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Vol 22, No. 04, April 2018   |   Issue PDF view/purchase
Humanities for health: Mediating between the disease, the patient, and the physician
by Ivy Chua, Izza Haziqah and Rafiq Ismail

What is the medical humanities?

Medical humanities is an interdisciplinary endeavour that investigates the social, cultural, philosophical, linguistic and historical contexts of medicine and healthcare. Medical humanities scholars research a variety of issues including doctor-patient interactions, the spread of diseases in world history, and the flourishing genre of illness narratives. As well as providing insights into one of the most basic and universal of human concerns these disciplines inform the science and practice of medicine.

Faculty members in the School of Humanities (SoH) have founded a new medical humanities research cluster as part of a drive at Nanyang Technological University Singapore (NTU) to enhance interdisciplinary learning and research. We speak to them to grasp a fuller understanding of their work, which offers insight into medicine beyond the treatment of physical ailments.

Scholars in the humanities aim to shift the perception that medicine is a utilitarian discipline confined solely to the natural sciences. By analysing the history of medicine, interrogating the social interactions that govern it, and examining the lived experience of health and illness, they are reviving the human face of medicine across various fields.

Medicine, in its modern formulations, has adopted a biomedical paradigm in which the body is seen as being akin to a machine. This paradigm, focusing solely on biological factors, offers a specific but narrow definition of health as freedom from pain, defect, and disease. This definition was challenged in the mid-1970s when medical practitioners developed a more holistic understanding of medicine, considering variables beyond the physical body such as social factors and the subjective experience of sickness. This new ‘biopsychosocial’ medical model, spearheaded by psychiatrist George L. Engel, now lies at the heart of inquiries in the medical humanities.

Emphasising patient care

For linguist and Chinese language scholar Assistant Professor Lim Ni Eng, biopsychosocial medicine is underscored by a simple yet fundamental principle.

“People tend to forget that medicine is inherently humanistic. I think that doctors tend to look at the un-human human body. No feelings, no thoughts, no mind” stressed the linguist. “Medicine is about one human being trying to cure another.”

Asst Prof. Lim is at the forefront of understanding the uniquely Singaporean experience of medicine. In collaboration with the Urology Department at Tan Tock Seng Hospital, Asst Prof. Lim records doctor-patient interactions and analyses conversations that occur in the consultation room.

His research assists medical practitioners in honing their situational awareness when communicating with patients and elucidates how patients perceive medical messages. This enhances the quality of doctor-patient interaction, ensuring accurate and safe diagnoses.

“In the end, it’s about sensitising the doctors to the rich and complex tapestry of interaction,” said Asst Prof. Lim.

For Assistant Professor Michael Tan from NTU’s School of Art, Design, and Media (ADM), the humanities can promote health and wellbeing directly.

“I think in terms of what the arts can actually do to enhance the understanding of humanities within the medical context,” said Asst Prof. Tan.

Asst Prof. Tan’s work fuses the arts with the medical humanities for public engagement. His current projects include the AD4H Lab, which explores the use of art and design for health and wellbeing, and a collaboration with the Agency for Integrated Care (AIC) and the National Arts Council (NAC) which investigates the impact of art programs in nursing homes. Asst Prof. Tan looks forward to engaging partners and corporate players from the medical industry in more in-depth discussions between the public and private sector on the role of art in medicine.

Asst Prof. Tan intends to use the AD4H Lab as a platform for international networking through which students, teachers, and academics can engage in discourses on the medical humanities. He is also a firm advocate for global exchange. His efforts include establishing ties with Durham University and King’s College London, British institutions with distinguished reputations as leading global research centres in the medical humanities.

Historical data, contemporary benefits

If Asst Prof. Lim seeks to understand the contemporary interactions of medicine and the humanities, medical anthropologist Assistant Professor Ivy Yeh Hui-Yan examines the connections between history, disease, and human genealogy. Working in remote regions in North-West China, Asst Prof. Yeh traces the historical and biological evolution of medicine and charts the movement of disease following patterns of human migration.

Although her primary research seeks to understand the evolution of medical and pathological patterns, her work also has impact in the present day.

“We help the current population to improve or understand some of their health issues,” said Asst Prof. Yeh. “For example, in certain geographical areas, certain populations or ethnic groups are more vulnerable to infectious or genetic diseases”.

As such, her findings facilitate the fight to prevent the same diseases that ravaged the ancestors of a community from blighting their descendants.

Beyond creating a meaningful impact in the local communities where she conducts her research, Asst Prof. Yeh also seeks to nurture the growth of Singapore’s research in the medical humanities by establishing close working relationships with international colleagues.

The cultural context of medicine

Whether focused on contemporary or historical medical practices, the medical humanities seeks to understand the cultural context of medicine.

In his research into doctor-patient interactions, Asst Prof. Lim notes that medicine works differently in Singapore than in other regions such as the U.K. and U.S. In those areas, medical data is largely consistent due to the relative homogeneity of their societies, with recorded interactions often involving doctors and patients of the same ethnicity and culture. In Singapore, however, there is a conglomeration of disparate cultures and ethnicities of both doctors and patients. Asst Prof. Lim’s investigation of doctor-patient interactions remains at the forefront of efforts to understand how cultural differences affect medical practice.

The importance of culture also extends to literary studies. For medieval literature expert Assistant Professor Katherine Hindley, studying instances of medical discourse in medieval writing offers insights into both medieval society and how medical views have progressed and evolved.

Through her initial plan to look at the way medieval society thought about writing, Asst Prof. Hindley became intrigued by uses of medical charms in medieval texts.

“Many medieval people would not be into the idea of prayer alone as healing, and not seeing a doctor. They thought lots of things could cure you” notes Asst Prof. Hindley.

In the Middle Ages, reciting healing charms aloud or using written incantations as physical ingredients in medicinal brews were common practices. While these principles have been largely dismissed by modern science, the practice of imbuing the written word with the ability to produce results in the material world lives on outside institutionalised medicine.

The changing perception of diseases over time has impacted modern medical attitudes, including how mental health and disability are socially perceived today. As such, Asst Prof. Hindley’s research allows for an alternative understanding of medical progress by observing the evolving definition of medicine.

“Back in the medieval period, there was a much broader way of looking at health,” said

Asst Prof. Hindley. “If you think of the placebo effect, you can see how charms might have a scientifically measurable impact on the body. I think many elements in medieval medicine have to do with making people feel like they have been understood. That mindset extends further to questions like how do we keep people healthy, happy and improve their quality of life. The medieval perspective of medicine looks at the world more broadly and that, I think, is valuable.”

Current challenges

While research in the medical humanities offers exciting insights and possibilities, it faces its fair share of challenges.

Asst Prof. Lim notes the need for further integration between the medical field and the humanities and would like to see more medical humanities modules being offered. Given the opportunity, Asst Prof. Lim would also like to have these modules taught not only to students in the School of Humanities, but also to medical students in NTU’s Lee Kong Chian School of Medicine.

“Humanities scholars have a lot to offer doctors in terms of reacquainting them with the premise that medicine is inherently humanistic, and to expand their horizons beyond their daily physiological studies” added Asst Prof. Lim.

Asst Prof. Tan also recognises the potential for collaboration between the arts, humanities, and the medical fields. He states that this can be done once the medical industry buys into a “more refined understanding of what art is doing to people” and “recognises what the arts can do with respect to health and wellbeing”.

To this end, several medical humanities courses currently run at NTU. These include Asst Prof. Hindley’s Magic and Medicine in Medieval Literature while, over at ADM, Asst Prof. Tan aims to run a postgraduate photography course leading conversations on visual methods in arts for health. Assistant Professor Park Hyung Wook, a historian of science and medicine, teaches Health and Illness in History and The History of the Body and Assistant Professor Graham Matthews (Literature) teaches Literature and Medicine. Through research, teaching and continuous public engagement, the field of Medical Humanities is set to go from strength to strength in Singapore.

Future opportunities

Research in the medical humanities has already yielded a positive impact on Asst Prof. Yeh’s and Asst Prof. Tan’s teaching practices. Each has established a student-centred pedagogy, echoing the principle of patient-centred care. As Asst Prof. Tan explains, the idea of ‘people-centeredness’ varies according to who he works with, be it the patient when he is in hospitals and nursing homes, or his students in class. Both scholars, as a result, eschew an instructor-led teaching philosophy in favour of taking the role of enabler in a more interactive style of teaching.

Asst Prof. Hindley builds on her understanding of changing perceptions to reassert the value of medical history and to change many students’ initial perception of medieval society as backward and unintelligent. To achieve this, Asst Prof. Hindley finds it useful to talk about medicine due to its strong association with science, epistemology and reasoning. She explains that while medieval medical ideas may seem to be baseless, new scientific investigations on some medieval cures such as Bald’s eye-salve reveal them to be medically sound. This often surprises her students and provokes them reconsider and reexamine how knowledge is created and understood.

Concluding thoughts

In 1958, the physician Henry Borsook stated: “Without scientific knowledge, a compassionate wish to serve mankind’s health is meaningless. But scientific knowledge without wisdom is a frozen storehouse”. The medical humanities seeks to bolster that wisdom and help patients to express and overcome their pain, suffering, worry, anguish, and the sense of something just not being right.

Its tangible research benefits for our communities further underscore the importance of the medical humanities as a key research area that is beginning to gain traction in NTU and the wider Singapore society.

Given the varied and interesting research projects that medical humanities scholars have embarked on at NTU, we can only expect the further growth of this field as one of the most dynamic areas of research in Singapore today.

This article was originally published in Constellations, School of Humanities, Nanyang Technological University Singapore.

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