
J ennifer G reenwood
7 The cost of efficiency in Great War nursing literature 105
M . R enee B enham
8 Negotiating wonders: medical-triggered redefinitions of
humanity in popular fiction 121
A nna G asperini
9 The human ideal and the real: artistic vision and
anatomical sight 137
C orinna W agner
10 Medical imaging and the intrusive gaze 162
C atherine J en k ins
PART III
Limits of medical intervention 177
11 The fairytale narratives of plastic surgery makeover
TV shows in South Korea: surgical metamorphosis, the
“surgical gaze,” and the permeability of medical knowledge 179
C armen V oinea
12 “John-o is interested in cutting up whatever he finds at the
limits of life”: monstrous anatomies and the production of
the human body in Alasdair Gray’s Poor Things and
Hilary Mantel’s The Giant, O’Brien 194
Kathryn B ird
13 In Lady Delacour’s shadow: women patients and breast
cancer in short fiction 208
A pril P atric k
14 “My lawful wife and mistress”: a physician’s perspective 223
U z o D ibia
Contents ix
15 A humanistic perspective on the healing power of language
at the end of life: restoration of the self through words and
silence 237
A ndrea R odr í gue z - P rat and X avier E scribano
Index 251
Figures
9.1 Léon de Wailly, “Frontal view,” “Femme de race
Boschismanne,” Histoire de naturelle mammifieres, 1824 139
9.2 Léon de Wailly, “Side view,” “Femme de race
Boschismanne,” Histoire de naturelle mammifieres, 1824 140
9.3 P.J. Hetzel, Scenes de la vie privee et publique des animaux
vignettes par Grandville, 1842 142
9.4 “A Venerable Orang-outang”: A Contribution to Unnatural
History, The Hornet, 22 March 1871 143
9.5 Engraving by C. Grignion after B.S. Albinus, A skeleton,
front view, standing with lift arm extended, in a pastoral
setting, 1747 145
9.6 Smugglerius, cast by William Pink from original cast of 1776
supervised by Agostino Carlini RA, Smugglerius, c.1834 147
9.7 Engraving by Nicolaes Lauwers, after Peter Paul Rubens,
c.mid-1700s, Adoration of the Magi 150
9.8a Petrus Camper, Facial Angle, 1792 151
9.8b Petrus Camper, Facial Angle, 1792 152
9.9 After Albrecht Dürer, Melancolia I, 1514 154
9.10 Albrecht Dürer, Skeleton Study Sheet, 1523 155
9.11 Albrecht Dürer, Death and the Landsknecht, 1510 156
Contributors
M. Renee Benham is a Postdoctoral Teaching Fellow at Ohio University, where
she received her PhD in 2017 for her interdisciplinary dissertation, Beyond
Nightingale: The Transformation of Nursing in Victorian and World War I
Literature. Her research interests include the history of British nursing and its
representation in literature, as well as women’s role in the development of
sanitary reform in Victorian England.
Kathryn Bird is an Associate Lecturer at Edge Hill University in the Depart-
ment of English, History and Creative Writing. She has a PhD in English
from the University of Leeds and an MA in Contemporary Literature and
Culture from the University of Manchester. Her research interests are in
modern and contemporary literature, Gothic and detective fiction, and the
interdisciplinary fields of biopolitics, animal studies and medical humanities.
Her publications include book chapters and journal articles in The Routledge
Handbook to the Ghost Story, Landscapes of Liminality: Between Space and
Place and Neo-Victorian Studies, and she is currently working on a mono-
graph from her PhD dissertation, “Undeath and Bare Life: Biopolitics and the
Gothic in Contemporary British Fiction.”
Uzo Dibia is a poet and consultant in acute and general medicine with the
Metro-North Hospital and health service, based at Caboolture Hospital, where
he heads the hospital in the home (HITH) unit. He is also Senior Lecturer
with the University of Queensland medical school. After graduating with a
bachelor of medicine and surgery degree from the University of Ibadan,
Nigeria, he commenced his postgraduate training in the United Kingdom and
then moved to Australia where he completed a fellowship in acute and
general medicine. He holds master’s degrees in public health and health man-
agement from the University of New South Wales, Sydney, and his interests
are in the treatment of soft tissue infections in the home setting, clinical gov-
ernance and the use of literature as a means to understanding the patient’s
experience.
Xavier Escribano (Barcelona, 1970) obtained his doctoral degree in philosophy
at the Universitat de Barcelona (2003). Currently a lecturer in philosophical
xii Contributors
anthropology at the Universitat Internacional de Catalunya (UIC), his main
research interests concern theories and concepts of human embodiment, espe-
cially in contemporary thought, and the relationship between humanism and
health. He is a member of the Phenomenological Studies Group of the Catalan
Philosophical Association, as well as of the Spanish Society for Phenomeno-
logy. He is currently the director of the research project Anthropology of Cor-
poreality/Interdisciplinary Studies in Embodied Subjectivity (UIC 2012–2015)
and the coordinator of the SARX research group on the anthropology of
corporeality.
Ian Frazer is a clinician scientist, trained as a clinical immunologist in Scot-
land. As a professor at the University of Queensland, he leads a research
group working at TRI in Brisbane, Australia on the immunobiology of epithe-
lial cancers. He is recognised as co-inventor of the technology enabling the
HPV vaccines, currently used worldwide to help prevent cervical cancer. He
heads a biotechnology company, Admedus Vaccines, working on new
vaccine technologies, and is a board member of several companies and not-
for-profit organisations. He is the current president of the Australian Academy
of Health and Medical Sciences, and a member of the Commonwealth
Science Council, and was most recently appointed chair of the federal gov-
ernment’s Medical Research Future Fund. Professor Frazer was recognised as
Australian of the Year in 2006. He was recipient of the Prime Minister’s Prize
for Science, and of the Balzan Prize, in 2008, and was elected Fellow of the
Royal Society of London in 2012. He was appointed Companion of the Order
of Australia in the Queen’s Birthday Honours list in 2013.
Anna Gasperini received her PhD from the National University of Ireland
Galway, where she completed a thesis on discourses of ethics, monstrosity
and medicine in the Victorian penny blood. She co-edited for Palgrave
Macmillan the collection of essays Media and Print Culture Consumption in
Nineteenth-Century Britain: The Victorian Reading Experience (2016), and
she is the current Membership Secretary of the Victorian Popular Fiction
Association (VPFA). Her research interests include Victorian cheap serialised
fiction, popular culture and popular fiction, and the relationship between Vic-
torian literature and medicine.
Jennifer Greenwood trained as a nurse, midwife and teacher before training as
a philosopher. She was awarded a PhD in Education from the University of
Leeds in 2000 and she held a variety of positions in the operational and stra-
tegic management of health services in the UK before emigrating to Australia.
In Australia, she was a Professor of Nursing for eight years at the University
of Western Sydney prior to moving to Canada. Her special interests as a
nurse were evidence-based practice development and qualitative research
methodology. Jennifer spent five years in Canada training as a philosopher
and returned to Australia to research for her PhD (2013) at the University
of Queensland. Her special interests in philosophy are the philosophy of
Contributors xiii
emotion and mind. She is currently researching the philosophy of pain.
Jennifer teaches philosophy at the University of Queensland and tutors in
nursing, in education and in philosophy at Emmanuel College, University of
Queensland.
Catherine Jenkins holds a PhD in Communication and Culture from Ryerson-
York Universities in Toronto, Canada. Fostered by her experience teaching
communication skills to healthcare students and professionals at the Univer-
sity of Toronto, her research explores the impact of healthcare technologies
on patient-practitioner communication. She currently teaches Professional
Communication at Ryerson University. Her article “Curing Venice’s Plagues:
Pharmacology and Witchcraft” was published in the journal Postmedieval’s
special medical humanities issue (2017). She has published book chapters in
the peer-reviewed anthologies Finding McLuhan (2015) and The Power of
Death (2014) and has several other book chapters forthcoming. Her current
research interests remain in medical humanities and cultural studies, includ-
ing the medicalisation of comic book superheroes.
Hannah Lesshafft is a Research and Teaching Fellow at the Medical School,
University of Edinburgh and a member of the Edinburgh Centre for Medical
Anthropology. She trained and worked as a medical doctor and obtained a
research doctorate degree from the Charité School of Medicine, Berlin, before
she completed an MSc degree in Medical Anthropology and a PhD in Social
Anthropology at the University of Edinburgh. Hannah has conducted research
in Brazil on the social exclusion of leprosy patients, cutaneous larva migrans
(a poverty-associated parasitic skin disease), and on healing and the notion of
care in the Afro-Brazilian religion Candomblé. Currently, she works on a
mixed-methods study on video consultations in primary care in Scotland and
teaches social aspects of medicine. Her main research interests include ritual
practice in biomedicine and traditional healing, the placebo effect, social
movements, practices of care and most recently environmental medical
anthropology.
Bonnie Millar is the Musculoskeletal Project Manager within the NIHR Not-
tingham Biomedical Research Centre in the School of Medicine, University
of Nottingham. She has authored a critical study of the “Siege of Jerusalem,”
and has published extensively on alliterative poetry, medieval romances,
gender theory, disability studies, medical humanities and sound studies.
Recent publications include a paper entitled “Hero or Jester: Gawain in
Middle English Romances and Ballads” in Le Personnage de Gauvain dans
la literature européenne de Moyen Âge, a chapter on “Key Critics, Concepts
& Topics” in the Continuum Handbook of Medieval British Literature, “A
Measure of Courtliness: Sir Gawain and the Carl of Carlisle” in Cultures
Courtoises en Mouvement: Proceedings of the Thirteenth Congress of the
International Society of Courtly Literature and “Naming and Un-naming:
Cynewulf ’s Runic Signatures” in La constucció d’identitats imaginades.
xiv Contributors
Current projects include the analysis of Tinnitus narratives, an exploration of
the language of Tinnitus and a full-length study of Gawain in Middle English
and Early Modern English romances and ballads.
Hazel Morrison most recently held the post of Research Associate at Durham
University, on the Volkswagen Foundation-funded project “Wandering Minds:
Interdisciplinary Experiments on Self-generated Thought,” 2016–2017. Before
this, she graduated in 2014 from the University of Glasgow with a PhD in
historical human geography, specialising in the history of psychiatry. Her
specialism is the study of the dynamic, or psychobiological, approach to
psychiatry as employed by early twentieth-century Scottish psychiatrist Dr
David Kennedy Henderson. An in-depth hermeneutic engagement with the
patient case note records of Gartnavel, Glasgow’s Royal Mental Hospital
(1921–1932), enabled her work to explore the development of psychiatric
knowledges from within clinical encounters. Taking methodological and
theoretical influence from research emerging in the interdisciplinary spheres
of the medical humanities, her aim is to understand the agency of both patient
and psychiatrist in shaping the history of psychiatry.
April Patrick is the Director of the University Honors Program and faculty in
Literature at Fairleigh Dickinson University’s Florham Campus. Her work
and reviews have appeared in Victorian Periodicals Review and Victorian
Review. She is one of three Co-Directors of Periodical Poetry, an index of
poetry published in nineteenth-century periodicals, and is currently working
on a project about nineteenth-century breast cancer narratives.
Michelle Pfeffer is a PhD candidate at the University of Queensland’s Institute
for Advanced Studies in the Humanities and is concurrently completing a
Master of Science in History of Science, Medicine and Technology at the
University of Oxford. Her research explores the multifaceted discussions
about the human soul in the seventeenth and eighteenth centuries, which
embraced scientific, philosophical, medical, theological and historical dis-
courses. Her particular interests lie in the contentious debates over the immor-
tal and immaterial nature of the human soul. Other research interests include
early modern medicine, the history of scholarship and religiously motivated
responses to contemporary “materialist” science.
Andrea Rodríguez-Prat (Barcelona, 1988) obtained a degree in humanities
(2010) and a master’s in nursing and health research (2014). She is currently
a lecturer in philosophical anthropology at the Universitat Internacional de
Catalunya (UIC). As a research member of the WeCare Chair: End-of-life
Care at the UIC she brings her humanistic background (and especially a
philosophical/anthropological perspective) to the biomedical and experi-
mental sphere. Currently her main research interests are focused on the con-
cepts of dignity, autonomy and the wish to hasten death in the end-of-life
context. She is also interested in the phenomenology of embodiment and
illness, and in the experience of suffering, death and dying from the
Contributors xv
perspective of the history of mental illness, cultural anthropology and qual-
itative analysis.
Patrick Seniuk is a doctoral student at the Centre for Studies in Practical Know-
ledge at Södertörns University in Stockholm. His background in philosophy
and bioethics has led him to specialise in existential-phenomenology and
philosophy of psychiatry. His dissertation addresses the way in which clinical
psychiatry conceptualises selfhood in depression. The dissertation is part of a
larger project entitled “Phenomenology of Suffering in Medicine in the Baltic
Sea Region,” which encompasses topics such as teaching of medical ethics,
bioethics and personhood, and the nature of empathy in medicine.
Carmen Voinea is a PhD student at the Faculty of Sociology and Social Work,
University of Bucharest. Her research is exploring the plastic surgery phe-
nomenon in Romania, concentrating on the negotiation of the surgical change
between the patient and the aesthetic surgeon as reflexive actors in the context
of a consumer society. She has a bachelor’s degree in political sciences from
the University of Bucharest and a master’s degree from the Faculty of Soci-
ology and Social Work, University of Bucharest.
Corinna Wagner is Associate Professor in Literature and Visual Culture at the
University of Exeter. Her research interests include Victorian art, architecture
and photography, and the relationship between medicine and the arts. Her
books include Pathological Bodies: Medicine and Political Culture (Califor-
nia UP, 2013) and with Joanne Parker, Art and Soul: Victorians and the
Gothic (Sansom, 2014). She has also edited A Body of Work: An Anthology of
Poetry and Medicine (with Andy Brown, Bloomsbury, 2015) and Gothic Evo-
lutions: Poetry, Tales, Context, Theory (Broadview, 2014). She is completing
a monograph titled Art and Anatomy: The Body and Visual Culture.
Foreword
Medicine, health and being human
Ian Frazer
We live in an increasingly technology-led, business-oriented and time-poor age,
in which the art of medicine, and the essential humanity of the interaction
between patient and doctor, is at risk of being relegated to second place behind
the science of “precision medicine.” While the practice of medicine is, appropri-
ately, increasingly assisted by new technologies which are giving new insights
into diagnosis and management of disease, these technologies have tended to
separate the health care practitioner from direct contact with the patient seeking
help. The collection of essays that make up this book serve to remind us of the
complexity of the relationships between body and mind and between health and
disease and draw the distinction between the patient as a human being and as an
object to be examined and managed. The reader of these essays should enjoy and
benefit from the insights provided by the various essayists, who have drawn on a
diverse selection of perspectives on this topic. Hopefully, they will come away a
wiser and more thoughtful person from their reading, whether they approach the
topic of health and disease as a patient, a caregiver or a philosopher.
Acknowledgements
Within 36 hours of my birth, I was rushed interstate for a seven-hour life-saving
operation. This operation was performed by Dr Des McGuckin and his team at
the Mater Hospital in Brisbane. Throughout my childhood I would return to Dr
McGuckin for consultations on my progress. He was the only doctor I looked
forward to seeing, perhaps partly because of the adventure of travelling away
from home to do so, but also because he was kind and had a funny beard. In
general, though, with the excess of doctors in my young life, I didn’t like them;
at best, the relationship was fraught. Doctors were associated with pain, with my
childhood inability to understand why they couldn’t make everything better, and
my frustration that they didn’t seem to understand what my feelings were. By
the time I was a precocious 10-year old, I felt like I knew more about medicine
than they did – at least about my own health.
In a lot of ways, that childhood experience undergirds my interest in the
themes of this book: the relationship between the doctor’s and the patient’s
humanity; the capacity to communicate; angst regarding the medical profession;
and the willingness to accept the doctor’s limitations. I grew up with the unfair
image of doctors as failed gods: they were meant to be able to fix everything, but
inevitably didn’t succeed in doing so. As an adult, of course, I look back with
incredible gratitude, especially for that life-saving surgery and the kindness of
my specialist, who was known for understanding how to treat sick children with
compassion. But at the same time, I can appreciate the clinical distance that, as
Jane Macnaughton observes, helps to maintain the dignity of the patient when in
a position of vulnerability: it helps not to think of the doctor as a human being
with thoughts, feelings and flaws as you are exposed before them. These ten-
sions remain something to grapple with, a part of the complexities of human
expectations.
In a practical sense, this volume began as a part of an interdisciplinary
research group I ran, in which our conversations persistently returned to ques-
tions of health, well-being and ethics. Stewart Gill, Master of Queen’s College,
University of Melbourne, was particularly supportive of the project from the
start, as were longstanding members of the group who didn’t end up contributing
chapters to the volume, but were instrumental in its formation: Charlotte Cham-
bers, Myles Lawrence, Marissa Daniels, Prue Ahrens and Stephen Young each
xviii Acknowledgements
played a significant role in the shape of the volume, and contributed to the inter-
disciplinary conversations that, most crucially, connected contemporary con-
cerns regarding medical culture across historical frameworks and disciplinary
boundaries. Anna Ritt was also of great assistance in drawing together the
current state of the medical humanities from the perspective of a medical
student.
I would also like to thank Katherine Inglis at the University of Edinburgh,
and Jane Macnaughton and Angela Woods at Durham University’s Centre for
Medical Humanities for their support of this project, for their advice as well as
helping me find the right contributors for this collection. In particular, I am
grateful for Professor Ian Frazer’s support of the project from its inception, and
Shelley Templeman for helping to make it happen.
Each of my contributors has shown great patience and faith, agreeing to work
on the project before publication was guaranteed. Their commitment to Medi-
cine, Health and Being Human has been extraordinary, especially given the
complications and difficulties some of them experienced through the process of
writing. I’m so grateful for their willingness to work on this book, and for their
vision to see an increased conversation between the medical sciences and various
humanities and social science disciplines. At Routledge, I’d like to thank Grace
McInnes for believing in this project, Carolina Antunes, for her friendly and
helpful efficiency throughout, and the anonymous readers, whose feedback
helped significantly in bringing the book together.
It would be remiss not to thank my adopted family – the team at the Arm-
strong Browning Library at Baylor University in Waco, Texas – for providing
me with an amazing space to work, first with a one-month fellowship in 2017,
and then on my ad hoc return visits. You always welcome me back with open
arms. My parents continue to give me unwavering support in all of my endeav-
ours. Finally, I would like to thank Professor Mike McGuckin, Dr Des McGuck-
in’s son, who gave me more insight in the man behind the beard: a passionate,
caring doctor who knew how to enjoy the diversity and beauty of life, with a
deep love for music and the theatre. Having a window into the humanity of the
man who saved my life gives me a profound sense of wholeness; and I hope that
he would be pleased to know that his legacy is living on through both medicine
and the humanities.
Introduction
Medicine and modernity
Lesa Scholl
Over the past decade in particular, the medical humanities have become a signi-
ficant field for interdisciplinary study, drawing attention from the sciences in
relation to “humanising” medical students, and from the humanities as a form of
legitimisation and research impact. Yet such binaries are potentially reductive
and unsatisfactory in addressing the role or importance of medical humanities in
current scholarship, or its potential to impact future generations of society. Alan
Bleakley has observed quite rightly that “Science study has … progressively
claimed and partially eroded the ground of a liberal education once thought to be
an essential background for practicing medicine,” arguing:
The benefits of scientific and technological advances in medicine are clear
and we might say that the erosion of the art of medicine is a small price to
pay for advances in population health. However, this erosion of the human
face of medicine is a symptom of a wider structural problem – that of the
continuing dominance of hierarchical clinical teamwork that favours doctors
and marginalizes other healthcare professionals and patients.
(2015, 9)
Similarly, Sander Gilman has emphasised in Illness and Image (2015) that the
medical humanities are crucial and intrinsic to all health sciences, including
“nursing, public health, dentistry, disability studies, and all other fields that deal
with human illness and wellness” (xi), deliberately extending the definition of
medicine itself. Indeed, medicine is being challenged to broaden its concepts of
wellness and illness. Des Fitzgerald and Felicity Callard suggest that “If the task
is to think how practices of making, breaking and shifting boundaries constitute
moments of illness and healing,” the medical humanities have a role in defining
those boundaries, and simultaneously the boundaries of what constitutes human-
ity: “we need to displace, if not significantly reimagine, how medical humanities
has tended to figure the ‘human’ – an entity whose boundaries have commonly
been understood to end at her skin” (2016, 43).
Indeed, given the growth of focus on mental wellness and illness, and its
impact on physical health, questions arise regarding how wellness and illness
can be identified in and through the body, primarily centred in sensory
2 Lesa Scholl
experience. In the 1960s, Georges Canguilhem evoked René Leriche’s “life lived
in the silence of the organs” to suggest that “[t]he state of health is a state of
unawareness where the subject and his [sic] body are one. Conversely, the
awareness of the body consists in a feeling of limits, threats, obstacles to health”
(Canguilhem [1966] 1978, 46). Although Canguilhem acknowledges, as Leriche
does, that “the silence of the organs does not necessarily equal the absence of
disease, that there are functional lesions or perturbations which long remain
imperceptible to those whose lives they endanger,” he importantly draws atten-
tion to the role of sensory awareness in understanding disease, and the problems
of the “invalidity of the sick man’s judgement concerning the reality of his own
illness” (46). Jo Winning asks fundamental questions regarding the relationship
between the body, human identity and sensory experience: “What is a body?
What are its boundaries and its contours? Can we ever really know the body in
its entirety, or only ever in its parts? How do we come to know the body through
the senses?” and finally, “what does it mean to be a body and to encounter the
body of the Other?” (2016, 325) In a similar manner, sensory historians David
Howes and Constance Classen have suggested that as “ ‘gateways’ to the body,
the senses [seem] eminently suited to receive influences that could either benefit
or injure the body” (Howes and Classen 2014, 38). Thus, interactions between
the mind and body, including the mind’s perceptions of the body, and therefore
the interactions between science, social science and humanities, become central
to understanding what it means to be human.
While the medical humanities began with pleas to incorporate and “make
space” for the humanities in the training of doctors, as seen in articles, for
example, in the longstanding medical journal The Lancet in the early 2000s, the
field has developed to critique its own position, constituting a much broader
stance and clearer definitions through the contributions of key scholars such as
Angela Wood, Jane Macnaughton, Felicity Callard and William Viney. Mac-
naughton has observed that there are historical and political reasons for the char-
acterisation of medical humanities as a field of studies designed to help doctors
learn to “do what they are already doing in a more humane, empathetic way”
while not interfering with “medicine itself ” (2011, 928). Yet she also points
towards the “much bolder intention” of current medical humanities (928), with
“a compelling vision of human nature, informed by philosophy, illustrated and
explored in literature and the other creative arts, assumed by the empirical enth-
nographic and qualitative methods of social science” (929). However, while
Macnaughton goes on to say that medical humanities has failed to take its
agenda “forward into collaborative discussion with those at the forefront of
policy and research in medicine so that it can inform the basis of decision
making about how medicine is practiced” (929–30), this failure is one aspect that
Medicine, Health and Being Human seeks to address – not as a definitive project,
but to open up conversations between medical practitioners and researchers,
alongside humanities and social science scholars, from across the globe, who are
concerned about the narrowing of medicine to medical science that has been
occurring since the early modern period.
