Introducing this interdisciplinary collection of essays, the editor argues that the advent of medical humanities demands revived historiographical interest in doctor–patient relationships. The book’s primary objective is to reconsider how history might enlighten medical humanities in an interdisciplinary dialogue, and it sets out to ‘achieve a far reaching reconstruction of the doctor patient relationship from antiquity to the present day’ (p. 8). It begins with four historiographical essays that share an interest in the professionalisation of medical practice, with the doctor–patient relationship framed as a stage on which medical identity was performed and constructed. Daniela Rigato discusses medicine in Greek and Roman antiquity: the divisions between divine, Hippocratic and magical popular medicines and the intersections between the three. In this world, sick persons were offered multiple bargaining choices, whether a pact with a deity or a contract with an earthly practitioner. Interactions between Hippocratic doctors and the individual were governed by sets of rules to protect professional interests of doctors, in particular rules concerning communications of a poor prognosis and potential charges of homicide. Tommaso Duranti discusses the Middle Ages and the intersection between classical medical culture and the rise of Christianity. Christian thought ascribed spiritual and moral meaning to physical suffering. The performance of medicine was shaped by the imperative to embody Christian virtues, to observe principles of charity, and to facilitate a good death. Attention to patient subjectivity is asserted, with careful consideration of individual emotional states. Facilitating psychological harmony would have a therapeutic benefit as well as fostering trust in the doctor; trust is framed as a therapeutic instrument. Although obedient to medical instruction, the patient is ‘an actor of equal standing with the doctor’ (p. 67). Claudia Pancino discusses early modern France, Britain and Italy using treatises on ‘medical errors’, handbooks of medical etiquette (the galatei) and correspondence. Responding to the threat of ‘irregular’ practitioners, and an environment of distrust, Pancino identifies a growing emphasis on technicalities of medical practice. Doctors in early seventeenth-century Italy, for example, are urged to initiate a consultation by first examining the patient’s urine. Individual subjective experience begins to diminish, as does the notion that the relationship with a doctor is itself a therapeutic intervention. The first half of the book closes with Emmanuel Betta’s consideration of the origins of informed consent in the pages of nineteenth-century French and British medical journals. Betta argues that the origins of ‘informed consent’ lie in the ‘liminal space’ between surgery and assault, and early attempts to carve out legal protections for medical practice. Faced with the threat of being sued for assault, doctors were encouraged to establish formal permissions to protect them from prosecution. Such permissions were not framed in terms of a patient’s right to choose, but rather as a formal ratification of a decision already taken by the doctor. The best interests of the patient are no longer subject to complex negotiations. Thus the process of professionalisation explored throughout these essays concludes with the advent of this legal formulation, the role of individual subjectivity and the capacity for patient agency profoundly diminished. The second half of the volume discusses how ‘the humanities’ can facilitate the delivery of care and healing. Ivo Quaranta introduces medical anthropology: the experiential and cultural dimensions of ill health, and the co-construction of the meanings of illness between doctors and patients. He illustrates such an approach with the example of AIDS management in north-west Cameroon. Local interpretations of AIDS as a manifestation of state witchcraft were dismissed by international agencies adopting a rationalist model of individual choice. However, adequate sensitivity to local belief revealed that witchcraft explained power asymmetries and inequality: this was not a lack of understanding but a ‘culturally connoted discourse’ which underscored the politics that render the underprivileged powerless, an alternative knowledge system that better explained constraints on individual agency. Other essays include Cappi’s discussion of televisual representations of medicine. Cappi notes that the hospital medical drama privileges a model of describing disease and constructing knowledge in a manner that favours biomedicine, transcending culturally specific ways of thinking about illness. The volume concludes with essays on end-of-life care, including Giuliana Gemelli, who argues that the reductionism of biomedicine, the predominance of technology and the specialisation of medical practice, fatally undermines adequate palliative care. Drawing on the history of the hospice movement Gemelli argues that the culturally sensitive and person-centred matrix of hospice care, drawing on anthropology and built around ongoing dialogue and communication, might successfully challenge and redefine doctor–patient relationships and disrupt the biomedical paradigm. The volume achieves some of its ambitious objectives. Students of medical ethics, informed consent or narrative medicine will recognise the continuities between the distant past and the ongoing challenges of the present. The volume challenges notions of teleological progress and asserts the significance of medical humanities. It draws attention to the consequences of professionalisation and the barriers constructed to protect and enact professional interests, barriers that the humanities can identify and negotiate. In publishing in one volume essays that might not otherwise appear side by side, the book does invite dialogue between disciplines. However, the structure, dividing the historiography from medical humanities, undermines that potential dialogue. Were the individual essays interspersed, the relationships between historiography and humanities might be strengthened. Discussions of altruism and faith in classical antiquity and the Middle Ages, for example, might have been profitably situated side by side with the chapters on palliative care. Enactment of medicine in the early modern marketplace might have been provocatively positioned adjacent to discussion of ER or Scrubs. There is also the question of inevitable omissions that undermine the intended survey from ‘antiquity to the present’. The gap between 1900 and the 1970s is a troubling one. Some historiography of that intervening period might account for the reinstatement of patient agency, respect for bodily autonomy and the acknowledgement of subjectivity in therapeutic practice. The volume pays inadequate attention to the efforts that have ensured the existence of ‘medical humanities’: its conflicts and its politics. To acknowledge that conflict is to better understand how to safeguard and promote medical humanities. Nor does the collection attend to patient groups as agents of change. It is not sufficient to suggest that the practices so eloquently described in the latter half of the book are solely the product of enlightened academic practice. It is essential to examine how ill persons have acted with historical agency, not just in the articulation of personal experiences, but in the politics of collective action and its place in complicating professional authority and paternalism. However, this is simply to insist on the merits of history and to reiterate the editor’s assertions that historiography is instructive. The volume demonstrates the merits of a dialogue between historiography and the medical humanities that demands sustained attention. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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