Narrative trajectories of disaster response: ethical preparedness from Katrina to COVID-19

While COVID-19 brings unprecedented challenges to the US healthcare system, understanding narratives of historical disasters illuminates ethical complexities shared with COVID-19. In 2005, Hurricane Katrina revealed a lack of disaster preparation and protocol, not dissimilar to the challenges faced by COVID-19 healthcare workers. A case study of Memorial Hospital during Hurricane Katrina reported by journalist-MD Sheri Fink reveals unique ethical challenges at the forefront of health crises. These challenges include disproportionate suffering in structurally vulnerable populations, as seen in COVID-19 where marginalised groups across the USA experience higher rates of disease and COVID-19-related death. Journalistic accounts of Katrina and COVID-19 offer unique perspectives on the ethical challenges present within medicine and society, and analysis of such stories reveals narrative trajectories anticipated in the aftermath of COVID-19. Through lenses of social suffering and structural violence, these narratives reinforce the need for systemic change, including legal action, ethical preparedness and physician protection to ensure high-quality care during times of crises. Narrative Medicine—as a practice of interrogating stories in medicine and re-centering the patient—offers a means to contextualise individual accounts of suffering during health crises in larger social matrices.

When numbers eclipse narratives: a cultural-political critique of the ‘ethical’ impacts of short-term experiences in global health in Dominican Republic bateyes

With the rising demand for short-term experiences in global health (STEGH) is an ever-increasing volume of literature that focuses attention on ethics and ethical concerns, such as the effects of STEGH on host populations. Such concerns have driven the development of ethical principles and guidelines, with discussions and debates largely centred around normative questions of positive/negative and benefit/harm for us/them. Using a critical medical humanities lens, this paper blurs these dichotomous framings and offers a more complex understanding of the effects and effectiveness of STEGH on hosts. I explore STEGH that send volunteers from North American universities to the Dominican Republic to participate in service-learning activities aimed at improving the lives of impoverished Haitian migrants living in bateyes. I address the following questions: What perspectives about the impacts of interventions on host communities manifest through STEGH? What tensions emerge through interactions among diverse stakeholders related to those perspectives, and with what effects? Drawing together critical theory and ethnography, I examined the perspectives of three stakeholder groups: student and faculty volunteers, host organisation staff, and hosts in batey communities. Data collected from observations and interviews were counterposed; I analysed interactions and interplay between stakeholders. My findings revealed conflicts around an emergent theme: counting efforts, or volunteers’ proclivity for numerical evidence of impactful STEGH for hosts. With attention on power relations, I argue that a preoccupation with quantifiable evidence eclipsed and erased the lived realities of hosts, thereby blocking a fully ethical engagement. These sociopolitical effects, often overlooked in conventional ethics assessments, are no less harmful and may reinforce rather than reduce inequalities that the global health movement seeks to eliminate. My study offers a compelling case for how the critical medical humanities lend critical insights in the name of improving global health.

‘I will never love anyone like that again’: cognitive behavioural therapy and the pathologisation and medicalisation of ordinary experiences

Psychiatry has a long history of being criticised for the pathologisation and medicalisation of ordinary experiences. One of the most prominent of these critiques is advanced by Allan Horwitz and Jerome Wakefield who argue that instances of ordinary sadness in response to events such as bereavement, heartbreak and misfortune, are being mistakenly diagnosed as depression due to an increasing lack of consideration for aetiology and contextual factors. Critiques concerning pathologisation and medicalisation have not been forthcoming for psychiatry’s close cousin, psychotherapy. Using Cognitive Behavioural Therapy, one of the most prominent schools of contemporary psychotherapy as a case study, I demonstrate that psychotherapy also contributes to medicalising and pathologising bereavement, heartbreak and misfortune.

Nations must be defended: public health, enmity and immunity in Katherine Mayo’s Mother India

This essay explores repressed hostility and punitive fantasies in the discourse of international health, using Katherine Mayo’s Mother India (1927). Multiple tendencies in interwar thinking converge in Mayo’s book, making it a veritable archive of major, minor and emergent forces, including those shaping the phenomenon of ‘international health’ post-Versailles. Mother India provides a unique opportunity to explore how progressive principles of international public health tend to obscure a ‘minor’ and forgettable yet disturbing truth: the discourse on life and health can ‘safely’ harbour an alternative politics and poetics of enmity. Spotlighting the way international health interventions, centrally shaped by USA, operated across multiple levels of governance, the essay locates the significant detail of Mayo’s representation of India as ‘world-menace’. Propelled by the logic of enmity, her shaming portrait of a dysgenic Hindu India justifying emergency international intervention resonates with a strand of interwar conservatism given theoretical expression in the writings of Mayo’s contemporary, Carl Schmitt. Schmitt’s animosity towards political liberalism helps identify Mother India’s vision of imperial sovereignty as a curious antiliberal, American iteration of the logic of enmity in extra-European space and in the ‘humane’ domain of health. Biologising the discourse of juridical-political maturity at a time when Indian nationalism’s organised challenge to Empire could not be gainsaid, Mother India urges a re-imagination of the political field as a battlefield where ‘the enemy’, construed as a problem of health, will kill. Building a case for continued imperial domination in the name of global health and immunity, the book’s humiliating representation of colonial bodily habits, habitations and contagions aimed to undermine liberal imperialism, internationalism and Indian nationalism, all increasingly vocal after World War I.

‘Written of by novelists’: scripting and managing emotions in 19th-century medical manuscripts

Literary and medical historical scholars have long explored the work of physician–writers and the cross-pollination of literature and medicine. However, few scholars have considered how these interactions have shaped medical manuscripts and the echoes they contain of the emotional contours of the medical encounter. This essay uses the papers of Southern physician Andrew Bowles Holder (1860–1896) to explore how the emotions of the physician were managed at the bedside and in the aftermath of medical encounters through recourse to literary thinking. Holder, like many 19th-century physicians, was an avid reader with an interest in literary endeavours, and his manuscripts reveal the influences of literature on his work as a physician. This article frames the bedside as a theatre of emotions, in which Holder’s performance and management of his emotions was key to his professional identity. His literary interests thus provided him with two tools: first, literature provided him with models for how to respond to and record different kinds of medical encounters, particularly deaths, near-death experiences and childbirth; second, his mode of keeping these records, which included the production of poetry as well as medical prose, served as a technology of coping, further allowing him to manage his emotions by exorcising them on the page.

‘Living in a Material World’: Frankenstein and new materialism

This paper uses concepts from Karen Barad’s theories from quantum physics and other theoretical approaches from new materialism to show how Frankenstein can be used to introduce this new framework and to challenge an older one based on dualism, representationalism and individualism. A new ethical understanding of the message of the text emerges from this reading—one that rethinks the prohibitions against ‘playing God’ or creating the unnatural and relies instead on an ethics of care.

Sexual assault and fatal violence against women during the Irish War of Independence, 1919–1921: Kate Maher’s murder in context

At the height of the Irish War of Independence, 1919–1921, 45-year-old Kate Maher was brutally raped. She subsequently died of terrible wounds, almost certainly inflicted by drunken British soldiers. This article discusses her inadequately investigated case in the wider context of fatal violence against women and girls during years of major political instability. Ordinarily her violent death would have been subject to a coroner’s court inquiry and rigorous police investigation, but in 1920, civil inquests in much of Ireland were replaced by military courts of inquiry. With the exception of medical issues, where doctors adhered to their ethical responsibility to provide clear and concise evidence on injuries, wounds and cause of death, courts of inquiry were cursory affairs in which Crown forces effectively investigated and exonerated themselves. This article adopts a microhistory approach to Maher’s case to compare how civilian and military systems differed in their treatments of female fatalities. Despite the fact that the medical evidence unequivocally showed that the attack was of a very violent sexual nature, the two soldiers directly implicated were not charged with rape or any other sexual offence. In her case, and in those of other women who died violently while in the company of soldiers and policemen, prosecutions of the men involved resulted in acquittal by military court martial. This was so both for women portrayed as of immoral character and for others assumed to be ‘respectable’. It also reflects on the wider question of sexual violence during the Irish War of Independence, concluding that while females experienced a range of gender-determined threats and actions such as armed raids on their homes, the ‘bobbing’ of hair and other means of ‘shaming’, rape, accepted as the most serious act of sexual assault, was regarded by all combatants as beyond the pale.

Digital hermeneutics: scaled readings of online depression discourses

When it comes to understanding experiences of illness, humanities and social sciences research have traditionally reserved a prominent role for narrative. Yet, depression has characteristics that withstand the form of traditional narratives, such as a lack of desire and an impotence to act. How can a ‘datafied’ approach to online forms of depression writing pose a valuable addition to existing narrative approaches in health humanities? In this article, we analyse lay people’s depression discourses online. Our approach, ‘digital hermeneutics’, is inspired by Gadamer’s dialogical hermeneutics. It consists of a ‘scaled reading’ on five different scales: platform hermeneutics; contextual reading with term frequency—inverse document frequency (TF–IDF); distant reading with natural language processing topic modelling; hyper-reading with concordance views and close reading. Our corpus consisted of three data sets, from the blogs and message boards of, respectively, time-to-change.org.uk, a UK-based social organisation and movement that aims to counter mental health discrimination and alleviate social isolation by spreading awareness; Sane.org.uk, a leading UK mental health charity that seeks to help people in facing the challenges of mental illness and to improve quality of life; and the subreddit ‘r/depression’ on web discussion platform reddit. We found that the manner in which people express experiences of illness online is very much dependent on the specific affordances of platforms. We found degrees of ‘narrativity’ to be correlated to authorship and identity markers: the less ‘anonymous’ the writing, generally speaking, the more conventionally ‘narrative’ it was. Pseudonimity was related to more intimate and singular forms, with less pressure to conform to socially accepted and positive narratives of the ‘restitution’ type. We also found that interactive affordances of the platforms were used to a limited extent, nuancing assumptions about the polyvocality of online depression writing. We conclude by making a claim for increased cooperation between digital and medical humanities that might lead to a field of ‘Digital Medical Humanities’.

‘A Procedure Without a Problem’, or the face transplant that didn’t happen. The Royal Free, the Royal College of Surgeons and the challenge of surgical firsts

Face transplants are an innovative and unusual form of modern surgery. There have been 47 face transplants around the world to date, but none as yet in the UK. Yet in 2003, the UK was poised to undertake the first face transplant in the world. The reasons why it didn't take place are not straightforward, but largely unexplored by historians. The Royal College of Surgeons, concerned about the media attention given to face transplants and the ethical and surgical issues involved, held a working party and concluded that it could not give approval for face transplants, effectively bringing to a halt the UK’s momentum in the field. This extraordinary episode in medical history has been anecdotally influential in shaping the course of British surgical history. This article explores and explains the lack of a face transplant in the UK and draws attention to the complex emotional, institutional and international issues involved. Its findings have implications beyond the theme of face transplants, into the cultural contexts and practices in which surgical innovation takes place.