Transcript Using Literature to Teach Social Justice and Activism Martin Donohoe

Using Literature to Teach
Social Justice and Activism
Martin Donohoe
William Butler Yeats
“Education is not filling a
bucket, but lighting a fire”
Stories
Perspectives
Tumbling in the Hay
Oliver St John Gogarty
An Old Horse
William J Kornrich
Background/Rationale
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Social, economic and cultural contributors to
health of individuals and populations underemphasized in health professions curricula
Schism between medicine and public health
Students idealistic/motivated, but grow
increasingly cynical and develop
negative/defeatist attitudes as training
progresses
Harvey Cushing
“A physician is obligated to
consider more than a diseased
organ, more even than the
whole man. He must view the
man in his world.”
The Role of Literature
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Vicarious experience
Explore diverse philosophies
Promotes empathy, critical thinking,
flexibility, non-dogmatism, self-knowledge
Encourages creative thinking
Allows for group discussion/debate
Why Use Literature
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Encourage appreciation of non-medical
literature
Develop reading, analytical, speaking and
writing skills
Promote ethical thinking (narrative ethics)
Identification with doctor authors (e.g.,
Keats, Chekhov, Maugham, Williams)
Enjoyable
Margaret Sanger
Books have been to me what
gold is to the miser, what new
fields are to the explorer.
Rudolph Virchow
“You can soon become so engrossed
in study, then professional cares, in
getting and spending…that you find
too late with hearts given away that
there is no place in your habitstricken souls for those gentler
influences that make life worth living”
Uses of Literature
 Pedagogy
 Therapy
 Psychoanalysis
 Promote
communication
Goals
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Educate students and practitioners
about social justice issues
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Highly motivated
Counter negative attitudinal changes
and cynicism of trainees
 Provoke thoughtful discussion about
ethical and policy issues related to
social justice
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Goals
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Promote activist-oriented research
and writing
Translate knowledge into practice
through volunteerism and service
Encourage lifelong, interdisciplinary
learning and collegial practice
Issues
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Access to care
Racial, sexual and SES discrepancies
in outcomes
The effects of poverty on health
Issues
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Violence against women
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Human subject experimentation
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Environmental degradation
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War, peace and human rights
Issues
Homelessness
 Substance abuse
 Tobacco industry
 Privacy:
 Genetic testing
 Drug testing
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Issues
Corporatization of academic and
clinical medicine
 The pharmaceutical and tobacco
industries
 Conflicts of interest / Role
responsibilities
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Where and When to Teach
Elective courses
 Incorporation into existing curricula
 Service learning; community-based
teaching
 Ethics and Humanities Grand Rounds
 Interdisciplinary seminars
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Where and When to Teach
Clinical teaching rounds
 Including at the bedside
 Reading groups
 Summer research/service stipends
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Faculty development
Stigmatization
John Updike
“From the Journal of a Leper.”
Am J Dermatopathol 1982;4(2):137-42
Homelessness
Doris Lessing
“An Old Woman and Her Cat”
From the Doris Lessing Reader (New
York: Knopf, 1988)
Human Subject Experimentation /
Human Rights Abuses
Shusaku Endo
The Sea and Poison
(New York: Taplinger Publishing Co., 1972)
Poverty
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Orwell, George. How the Poor Die. In Sonia Orwell
and Ian Angus, eds. The Collected Essays, Journalism
and Letter of George Orwell, IV; In Front of Your Nose,
1945-1950. New York: Harcourt, Brace and World, Inc:
pp.223-233.
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Checkhov, Anton. Letter to AF Koni, January 26,
1891, Letter to AS Survivor, March 9, 1890. In
Norman Cousins, ed. The Physician in Literature
Philadelphia: WB Saunders, 1982.
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Eighner, Lars. Phlebitis: At the Public Hospital. In
Travels with Lizbeth. New York: St. Martin’s Press, 1993.
Chekhov on Sakhalin
“Sakhalin is a place of unbearable
sufferings…[W]e have let millions
of people rot in prison, destroying
them carelessly, thoughtlessly,
barbarously”
Chekhov on Sakhalin
“A woman on Sakhalin is not
exactly a human being…and not
exactly a creature even lower
than a domestic animal, but
somewhere between the two.”
“[A]ll of us [are to blame]”
Fyodor Dostoevsky
“A society should be judged
not by how it treats its
outstanding citizens but by
how it treats its criminals”
Race and Access to Care
Ernest J Gaines
“The Sky is Gray”
in Gray, Marion Secundy, ed. Trials,Tribulations,
and Celebrations: African American Perspectives
on Health, Illness, Aging and Loss. Yarmouth,
Maine: Intercultural Press, 1992
Mental Illness
Anton Chekhov
Ward Number Six
in Chekhov A. Seven short novels (New York:
Bantam, 1976)
Conflicting Responsibilities of
Physicians
Pearl S. Buck
“The Enemy”
In Far and Near: Stories of Japan, China, and
America (New York: The John Day Company,
1934)
Domestic Violence
Michael LaCombe
“Playing God”
In LaCombe M, ed. On Being a Doctor.
Philadelphia: American College of Physicians,
1994
Single Motherhood / The Welfare
System
Grace Paley
“An Interest in Life”
In We are the Stories We Tell: The Best Short
Stories by North American Women since 1945,
Wendy Martin, ed. (New York: Pantheon Books,
1990)
The Humanities and Social Sciences
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Literature
Art
History
Law
Philosophy
Photography
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e.g., Margaret Sanger, W Eugene Smith
Others
“Activist” Journals
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American Journal of Public Health
Public Citizen’s Health Letter
PNHP Newsletter
Mother Jones
Harpers
Z Magazine, The Progressive, In These Times
Dollars and Sense
“Activist” Journals
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Rachel’s Environmental Weekly
Bulletin of Atomic Scientists
Multinational Monitor
Hightower Lowdown
Some articles in NEJM, JAMA, JGIM, SSM,
Policy, Politics, and Nurs Prac, others
Additional Resources
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NYU Literature and Medicine On-line Database
http://endeavor.med.nyu.edu/lit-med/lit-meddb/topview.html
Public Citizen’s Health Research Group – Activistoriented courses
http://www.citizen.org/hrg/activistcour/index.cf
m
On-line syllabus exchange projects – e.g., ASBH
Syllabi, reading lists available from MD
Rudolph Virchow
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Father of pathology
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Established cell doctrine, elucidated pathology
of thrombosis, PE, leukocytosis, and leukemia
Member of Prussian state and local
government for over 30 years
Founded Journal “Medical Reform”
Rudolph Virchow
 Advocated
 Public
provision of medical care
for indigent
 Prohibition of child labor
 Universal education
 Free and unlimited democracy
Rudolph Virchow
 Instituted
programs for
 Improved sanitation
 Stricter food inspection
 Revamping ineffective hospital
policies
 Enhanced nursing education
Rudolph Virchow
“Typhus, cholera, tuberculosis,
scurvy, some mental diseases,
and cretinism [are among] those
maladies that result from the
unequal distribution of
civilization’s advantages”
Rudolph Virchow
“Doctors are natural attorneys
for the poor … If medicine is
to really accomplish its great
task, it must intervene in
political and social life…”
Günter Grass
“The first job of a citizen is to
keep your mouth open.”
First They Came for the Jews
Pastor Niemoller
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
[email protected]