Why The Humanities in Medicine?

In the book of Genesis, after murdering his brother Abel, Cain asked the rhetorical question to God, “am I my brother’s keeper?” Instead of providing a direct reply, the Lord God told Cain, “What have you done? The voice of your brother’s blood cries out to Me from the ground.” Not only should Cain have been his brother’s keeper, the voice and the blood of his brother still cried out to God - and in one masterful stroke, the Lord God invested Abel with both a voice and the life-blood of human suffering.

To those readers who are not physicians or nurses, it may seem strange, incredulous, even outrageous, that a physician may be the “keeper” of a human being’s health - and yet be quite ignorant of the human story, the human narrative.  It is possible however and increasingly common, for physicians to disengage from the story of human suffering (or joy) for example and treat patients simply as examples of disordered physiology and anatomy and according to algorithmic “guidelines” that are provided courtesy of massive funding from major pharmaceutical companies. 

The rationalistic approach to medical education has been quite correctly credited with having a major role in some of the key medical and scientific breakthroughs that have made our material lives unimaginably better than even a century ago. The scientific method has been the backbone of this material progress and this breaking down of disease processes into verifiable, component parts is of course, a core part of the life-long education of the physician, beginning at medical school. It is also the post-Enlightenment construct of the modern world that is accepted without any question as the touchstone of human progress. 

However, a coming together of the individual and of communities, the subjective experience of disease by the patient and an education and engagement in the hopes, fears, doubts, joys and sorrows that are an integral part of the human condition, has not had anything like the same emphasis in medical education. 

This is partly because we think we do science so well. So well in fact, that the evolution of this objectivist approach to science has had the predictable outcome of the machine being more coldly “rational” and “efficient” than a human being! Indeed, in the dispensation of medical treatment, the algorithm is on the verge of replacing the human being as physician.

Amongst other numerous and sobering examples, the experience of the two world wars have taught us that science and its phenomenal triumphs, when divorced from the spiritual, the moral and the ethical, works powerfully and tragically for the destruction of the very thing it was meant to preserve. 

The first half of the twentieth century witnessed the splitting of the atom and the resulting discovery of radiation therapy in the treatment of cancer. In that relatively short period in human history, we also witnessed the use of the same technology in the destruction and maiming of hundreds of thousands of human lives as atomic bombs were dropped on Hiroshima and Nagasaki.

At its most basic level an education and engagement in the medical humanities makes us more fully human. The human narrative must inform a study of human disease. And without such an education and engagement, physicians will become well trained scientific purveyors of pills, potions, vaccines (and operations) without ministering to the whole individual with compassion, understanding and empathy.

It is not enough, for example, for the physician to know in elegant detail the pain pathways in the peripheral and central nervous systems and the elaborate pharmacology of how these may be affected. There must equally, be an intimate understanding of the nature of suffering and pain and of its myriad social, psychological, spiritual, cultural and historical underpinnings. The kind of physician we would want for ourselves is surely one who has a thorough grasp of the former and a compassionate understanding of the latter.

My surgical colleagues and readers will readily recognize the name, “Billroth.” For my non-medical readers - the major operations surgeons do on the stomach are still called, “Billroth 1” and “Billroth 2” after the surgeon who first described them in the nineteenth century.

In the Vienna of the latter half of the 19th century, the German immigrants to the once-mighty seat of the Austro-Hungarian empire, recognized Vienna’s eminence in the sciences, but also in the arts. It was this combination of the creative pursuits of mankind that acted like a magnet, drawing in one of the leading surgeon of the nineteenth century Christian Theodor Billroth (1829-1894) to take over the chair of surgery in Vienna in 1867.

Christian Albert Theodor Billroth - surgeon and musician

Billroth quickly brought in new methods of investigation and practice to the Viennese school, some of which he had learned as a pupil of the famed German school of surgery under Bernard Von Langenbeck.

Moving away from a simplistic understanding of disease based on cadaveric or dead body dissection, Billroth advocated to his devoted surgical pupils, an understanding of surgical disease based on anatomy and surgical physiology and pathophysiology – in other words, structure studied together with function of the human body in health and disease. Whilst in Vienna, he introduced bold, new operations on the larynx (voice box), the esophagus (food pipe) and the stomach (we still speak of “Billroth 1 and Billroth 2 gastrectomies, operations for removing parts of the stomach). Very uniquely for his time, he introduced an audit of his own results and widely shared these results with his colleagues and residents.

Much before he arrived in Vienna, at the age of 19, the talented pianist Theodor Billroth had been persuaded by his parents to pursue medicine as a career instead. As it turned out, Billroth devoted an equal energy to both his life-long pursuits and credited music with providing him the inspiration and wherewithal for his remarkable scientific achievements.

By the time he was in Zurich (1860 - 1867) he had taught himself the violin and viola and had become proficient in both. He was sufficiently well recognized as a musician to be offered to guest conduct the symphony orchestra in Zurich. This was also where he was introduced to the great Austro-German composer Johannes Brahms (1833-1897).

When Billroth moved to Vienna at the age of 38, he immediately sought out Brahms. Within a few months, Billroth had converted a large room in his home into an ornately decorated musical studio.

For the next three decades, Billroth’s home was the regular meeting place of Brahms himself, together with Billroth and a few other musicians, who played together in a musical quartet. Brahms would send his compositions first to Billroth for his comments, before considering it for performance - so great was his regard for his musician-surgeon friend. In deep appreciation, Brahms dedicated two of his three String Quartets (the A minor and C minor quartets) to Billroth.

Brahms dedicates his String Quartet to his friend Billroth, the surgeon and musician

Billroth of course, is only one of several examples of scientists and physicians who have found inspiration for their scientific work, in the arts and humanities. In a letter to his art historian friend Lubke, Billroth wrote, “It is one the superficialities of our time to see in science and in art, two opposites. Imagination is the mother of both.”

To those of you who are in mathematics related disciplines and even to those who are not, the Fields Medal will be very familiar to you – it is the equivalent of the Nobel prize in Mathematics and is awarded once every four years to those who make path-breaking, novel and significant contributions to Mathematics. Among mathematicians, winners of the Field medal are treated like rock stars.

A recent winner of the Fields medal (2014), Manjul Bhargava, grew up in Hamilton Ontario and is now Professor of Mathematics in Princeton University – the third youngest professor ever, in the history of Princeton.

His citation for the Fields Medal award reads: "the Fields medal is awarded to Professor Bhargava for developing powerful new methods in the geometry of numbers, which he applied to count rings of small rank and to bound the average rank of elliptic curves" Apart from mathematicians among my readers, most of us will not really know what that citation means!

But what is common knowledge in Princeton University campus and elsewhere is that Manjul Bhargava is also a concert level player of the Indian classical music instrument, the tabla – and not only does he read the Sanskrit fluently, he takes inspiration for his mathematics from Sanskrit poetry. Quoting the Professor himself, “There was incredible math discovered by ancient poets when they were composing poetry. There is  just a fine line between math and poetry, and while math is a science it is also an art,”

In my brief account of contemporary and historical physicians and scientists who draw inspiration for their work from the arts, we must not pass over the remarkable life and achievements of Steve Jobs. Almost everyone who uses a cell phone knows who he is and whether one is an iPhone user or a resolute Android user, there are few amongst us who will not acknowledge Job’s technological and artistic genius. 

There was certainly no compartmentalizing of science from art in the life and work of Steve Jobs - he repeatedly claimed that it was art that inspired his work and that he always strived to create a thing of beauty. “Technology alone is not enough” he once proclaimed, “it's technology married with the liberal arts, married with the humanities, that yields the results that makes our hearts sing.”

An engagement and education in the arts and humanities cannot be broken down into its component parts, in the way medical and surgical residents are taught to take apart a scientific paper in our journal clubs.  As physicians and nurses, we must allow our minds to have unfettered access to literature, the visual arts, philosophy, history, music and drama - the human story, the humanities. But for a proper education in the humanities, the health professional must actually engage with some or all of them - play music for example, sing in a choir, write a poem, act in plays, read great literature or the consequential philosophers.  

A logical extension of the disastrous approach of using rationalistic science alone for human progress is a rather well known, dystopian future in which the human being is subservient to a vast, computer network which will be able to control and “hack” into “wired” individuals. According to the World Economic Forum’s (WEF) top advisor Yuval Harari in a recent speech to assembled world leaders, “Human beings are no longer mysterious, spiritual souls, we are now hackable animals. There will be two classes: The exploited and the useless class. It’s better to be exploited than to be useless.”

The future imagined for mankind by the WEF and other similar organizations is often presented as an undesirable outcome of corporate and global control of nation states - whilst these same organizations, including the WEF and nation states, pursue the very same goals they warn against!

For example, last week, the White House of the present American administration released its “Executive Order on Advancing Biotechnology and Biomanufacturing Innovation.” This disturbing document is part of the agenda that drives politicians who do not believe they need the consent of the people to govern - an “executive order” circumvents the need for debate, for exposure and for approval. In part, the executive order reads, “We need to develop genetic engineering technologies and techniques to be able to write circuitry for cells and predictably program biology in the same way in which we write software and program computers.”

The first step back for humanity from this cliff of civilizational collapse is to repent and regroup and regain our connection to a Power and Authority and Wisdom higher than our own - the Force for good in our universe. Those who do not believe in God, must still make a conscious and consequential choice for good, a choice founded upon the growth of the present and historical relationship of nations and societies with God.

In my essay on medical ethics last week, I wrote about how the soul of medical ethics has been lost in the present, postmodern university, with its own, localized and customized definitions of “truth” and “reality.” It was thereafter only one short step away from a set of detached, rationalistic ideas to take over the pursuit of science and medicine, such as the idea of the “hackable” human!

An engagement with the humanities should reveal unmistakably to physicians that the experience of joy and love and suffering described by our great poets, dramatists and novelists; the exquisite beauty of a Greek vase or a painting or song; the familiar foibles and weaknesses of mankind exposed in literature and history; or the mystery of unmerited suffering described by our philosophers - all these are linked inextricably to a search for transcendent and eternal Truth that is unshakeable and impervious to change, or the passing age.

The humane, compassionate and informed physician we all want for ourselves is one who has chosen the straight and narrow way of allegiance to timeless medical ethics and who constantly engages with mankind’s quest for beauty and truth, through the humanities.

Our destiny as human beings is not confined to the straitjacket of science or medicine and certainly not linked to the transhuman future that the elites have imagined for us.

Instead, as in John Bunyan’s Pilgrim’s Progress, we are destined for the Celestial City, shimmering and clear in both the distance and the present, to taste eternity in our temporal experiences and to live rich, full lives in

“this our wayside planet,

carrying land and wave,

love and life multiplied

and pain and bliss”