Medical Humanities Association conferences are always hugely enjoyable, chiefly because of the diversity of delegates. It's a melting pot of doctors, artists, authors, academics and students, all feeding on each other's creativity and intellectualism. There's nothing like a bit of controversy to spice up a conference, a this year, a good-natured spat surfaced which revealed a very deep-running schism in academia. Squaring up for the rationalists was John Wiltshire of La Trobe University, author of the hugely impressive tome Jane Austen and the Body. In the social constructionist corner was Sander Gilman of Emory University. Both were keynote speakers.
In his talk Wiltshire argued that the 'true' history of medicine has not yet been written: what we have is a history of profession and institutions. History is made up of narratives, but the performative act of medicine robs the patient of the opportunity to shape his/her own story into narrative (for Wiltshire, narratives are primarily written, addressed to a reader and involve an intellectual presence that mere story does not). The 'true history' of medicine is the formal patient narrative which also serves as a valuable critique of medicine, for example Fanny Burney's description of her mastectomy. In the interesting discussion that followed, Gilman said narratives don't necessarily reflect patient reality, they are are patients' encounters with 'the system' and are no more 'true' than other types of narrative. Patrica Law weighed in with the observation that there is a wealth of patient narrative available on the internet (notably DIPEx) which suggests that the patient's unmediated 'voice' is more readily accessible.
The following morning it was Sander Gilman's turn to deliver his address, entitled: 'What is the colour of the gonnorrhea ribbon? Stigma, sexual diseases and popular culture in George Bush's world.' Gilman made a fairly complex argument about shame and political activism. He used as his text a novel aimed at young adults called 'The Rainbow Party' which met with a barrage of criticism because it dealt with oral sex (read the conflicting reviews on Amazon.com to get a flavour of the controversy) in the context of a politically charged debate about what exactly constitutes 'sexual relations' and the abstinence culture. Gilman linked the success of AIDS and cancer ribbons with the successful dissociation of the infected with the means of infection (so one identifies with the sufferer rather than the manner in which the patient became ill). Gilman showed how surveys of sexual activity share with novels the ability to offer an insight into attitudes and fantasies. He argued that STDs would never have a 'ribbon' because of the shame culture. This time John Wiltshire weighed in with a comment about the dubiousness of using 'trashy' novels to talk about social trends, whereas surely proper literature was what could and would effect change (I paraphrase). This caused both tutting and nodding in the auditorium.
At the root of the disagreement between these two distinguished authors, I think, is the notion that for Wiltshire, it is important to give certain narratives priority over others. For Gilman, this ranking of narrative is untenable. Personally, I'm in favour of all narratives contributing to an understanding of attitudes. I don't think 'proper literature' should claim priority in critical analysis, although I accept that in practice it probably does.
There were a lot of thought-provoking sessions at the conference. The full programme can be downloaded here. Borneo Breezes asked how AJ and my session on medical blogging went. We had a lot of interest in our talk, although I hope we didn't put people off by cataloguing the ethical pitfalls in blogging medicine. We couldn't cover much in the 14 minutes allowed but hopefully we gave people a taste for all the good stuff out there.