Medievalism and the medical humanities

‘He was a verray, parfit praktisour’ (Benson, 1987, 30). This is the high – though in context equivocal – praise given to the Physician, one of the pilgrims in Geoffrey Chaucer’s Canterbury Tales. The endorsement is based on the Physician’s knowledge of his subject: he has expertise in medicine and surgery, including the humoral system and astrology – ‘magyk natureel’ (Benson, 1987, 30). He is deemed a successful physician for his ability to discover an origin and remedy for every illness: ‘The cause yknowe, and of his harm the roote, / Anon he yaf the sike man his boote’ (Benson, 1987, 30). Direct engagement with the ‘sike man,’ however, seems limited, and indeed, it was not until the eighteenth century that medical practice would include physical examination of a patient. In Chaucer’s depiction, there is no real sense of individual diagnosis, but rather of a framework applied to ‘sickness’ so that a solution can be found as efficiently as possible. The Physician’s main interest proves to be his fee. How influential, then, was the patient, or the individual more generally, in shaping medieval conceptions of medicine and wellbeing? What were the roles of society, economics, politics, culture, and language? What were the boundaries between illness and health, how were normal and pathological distinguished, how did minds and bodies intersect, and how did medical, philosophical, social, and cultural discourses construct or compete to shape understandings?

These are some of the questions that the essays in this special issue address, inspired by and drawing on the provocative and evolving methodologies of the medical humanities. The editors of the recent Edinburgh Companion to the Critical Medical Humanities define the field as ‘a series of intersections, exchanges and entanglements between the biomedical sciences, the arts and humanities, and the social sciences [. . .] an area of inquiry that is highly interdisciplinary, rapidly expanding and increasingly globalised’ (Whitehead and Woods, 2016, 1).¹ Originally rooted in medical education, with a particular focus on the ways that the humanities could illuminate clinical encounter, ethical questions, and the experience and narration of illness, medical humanities has widened its gaze to social, cultural, and political problematics of health. Its topics look beyond the individual to language, narrative, ideology, visual cultures, health institutions, and technologies.

Yet in bringing this comparatively new field into conversation with medieval studies, are we in danger of imposing a modern framework onto a very different, premodern culture and set of values? In an early definition of the medical humanities, David Greaves and Martyn Evans distinguished two main areas of research:

The first is concerned with complementing medical science and technology through the contrasting perspective of the arts and humanities, but without either side impinging on the other. The second aims to refocus the whole of medicine in relation to what it is to be fully human; the reuniting of technical and humanistic knowledge and practice is central to this enterprise. (Greaves and Evans, 2000, 1)

Medical humanities has taken up the challenge of reuniting knowledges and practices. If medicine is to be refocused, however, so too are the arts and humanities. Medicine and related topics – health, illness, body, mind, gender, emotion – provide flashpoints, ways into some of the most profound aspects of human existence, of being and feeling. Medical humanities draws attention to and explores such flashpoints, bringing to bear on them the methodologies not only of the arts but also the sciences – most recently, psychology and cognitive neuroscience. Taking a long cultural perspective not only reveals shifts in understanding, but also continuities and connections. The present is shaped by the past – but the past can also open up powerful new ways of seeing. Historical perspectives ‘offer alternative vantage points,’ suggest ‘different forms of qualitative critical thinking,’ and ‘help us to understand the extended, continual and shifting process of negotiation through which certain objects and practices come to our attention and others fade from view’ (Whitehead and Woods, 2016, 7).

Thinking historically is essential to this ‘critical medical humanities,’ a field

interested in illuminating diverse ways of doing medical humanities that are not only sensitive to imbalances of power, implicit and explicit, but include activist, sceptical, urgent and capacious modes of making and re-making medicine (and those domains closely allied to it) – and hence its ability to transform, for good and ill, the health and well-being of individuals and societies. (Viney, Callard, and Woods, 2015, 3)

Through its power to shift thought paradigms, to extend and change understandings, research in medical humanities has the potential to influence health and wellbeing. The apparent otherness of pre-modern ideas of medicine, health, body, and being conceals surprisingly topical messages that take up the challenge of critical medical humanities. While objective medical diagnosis seems distant from medieval medical notions, with their emphasis on morality and character, behind the overt language of sin and the archaic practices of humoral purging is a holistic perspective that takes into account individual lives both past and present. Chaucer’s description of his Physician is satirical because it deliberately removes the patient from the scene. Medieval medical theory and related discourses, by contrast, did not focus exclusively on diagnosis of disease but assumed the need for a wider gaze. Contemporary medical practice and public health initiatives have begun to recognise the value of holistic approaches, of identifying the origins and social contexts of medical conditions, rather than simply prescribing treatments. Whereas the latter approach may allow targets to be met, and may be more immediately cost effective, in the longer term this is unlikely to be the case. Short-term perspectives have serious implications both for patients and for the health of society more generally, particularly in an era when practitioners, who themselves are becoming more specialised, are facing an increase in ‘multi-morbidity’ (where patients suffering from more than one chronic illness present an array of symptoms). Critical medical humanities argues for the importance of clinical generalism, the need for practitioners to understand the person holistically, in terms of the interdependence of mind, body, and affect, and in wider cultural and social contexts. It also underlines the need to recognise the practitioner as embodied, and so stresses the complex interrelation of physical, mental, and affective elements of practice. The medieval thought world speaks to all these concerns.

It also speaks to enduring questions concerning mind, memory, emotion, and consciousness. The medieval period was distinguished by its own complex understandings of what it was to be ‘fully human,’ including a variety of beliefs about body, mind, and soul. Medical theories competed with those of other socio-political, theological, and cultural discourses.² Because medieval thought was not predicated on Cartesian dualism, the dynamic relationship between mind and body was central to understandings of the human: all experience was embodied, and mind, body, and affect were intimately connected. Recent research in this area has explored the intersections of mind and body in medieval imaginative writings in relation to corporeality, emotion, and identity.³ Literary texts illuminate how wounded, affected, or transformed bodies alter individual well-being and selfhood, influence lives irreversibly, shift the course of events, inspire legends, and change histories.

If understanding the dynamic between mind, body, and affect in a pre-Cartesian world is key to understanding medieval culture, it is also resonant for contemporary science. Recent research on memory and narrative, including in cognitive neuroscience and psychology, takes up the notion of embodied experience to emphasise that present moments should not be viewed in isolation, but rather appreciated as part of a series of linked episodes. Medieval writing, both biographical and imaginative, repeatedly draws attention to the shaping of an individual’s present by past experience and hints at how the present will in turn shape the future. McKinstry’s recent study of medieval romances argues that this was essential to medieval concepts of time and memory, with their roots in classical philosophy (McKinstry, 2015). Medieval models of memory, and of the connections between cognition and emotion, have opened up new ways of understanding aspects of mind and consciousness that remain enigmatic for contemporary researchers.⁴ They hold much potential for future explorations of mental health and illness, including of dissociation, trauma, post-traumatic stress, and psychosis, as well as in relation to ideas of mental wellbeing, the processes of cognition and its interplay with affect, inner speech and dialogue, and the role of spirituality in mental health. The medical humanities, then, urge a holistic approach that takes into account the past, present, and future of individuals and societies, by contrast to the more reductionist stances that have been typical of bio-medical approaches.⁵ Medieval thinkers, it seems, already understood the concept of the embodied mind and the crucial roles of introspection, retrospection, and prospection in shaping and comprehending the self.

The potential of the medical humanities and the value of taking a long cultural perspective are exemplified by two collaborative interdisciplinary projects based at Durham University, Hearing the Voice and Life of Breath.⁶ These projects bring together researchers in arts and humanities, social science and science, health-care professionals, and experts by experience. Hearing the Voice explores the mental phenomenon of hearing voices without external stimuli; Life of Breath addresses the physical symptom of breathlessness and the cultural history of breath. Probing the parallels and contrasts between pre-modern and contemporary experiences of and attitudes to voice-hearing contextualises and illuminates contemporary experience, by offering new frameworks of understanding and authorisation. Fundamental to Hearing the Voice is the belief that the perspectives on embodied experience offered by the imaginative worlds of literature can provide a corrective to narrowly bio-medical perspectives, widen the questions generated in clinical research, and present new therapeutic possibilities. The approach is exemplified in this issue by Saunders and Fernyhough, who bring cognitive psychology and medieval literary and cultural studies into dialogue in relation to the visionary experience of Margery Kempe. The Life of Breath project builds on the interdisciplinary approach of Hearing the Voice to propose that breathing and breathlessness can only be understood fully by drawing not only on physiological and pathological evidence, but also on cultural, historical, and phenomenological sources. Whereas much medical humanities work has focused on mental illness, this project addresses a physical symptom, breathlessness, with the aim of informing clinical practice by illuminating the ways in which the embodied experiences of breath and breathlessness connect with deep-seated assumptions and enduring cultural attitudes concerning breath.

Such projects demonstrate the remarkable potential of entanglement of the arts and humanities with medicine. While medical humanities have moved far beyond the notion that exposure to the arts, particularly literature, produces better doctors, the arts and humanities retain a powerful role in terms of communication, empathy, and imagination. The creative arts may convey the subtleties of experience in ways that scientific language cannot, may provide the images, analogies, and metaphors that represent what is often highly subjective, from bodily pain to the hinterlands of mental illness. Their communicative power speaks across boundaries – to patients and service-users, carers and clinicians, and the wider public. Imagination can function not just as a way in but as a methodology, challenging stigmas and transforming understandings. Medical humanities draws on the affective and empathic power of the arts to open out human experience, illuminate the present through the past, and transform understandings of health.

This imaginative potential was already recognised and exploited in the medieval period. Thus fifteenth-century banns advertising the services of a physician promise a cure for migraine (a term first recorded in Old French in the twelfth century) not in scientific terms but in vivid metaphor: ‘e wyl curyn ye mygreyn qwiche is a Maladyȝ yat takyth halff a man is hed & doth hym lesyn is syȝthe of his yie’ (Voigts, 2011, 245).⁷ Articulation of symptoms and creative expression combine to communicate the head-splitting pain and blurred vision characteristic of severe headache. The late medieval Scottish poet William Dunbar (c. 1459–c. 1517) employs similar terminology in his short poem about suffering from a headache or, specifically, a ‘magryme’ (Bawcutt, 1998, 127). Although the poet uses the same medical term discussed above, this is soon explained and elaborated further when the pain is compared to an arrow affecting his vision: ‘Perseing my brow as ony ganȝie, / That scant I luik may on the licht’ (Bawcutt, 1998, 127).⁸ Medical and poetic language coincide, as the physician adjusts his register for a lay audience of potential customers while the poet uses metaphor affectively to convey the pain of his condition.

The essays in this issue celebrate the rich and diverse range of opportunities offered by the medical humanities for medieval studies. They go beyond conventional medical history to reveal understandings and beliefs concerning health, well-being, and illness, and hence illuminate fundamental aspects of experience and existence. They suggest correspondences but also challenges, questions, contradictions, and opportunities for further research. Topics span the meanings of metaphor (Boyar and McKinstry), cultural medical practices (Crowcroft and Jenkins), experiences of and responses to certain conditions (Leahy, Chunko-Dominguez, and Saunders and Fernyhough), and practical and philosophical considerations concerning the relationship between medieval studies and the medical humanities (Hartnell and Macnaughton). Together, the essays demonstrate that responsibility for the health and well-being of an individual or society by no means belonged to medicine alone. Many other factors influenced the health and quality of life, including the powerful institutions of court, politics, and Church. This complex set of social and cultural forces requires the kind of dynamic and inclusive approach that the medical humanities offer, while medieval thought and writing can also speak directly to contemporary concerns.

Overall, then, the issue aims to suggest the creative and critical potential of medical humanities in relation to medieval studies, and the possibilities of new methodologies and subjects, while also offering fresh approaches to familiar texts and contexts. The essays included here represent only a starting point. The medical humanities have much more to reveal about the medieval period, methods of and approaches to research, and the benefits of dialogue across the arts, humanities, and sciences. Perhaps most crucially, they lead us to question and re-assess the nature of embodied experience in lives, cultures, and centuries that are temporally distanced from our ours – experience that is radically different from yet often profoundly connected to and even startlingly reminiscent of our own.