DR ANDREW HULLDEPARTMENT OF PHILOSOPHY, HISTORY AND LAW

SCHOOL OF HUMAN AND HEALTH SCIENCES SWANSEA UNIVERSITY

Medical Humanities @ Swansea University

MeSH - BSc Medical Sciences and Humanities BV95 (3 yrs f/t)

Exploring the scientific and human sides of Medicine & Healthcare since 1999

http://www.swansea.ac.uk/health_science/Undergraduate/MedicalSciencesHumanities/

This innovative, interdisciplinary degree reflects contemporary medicine’s patient-centred and bio-psycho-social understanding of health, illness, and healthcare interventions . It has been developed in conjunction with the University’s School of Medicine and allows you to study the broad spectrum of subjects that encompass the science and art of medicine.

The Course Ethos

‘It is more important to know what sort of person has a disease than to know what sort of disease a person has.’ (Hippocrates). 

‘My aim is not to make a system or to see patients as systems, but to picture a world, a variety of worlds – the landscapes of being where these patients reside.’ (Oliver Sacks, Awakenings New York, Harper, 1990).

Bringing together information related to biophysical, psychological, and social factors - a more holistic approach that focuses on the whole patient and not just the specific disease, condition, injury, or symptom.

To challenge received concepts of health, disease, well-being, human flourishing.

Scientific and Human

• Something has gone wrong with MedicineSomething has gone wrong with Medicine

• needs to be more patient-centred and this needs to be more patient-centred and this needs to entail substantive changes to theory needs to entail substantive changes to theory and practice of Medicine and healthcare.and practice of Medicine and healthcare.

• Medicine is an Art as well as a Science Medicine is an Art as well as a Science (practical art – techne?)(practical art – techne?)

• The Art comes in that The Art comes in that makingmaking by and by and applying applying of of science to individual human beings – science to individual human beings –

• Analyse knowledge making and applicationAnalyse knowledge making and application

• Transferable skills.Transferable skills.

History: Evolution of the Biomedical Paradigm

Each year - two modules in six distinct areas of study:

 Biological Sciences explores how knowledge of biological systems at the molecular, cellular and organismal levels underpins clinical medicine.

 Clinical Sciences key study and learning skills of medicine and healthcare: esp.essential critical information analysis of evidence-based-medicine; the issues surrounding implementation of public health interventions; and the integration of theoretical and practical knowledge in patient interactions, via reflective clinical observation.

Philosophy of Medicine –explores ethical and conceptual issues that shape the nature and goals of medicine, interrogating problems of life and death, genetic ethics, multiple personality disorder, and conceptions of mental illness.

Social Sciences and Medicine – comprises the economic, psychological, and sociological dimensions that inform the experience of medicine and health care, and also issues of costing and provision across the lifespan.

  History of Medicine

provides a critical view of the interaction of intellectual and social factors in the making of medical theory, practice, and professionalisation, and the overall role of medicine in the creation of modern society since 1500.

  Literature and Medicinecontrasts doctors’ and patients [Lynsey there is no dash there] views of disease by examining literary narratives of health care and illness.

Narrative Beyond Empathy: Oliver Sacks

Romantic Science: both scientific and human facts needed

Medical problem not just physical lesion but lesion of the soul/self - in linked:

Disruption in the story of the self (narrative identity)

Disruption to fundamental sense of self – BODY-IMAGE

Health = adaptability/new normality (Canguiheim)

Doctor’s role: facilitating this remaking of the physical/mental/idea of self

Bio-psycho- SOCIAL model

‘Medicine is a social science, and politics nothing but medicine on a grand scale.’(R. Virchow, Die Medicinische Reform, 1848)

Holism in Medicine

The patient is not merely the addition of circulatory, respiratory and excretory symptoms – a sort of heart-lung-kidney preparation – but a human being with all the desires and emotions, hopes and fears of humanity. Whereas the physiologist and pharmacologist can more or less isolate the object of investigation, the patient, like other living organisms, cannot be disassociated from this environment. One merges with the other with mutual action and interaction.

(Noah Morris, ‘Prolegomena to the Study of Therapeutics’, Glasgow Medical Journal, 1937, 7th series, 10, No. 4, p. 148).

MeSH Spectrum

• Explores Medicine and Healthcare in the various contexts that we experience them as a society:

1. Technical Knowledge (Medical Sciences)2. Human Sciences Perspective (Psychology,

Sociology, Economics, Law etc)3. Humanities Perspective (Philosophy

[Medical Ethics, Autonomy, Identity etc]; History (science of knowledge change); Literature)

The B.Sc. Year 1

•Human Anatomy and Physiology

•Applied Human Biology

•Maths and Physics for Physiological Measurement Systems

•Study Skills and Health Informatics

•Sociology of Health and Illness

•Health Law

•Philosophy of Medicine

•Psychology and Medicine

•Sociology of Health and Illness

•Sociology of Health and Illness

•History of Medicine

•Medicine and Literature

The B.Sc. Year 2

•Human Anatomy and Physiology 2

•Pathophysiology

•Research Methods & Statistics

•Health and Economics

•Health Law and Practice

•Health Disease and Illness

•People Populations and Medical Care

•Psychology, Health, Illness & Medicine

•Medicine and Society

•Genetics*

The B.Sc. Year 3

•Applying Information in Medicine*•Systems Physiology and Common Pathologies•Public Health Medicine and Epidemiology•Persons and Illness•Sociology of Health and Illness•Applied Psychology & Health•Genetics*•Hospitals in History•Dissertation

PG: MA in Medical Humanities (2001-)

David Greaves and Martyn Evans in 2001http://mh.bmj.com/content/27/1/51.fullPhilosophical element still central, but more

strongly supplemented now by Historical, Literary and Visual Art perspectives

History as a Medical Humanity: current research focus – ‘cultural history’ and bio-power formations

Target of Teaching/Research: How to re-frame conflicted role of MH is Medical/pre-medical curricula

Evolution of the Biomedical Paradigm?

Impact of Standard Historiography of BP on Role of MH: Something is missing from Medicine

1. Constructs role as bringing subjective experiential human facts as counterweight to reductionist objective scientific medical facts .

2. MH can only = bolt-on, not be integrated3. Assumes universal objectivity and

reductionism as intention and result of Scientific Medical Project/Professional Entity

4. House Built on sand: This leaves MH vulnerable to Positivist Backlash: non-core activity: MH is easily labelled as non-core because it hasn't justified its role as core/penetrated the core definitions of Medicine

Modernism/Postmodernism:HOM and the Postmodernist Critique

Critique of MH very similar to postmodernist critiques of History Structure vs. agency; objectivity versus subjectivity; material vs.

ideal

Modernist concern with subjectivities to be bolted on to existing epistemological

framework. Revision not abandonment of En project. Scientific medicine – plus subjectivities (Med Hum) HOM (medico-centric – knowledge/practice) – plus subjectivities

(patients) Postmodernist focus on process – everything is constructed – nothing is solid – all is

always emerging from social processes (including concepts of social processes!)

‘History’ is historical construct like ‘Science’, ‘Progress’ etc Our analyses must reflect this and not assume objectivity and thus reify

outmoded discourses of positivistic science

Disability and Industrialization: A Comparative Cultural History of British Coalfields, c.1700-1948.

What discourse of work injury/disability play around the coalfield industries and communities?

Role of Medical Discourses of Disability?How are they themselves constructed?What part do they play in individual or group

discourses of debilitating injury/illness?Inputs from self-help groups, Trades Unions,

insurance companies, religious groups, local authorities, national policy-makers, doctors (GPs, consultants, Public Health, Industrial Health) etc etc

Disability and Industrialization: A Comparative Cultural History of British Coalfields, c.1700-1948.

What discourse of work injury/disability play around the coalfield industries and communities?

Role of Medical Discourses of Disability?How are they themselves constructed?What part do they play in individual or group

discourses of debilitating injury/illness?Inputs from self-help groups, Trades Unions,

insurance companies, religious groups, local authorities, national policy-makers, doctors (GPs, consultants, Public Health, Industrial Health) etc etc