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Editorial
On identity in (the) Medical Humanities Deborah Bowman Questions of identity are inherent in health, illness and medicine. Those who live with illness often describe how the experience represents a challenge to, and change in, their identities. Those who aspire to treat illness and those entrusted with caring for the sick grapple with shifting personal and professional identities. For an editor relatively new in the post, matters of identity are preoccupying. How is the journal perceived? Who are our readers and our contributors? What is this field we call ‘medical humanities’ and where does this publication sit? These are some of the questions that have informed recent conversations with the editorial team at Medical Humanities. The discussions that have ensued have been rich and thought provoking, leading to a programme of planned development for the journal. It is a process that demands attention to identity. It serves as a reminder of the complexity and tensions inherent in defining and understanding identity. Identity may be both liberating and constraining. It is shaped and affirmed by a potent interplay of individual preferences and collective factors. Identity may be declared, elusive or assumed. It is a shifting, nuanced and contestable concept that is socially and philosophically situated. Most people writing for, or reading, this journal will be comfortable with the contextual nature of identity. Yet, too often we are asked or even required to disregard plurality and align ourselves with a single identity or way of being. For scholars, questions about our work often assume and demand that we identify with a single discipline or principal subject area. However rich and cross-disciplinary our work, we are required to locate it, often in traditional and sometimes inflexible categories. While the idea of the ‘vocation’ is less pervasive and persuasive than it once was, healthcare students are told from their earliest days that they are ‘different’ from their peers at university. Educational philosophy and training structures may change, but the student’s experience of professional socialisation endures.1 2 Once qualified, clinicians pursue increasing specialisation and Correspondence to Professor Deborah Bowman, Room 6.73, Division of Population Health Sciences and Education, St George’s, University of London, London SW17 0RE, UK; [email protected] Bowman D. Med Humanit June 2014 Vol 40 No 1
delineation of role. The power of the externally imposed identity3 and the tug of tribalism4 remain for even the most independent scholar or practitioner. The confining effects of identity are felt too by those who become patients, from the mundane, but significant, dehumanisation that occurs when a person is distilled into a hospital number, test results, systemic pathologies or bed location to the existential crises to which illness and suffering give rise. Diseases too are telescoped into singular identities in which a particular narrative, often predicated on a reductive or mechanistic account, dominates discourse, leading to what Havi Carel describes as ‘epistemic injustice’.5 The privileging of particular ways of describing illness or disease has significant implications for how we identify and respond to illness. It represents a clash of identities: the collision of personal, professional, individual, systemic and epistemological identities in which multiplicity of meaning may be unseen, disregarded, misunderstood or diminished. Matters of identity in all its forms recur in this issue of the journal. The ways in which discourses of disease and diagnostic identity are constructed are considered by Ciara Breathnach and Roberta Bivins in their papers about tuberculosis and rickets, respectively. Each of their analyses reveals the identities both claimed and overlooked in the dominant accounts of these diagnoses. Allan Beveridge explores not a specific diagnosis but the nature of ‘madness’ in his consideration of the work of Gerard de Nerval. The questions prompted by de Nerval’s autobiographical novel are fundamental to identity, both of the individual experiencing ‘madness’ and of the professional response of psychiatry (and its detractors) to the same. Anna Goodhart too is concerned with the ways in which professional responses to representations and interpretations of distress are insufficient to attend to the richness of identity and experience. In her paper, she considers the relationship between the heart, the notion of ‘the inner self ’, emotions and the significance for contemporary practice in cardiology. Changing and developing identities are the focus for another cluster of articles included in this issue. Two papers consider educational identity in their explorations of types of knowledge and medical students. Matthew Phillips and his co-authors describe and evaluate a module entitled
‘Power and its Implications’ that is offered to first year medical students. Neil Metcalfe and Elizabeth Stuart examine the ways in which history has been received when under consideration for inclusion in the curriculum and map the people and organisations that have served as the subject’s advocates and supporters in medical education. Sarah McNicol offers her insight into a growing area of attention in the medical humanities: graphic and comic art. In her paper, she argues that comic books have an educational value and identity that extends beyond the merely informational to provide a space for the diverse ways in which illness is experienced and to create a unique community of engagement and support. Identity is sometimes elusive, straddling the known and unknown. Lalit Krishna’s paper invites readers to consider the intersection between absence and presence in relation to sedation and end-of-life care. Drawing on the ring theory of personhood, he argues that identity extends beyond consciousness and has both innate and relational dimensions to which clinical medicine must attend. There is much to savour then in the pages that follow. Readers will, of course, bring their own identities to the contents herein: selecting, interpreting, disagreeing and avoiding according to preference, affiliation and influences known and unknown. And that is as it should be. Identity is not ‘brand’ or ‘personality’. It is much more than the sum of its parts. What then is an editor who is considering a journal’s ‘identity’ to do? Perhaps she should put aside the reader surveys and marketing reports and pull down her copy of ‘Swann’s Way’6 where, in a text crammed with gems, these words might resonate: None of us constitutes a material whole, identical for everyone, which a person has only to go look up as though we were a book of specifications or a last testament … Even the very simple act that we call ‘seeing a person we know’ is in part an intellectual one. We fill the physical appearance of the individual we see with all the notions we have about him, and of the total picture that we form for ourselves, these notions certainly occupy the greater part.
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
1
Downloaded from mh.bmj.com on May 17, 2014 - Published by group.bmj.com
Editorial To cite Bowman D. Med Humanit 2014;40:1–2. Accepted 21 April 2014 Med Humanit 2014;40:1–2. doi:10.1136/medhum-2014-010540
REFERENCES 1
2
Becker HS, Geer B, Hughes EC, et al. Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press, 1961.
2
3
4
Hafferty FW. Into the Valley: Death and the Socialization of Medical Students. New Haven: Yale University Press, 1991. Mavor KI, McNeill KG, Anderson K, et al. Beyond process to prevalence the role of self and identity in medical student wellbeing. Med Educ 2014;48:351–60. Leonard P. ‘Playing’ doctors and nurses? competing discourses of gender, power and identity in the British National Health Service. Sociol Rev 2003;51:218–37.
5
6
Carel H. It’s Hard to Think Without Your Pants On: Patient Testimonies and Epistemic Injustice. (Keynote 3) A Narrative Future for Healthcare Conference, 2013. Proust M. Swann’s Way. Trans. Davis L. New York: Viking, 2002:19.
Bowman D. Med Humanit June 2014 Vol 40 No 1
Downloaded from mh.bmj.com on May 17, 2014 - Published by group.bmj.com
On identity in (the) Medical Humanities Deborah Bowman Med Humanities 2014 40: 1-2
doi: 10.1136/medhum-2014-010540
Updated information and services can be found at: http://mh.bmj.com/content/40/1/1.full.html
These include:
References
This article cites 2 articles http://mh.bmj.com/content/40/1/1.full.html#ref-list-1
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to: http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Editorial
On identity in (the) Medical Humanities Deborah Bowman Questions of identity are inherent in health, illness and medicine. Those who live with illness often describe how the experience represents a challenge to, and change in, their identities. Those who aspire to treat illness and those entrusted with caring for the sick grapple with shifting personal and professional identities. For an editor relatively new in the post, matters of identity are preoccupying. How is the journal perceived? Who are our readers and our contributors? What is this field we call ‘medical humanities’ and where does this publication sit? These are some of the questions that have informed recent conversations with the editorial team at Medical Humanities. The discussions that have ensued have been rich and thought provoking, leading to a programme of planned development for the journal. It is a process that demands attention to identity. It serves as a reminder of the complexity and tensions inherent in defining and understanding identity. Identity may be both liberating and constraining. It is shaped and affirmed by a potent interplay of individual preferences and collective factors. Identity may be declared, elusive or assumed. It is a shifting, nuanced and contestable concept that is socially and philosophically situated. Most people writing for, or reading, this journal will be comfortable with the contextual nature of identity. Yet, too often we are asked or even required to disregard plurality and align ourselves with a single identity or way of being. For scholars, questions about our work often assume and demand that we identify with a single discipline or principal subject area. However rich and cross-disciplinary our work, we are required to locate it, often in traditional and sometimes inflexible categories. While the idea of the ‘vocation’ is less pervasive and persuasive than it once was, healthcare students are told from their earliest days that they are ‘different’ from their peers at university. Educational philosophy and training structures may change, but the student’s experience of professional socialisation endures.1 2 Once qualified, clinicians pursue increasing specialisation and Correspondence to Professor Deborah Bowman, Room 6.73, Division of Population Health Sciences and Education, St George’s, University of London, London SW17 0RE, UK; [email protected] Bowman D. Med Humanit June 2014 Vol 40 No 1
delineation of role. The power of the externally imposed identity3 and the tug of tribalism4 remain for even the most independent scholar or practitioner. The confining effects of identity are felt too by those who become patients, from the mundane, but significant, dehumanisation that occurs when a person is distilled into a hospital number, test results, systemic pathologies or bed location to the existential crises to which illness and suffering give rise. Diseases too are telescoped into singular identities in which a particular narrative, often predicated on a reductive or mechanistic account, dominates discourse, leading to what Havi Carel describes as ‘epistemic injustice’.5 The privileging of particular ways of describing illness or disease has significant implications for how we identify and respond to illness. It represents a clash of identities: the collision of personal, professional, individual, systemic and epistemological identities in which multiplicity of meaning may be unseen, disregarded, misunderstood or diminished. Matters of identity in all its forms recur in this issue of the journal. The ways in which discourses of disease and diagnostic identity are constructed are considered by Ciara Breathnach and Roberta Bivins in their papers about tuberculosis and rickets, respectively. Each of their analyses reveals the identities both claimed and overlooked in the dominant accounts of these diagnoses. Allan Beveridge explores not a specific diagnosis but the nature of ‘madness’ in his consideration of the work of Gerard de Nerval. The questions prompted by de Nerval’s autobiographical novel are fundamental to identity, both of the individual experiencing ‘madness’ and of the professional response of psychiatry (and its detractors) to the same. Anna Goodhart too is concerned with the ways in which professional responses to representations and interpretations of distress are insufficient to attend to the richness of identity and experience. In her paper, she considers the relationship between the heart, the notion of ‘the inner self ’, emotions and the significance for contemporary practice in cardiology. Changing and developing identities are the focus for another cluster of articles included in this issue. Two papers consider educational identity in their explorations of types of knowledge and medical students. Matthew Phillips and his co-authors describe and evaluate a module entitled
‘Power and its Implications’ that is offered to first year medical students. Neil Metcalfe and Elizabeth Stuart examine the ways in which history has been received when under consideration for inclusion in the curriculum and map the people and organisations that have served as the subject’s advocates and supporters in medical education. Sarah McNicol offers her insight into a growing area of attention in the medical humanities: graphic and comic art. In her paper, she argues that comic books have an educational value and identity that extends beyond the merely informational to provide a space for the diverse ways in which illness is experienced and to create a unique community of engagement and support. Identity is sometimes elusive, straddling the known and unknown. Lalit Krishna’s paper invites readers to consider the intersection between absence and presence in relation to sedation and end-of-life care. Drawing on the ring theory of personhood, he argues that identity extends beyond consciousness and has both innate and relational dimensions to which clinical medicine must attend. There is much to savour then in the pages that follow. Readers will, of course, bring their own identities to the contents herein: selecting, interpreting, disagreeing and avoiding according to preference, affiliation and influences known and unknown. And that is as it should be. Identity is not ‘brand’ or ‘personality’. It is much more than the sum of its parts. What then is an editor who is considering a journal’s ‘identity’ to do? Perhaps she should put aside the reader surveys and marketing reports and pull down her copy of ‘Swann’s Way’6 where, in a text crammed with gems, these words might resonate: None of us constitutes a material whole, identical for everyone, which a person has only to go look up as though we were a book of specifications or a last testament … Even the very simple act that we call ‘seeing a person we know’ is in part an intellectual one. We fill the physical appearance of the individual we see with all the notions we have about him, and of the total picture that we form for ourselves, these notions certainly occupy the greater part.
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
1
Downloaded from mh.bmj.com on May 17, 2014 - Published by group.bmj.com
Editorial To cite Bowman D. Med Humanit 2014;40:1–2. Accepted 21 April 2014 Med Humanit 2014;40:1–2. doi:10.1136/medhum-2014-010540
REFERENCES 1
2
Becker HS, Geer B, Hughes EC, et al. Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press, 1961.
2
3
4
Hafferty FW. Into the Valley: Death and the Socialization of Medical Students. New Haven: Yale University Press, 1991. Mavor KI, McNeill KG, Anderson K, et al. Beyond process to prevalence the role of self and identity in medical student wellbeing. Med Educ 2014;48:351–60. Leonard P. ‘Playing’ doctors and nurses? competing discourses of gender, power and identity in the British National Health Service. Sociol Rev 2003;51:218–37.
5
6
Carel H. It’s Hard to Think Without Your Pants On: Patient Testimonies and Epistemic Injustice. (Keynote 3) A Narrative Future for Healthcare Conference, 2013. Proust M. Swann’s Way. Trans. Davis L. New York: Viking, 2002:19.
Bowman D. Med Humanit June 2014 Vol 40 No 1
Downloaded from mh.bmj.com on May 17, 2014 - Published by group.bmj.com
On identity in (the) Medical Humanities Deborah Bowman Med Humanities 2014 40: 1-2
doi: 10.1136/medhum-2014-010540
Updated information and services can be found at: http://mh.bmj.com/content/40/1/1.full.html
These include:
References
This article cites 2 articles http://mh.bmj.com/content/40/1/1.full.html#ref-list-1
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to: http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to: http://group.bmj.com/subscribe/
