We host an interesting interview with Professor Carol Ann Farkas.
Prof Farkas, could you introduce yourself?
Hello! I started my academic career with a doctorate in Victorian literature, but the topic of my dissertation was a study of late 19th century novels featuring women doctors as the main characters. This project made me a good fit for my position at MCPHS University – once exclusively a school of pharmacy, MCPHS now offers degree programs in just about every health care profession you can think of. At MCPHS I direct the first-year writing program, and teach academic writing, 19th century fiction, and a course on Narrative and Medicine (which I need to rename Narrative and Health, to be more inclusive). My research has focused on health, wellness, and popular culture (particularly how fitness magazines teach both health, and health anxiety). More recently, I’ve become more involved with the scholarship of the health humanities – in particular, I’ve become very interested in how lay people and experts differ in their understanding of, and discourse about, illnesses of body and mind which elude easy diagnosis.
From your humanistic background why did you decide/or it happened to keep a course on medical humanities for future physicians, pharmacists, nurses, and other health care providers?
Before I had learned much about the health humanities, I was eager to teach Narrative and Medicine because, frankly, I just thought it would be fun for me, and a fun way to reach our undergraduates, for whom we do not yet have a humanities degree, and who consequently have relatively little preparation in studying literature. But then I started to read more of the scholarship on the health humanities, and could see the rationale for the course unfolding in front of me: my students were already, somewhat simplistically, absorbing some of the more harmful lessons of the “hidden curriculum” of health care practice in this country, where providers have a paternalistic knowledge of what’s best, and patients who don’t “adhere” well to treatment are regarded as frustrations, rather than equals. I’ve come to see our course, and other courses in the humanities, as an absolutely essential part of the undergraduate health sciences curriculum – these courses challenge the students in terms of critical thinking, imagination, and empathy, and demand that they pay compassionate attention to what it means – for them, for their students – to be human, to be humane.
What do you mean with this definition “medical Humanities”? Do they differ from narrative medicine or are these disciplines entangled togethers?
Let me start by endorsing the shift in nomenclature that we’re seeing, from “medical humanities” to “health humanities.” I like how the latter term de-emphasizes the primacy of medicine, especially with its focus on just bodily disease and those who have it or treat it – and instead offers a more biopsychosocial emphasis on health as it is lived by both lay people and experts.
Our discipline’s great strength is its interdisciplinarity; this is also one of its great challenges – encompassing so many interests and approaches means that one definition is tricky!
What unites scholars, working from a variety of disciplinary methods and theories – is an interest in how health and illness function as sites of meaning in culture, and as profound experiences which we humans all share. Much health humanities scholarship is performed at a fairly analytical, theoretical level – doing the abstract work of understanding how discourses of “health” or “illness” are culturally constructed for example. Such work is fascinating, and important, but pretty specialized. By contrast, I see narrative medicine as very much included within the larger category of the health humanities, but as a much more applied approach, taking the theories and principles of the larger discipline, and putting them into practice at the individual level, as part of the healing work of the clinical encounter.
You propose close reading of medical humanities literature, or “close watching” on illness centered movie at your course: which are the reactions of your students? What are the benefits of these activities? Do you Envision any downside?
In our Narrative and Medicine course, we start the course with a few short stories and novels focused on the experience of the health care provider (mainly doctors and nurses), studying how the narratives construct different versions of “professional identity”; in the second part of the course, we continue with short stories, novels, and films, representing the patient experience. I have the students write a few short research papers, wherein they must explain how fictional narrative can influence providers’ and patients’ experience of illness – and this work is the basis for our class discussion as well. I think the discussions go really well – most students respond very empathetically to the various narratives, and when they don’t, that generates challenging conversation: why DON’T you care about this character’s experience? Film works particularly well – the students, as products of their time, are much more comfortable responding to film than to literature (alas!). They can readily see suffering when it’s represented on film, and definitely feel a response to the characters’ experiences with unjust, unfeeling treatment, versus caring and compassion. So there’s no downside to getting future health care providers to be more mindful about what it means to care for their patients, at the level of the individual, as well as at the level of the institution, or the culture of health care itself. Rather than a downside, one obstacle I encounter: sometimes students just *can’t* read or watch a narrative in anything other than a literal, concrete way. That is, they can encounter a story as a case study which might have a simple, direct lesson about patient care, but for some, it’s very, very hard to make the leap to figurative, metaphorical readings, or to use the experience of a few individuals to draw inferences about larger, abstract problems, like structural inequality for example.
If you had the magic wand… how would you include the discourse of medical humanities teaching at the university? Or even prior? or later?
We have the magic wand! My colleagues and I are in the process of developing an interdisciplinary, inter-institutional degree program in health humanities! This program will allow students to study the humanities as they might in any undergraduate degree program, only with a thematic focus on health; we expect, however, that most students will use the health humanities degree as a preparation for further study in health care practice, policy, and public health. I’m hoping that many (if not most) of the courses in the degree program will NOT be directly focused on health – students will take the health sciences courses necessary for specific career choices (pre-med, for example), but will have a broader, more generous and liberal exposure to the humanities, arts, and social sciences as the mainstay of their undergraduate degree program.
In my opinion there is a clear distinction between story telling (stories inspired to facts but not written directly by patients and providers of care) and narratives of patients: how do you consider this issue, if for you this is an issue?
I think the difference definitely matter – in particular, I’m very interested in understanding what we use different kinds of illness for – the social and clinical work they can or should do. To help my students think critically about the different kinds of narratives about the illness experience (being ill, caring the someone who is ill), I take a rhetorical approach: who is telling the story? to whom? what might the story-teller hope for as a result? what meaning does the audience get from the story, in addition to, or instead of, the story teller’s purpose? These questions are accessible ones to start with, but can lead us to consider complicated problems – of social relationships, cultural values, knowledge and authority, power.
Using medical humanities Heritage, which are the Writers and screen makers of biggest impact in the hearts and souls and minds of your students up to now?
My students love a couple of texts I don’t actually teach: Tuesdays with Morrie, and W;t. My female students enjoy Helen Brent MD, and “The Yellow Wallpaper.” And I get a lot of good discussion going with William Carlos William’s story “The Use of Force,” which I combine with Richard Selzer’s “Brute,” and “Toenails.” As far as film or tv: the film we watched more recently, 50/50 seemed to be a favorite. Students used to all reference House MD (alarmingly, many would start the semester naming House as a role model), now it’s more Grey’s Anatomy.
Moving from Young students to senior doctors and other providers of care. Did you have to try the experience of teaching them medical humanities? Could you tell something about their reactions? Do you think that it could be too late to teach your subject to people who already entered in their role…and they have been practising for many years, and still they do it…
I’ve only taught undergraduates so far…and as I mentioned earlier, by just their second or third year of university, they have already acquired a lot of beliefs about what it means to practice medicine, from both popular culture and their professional courses. In particular, they’ve learned that despite the values of patient-centered care that we espouse throughout their curricula, doctors are really the ones in charge, of both patients and the health care team. My colleagues and I have to work really hard to challenge, or at least moderate, these beliefs! I’m not sure what it would be like to work with people more established in the health professions – though I suspect that the kinds of health professionals who would seek out courses in the humanities would certainly be open-minded and curious thinkers.
You just published a book on psychosomatic disease: what has to do psychosomatic diseases with medical humanities? Do you use it for teaching at your students?
The anthology, Reading the Psychosomatic in Medical and Popular Culture: Something, Nothing, Everything includes contributions from scholars in all kinds of fields – sociology, cultural studies, medicine, anthropology, but what situates the collection in the health humanities is that shared concern with illness as a fundamentally human experience, and one which inevitably involves trying to make meaning at the individual and social level. All the contributors are interested in analyzing the so-called “psychosomatic” as a site of unstable, disputed meaning, and disrupted, if not failed, relationships. All the contributors are working towards a better understanding of the problems posed by the psychosomatic, as it is constructed in different settings, through discourse in general, and narrative in particular. We hope that such analysis might help both laypeople and clinicians approach psychosomatic conditions with more open-mindedness, critical insight, and empathy – the qualities we value most in the health humanities!
