hltb50h3 lec’s 1, 2, 3

What are the humanities? 

• Literature — study of written works 

• History — research and interpretation of past events, societies and cultures 

• Philosophy — inquiry into fundamental questions about existence 

• Languages — study of modern and classical language and linguistics 

• Art — includes visual arts (paintings, drawings, sculpture

• religion — comparative religion, religious studies 

Medical humanities 

• Focused on education of medical professionals 

• Focused on physician- patient relationship 

• Focused on educating and training doctors 

Health humanities

• broader approach to social determinants of health 

• humanities is for everyone / wider audience 

Health humanities aka public health 

concerned with well-being, and promotes all sectors and communities 

— challenges privileging of professional expertise over lived experience and lay perspectives

Epistemology

branch of philosophy concerned with the nature of knowledge 

Ontology

Way of knowing, values interpretive methods and social experience

Activism

Health humanities as a vibrant site of public learning and activism, activism as a “free form and viral moment” that can inform and transform ways of seeing

Disciplinary knowledges

Epistemology: principles and theories of knowledge

Biomedical perspective

Focused on biological factors to to understand medical illness

Public health perspective

Studies patterns causes and effects of health and disease conditions defined populations, often by identifying risk factors for disease and targets for preventative health care

Art therapy

Art used in service of health care, uses the creative process of making art to improve a persons physical, mental and emotional well being

Preamble

• Health care practices are changing

Ex. economic pressure, corporatization, advances in AI

Trust

Critical element in medicine

Asymmetry of information

the recipient of care can not judge the effectiveness of care 

Imagination

• Details of a patient's world are told through the stories they tell, the act of telling and listening to stories depend on imagination 

William Osler:

• It is much more important to know what sort of patient has a disease then to know which disease as patient has” (p. 113)

• For patients storytelling is a matter of life or death 

Sociological imagination

• Capacity to see how a person's personal life is shaped by society 

Fractured Self 

• Patients struggle for language to articulate their lives 

Imagination is practice 

Origin of any hypothesis that lead to discovery

Disembodied medicine

• Primary articulations (accounts) of the body are lab values, images, and reports

Fractures

Can be reintegrated (made whole) even if physical condition does not leave 

Embodiment

• Requires integration of all dimensions in the human being 

—-> excludes poetic materiality: how imagination shapes our experiences across personal and historic dimensions

Enactivism

• Interchanging relationship between observer and observed 

• observers shape the world as they perceive 

Care as an embodied process

• Medical education must incorporate practices from arts and humanities -> what is illness, the body and what a person is 

Art Frank coined 4 key distinctions 

Disease vs illness, Patient vs ill person, Medical history vs ill persons story, Treatment vs care

Disease vs illness:

• Disease - reducible to biochemistry 

• Illness - involves reflective consciousness

Patient vs ill person 

• Patient - identity imposed upon a person by medical institutions 

• Ill person - patient some of the time 

Medical history vs ill persons story 

• Medical history - understanding patient in term of nature of the disease they have 

• Ill persons story - medical patient become delimited by his or her story 

Treatment vs care

• Treatment - serv ice with monetary value

• Care - gift 

Medical images 

• Imaginative leap 

Representation in health and medicine 

Mimetic - fixed meaning 

Diegetic - interpreted 

Pain

• No way to objectively measure pain, measurable yet to some extent visible 

• Representations of pain and culturally shaped 

What is the mc gill pain index?

• Clinical tool developer and mc gil uni 

• Provides list of gerunds to articulate pain 

Photographing pain 

Charles Darwin argued that emotions and mimetic (unmedicated) physical expressions of experience

Subjective knowledge and suffering

When patients suffer it is suffering and not pain 

• Suffering occurs because the integrity of a person is threatened 

Event

• Single occurrence where something happens 

Story

• Two or more meaningful events happening in a series 

Narrative

• Rendering/ telling of a story

Story vs the narrative 

• Used interchangeable but very different:

story = Factual sequence of events 

narrative = how story is communicated 

Plot

• Gives a sense of causality  

Character

• Human identity 

Pov

• Way story is narrated 

• Affects how story is told 

Enchantement

• Humanistic terms do something to the illness experience - they enchant them 

What is disenchantment?

• Term coined by max weber (1864-1920)

• As we subject world to rationalization we lose the sense of mystical 

Stories or narratives help rehabilitate enchanted life and care

Franks illness narrative 

• Restitution, chaos and care 

restitution (cure) narrative ?

• Illness is temporary and body can heal 

Chaos narrative 

• Illness is a permanent state of disaster, anxiety provoking 

Quest narrative 

• Departure, initiation, and return 

• Therapeutic “im not alone”

Literal and figurative language

literal: primary, what is actually written 

- figurative: figures of speech (metaphor, simile)

Defining poetics 

• Alliteration - repetition of consonant “ride rocket rockets”

• Apostrophe - “be still, my heart” “O, canada”

• Assonance - repeating vowel sounds “hot shot” “barren peaks and squeaks”

Simile and metaphor 

• Simile - association between two unlike things using like or as

• Metaphor - comparison between two unlike things “shes a night owl” “hes got cold feet”

Tenor and vehicle

• Metaphors have two parts tenors and vehicles 

• “life is a journey”

Tenors = life 

Vehicles = journey 

Metaphors and illness 

• Disease and illness described using metaphor 

What is a military metaphor? 

• prevalent in health care, provides strong countermeasures for feelings of powerlessness 

• Ex. influenza attacks the body 

Summarize poetics of health and illness

• language we use provide powerful frame to understanding to disease and illness 

• Ex. patient-professional relationship as a form of combat or military engagement 

Time line 

ancient -> medieval times -> renaissance 

Ancient

• Greece, Rome 5th c. BCE - 5th C. CE

Medieval

• Middle Ages” in Europe 5th to 15th CE