The Medical Humanities: Introduction

What is curriculum theory? Most people, including educators themselves, would reply that it is the guiding thought that results in a document that delineates goals, teaching methods, readings and exercises, and evaluation for an individual class or an entire course of study. However, curriculum theorist William F. Pinar (2004) would disagree. He argues that curriculum theory is actually a complicated conversation, one that encompasses academic knowledge, subjectivity, and culture; it is not—it should not be—an ahistorical and atheoretical packaging of knowledge and skills that is dictated from elsewhere, too often mired in a means-ends, outcomes-based business rationale.

Instead, Pinar continues, curriculum theory functions to provoke thought. It has less to do with curriculum development—physically putting a document together—and more to do with understanding curriculum as inquiry, focusing on history, politics, culture, context, and the self as they all converge upon what and how we teach. Since they made their appearance in the curriculum over 30 years ago, the medical humanities have often been tethered to traditional academic disciplines with the rules and boundaries that govern each. In literature and medicine, for example, early focus was on questions that now sound oddly quaint, such as the establishment of canonical texts. That is, those of us in the medical humanities were miming disciplinary norms from academic departments in comprehensive universities—sometimes, holding on to dear life—in order to stake our turf in professional schools such as medicine.

The medical humanities have changed considerably from those times. Hybridity is apparent in interdisciplinary alliances between humanities and clinical faculty; there is less talk about canonical knowledge and more about transcultural, transdisciplinary knowledge in new and sometimes provocative formats; and we are now more apt to look to the historical, political, and cultural moment in our curriculum deliberations.

As we searched for a format for this special issue on the medical humanities, we were drawn to Pinar's comprehensive book, Understanding Curriculum (1995). Pinar's schema of curriculum as various "texts," each representing contending discourses, provides a challenging way to think about the medical humanities—far beyond the traditional text of a roster of disciplines transported to medical settings and dragging their methods and content behind them. He asks us to think about the medical humanities curriculum as framed by various discourses representing particular ways of thinking, each with "boundaries" drawn by specific interests that define what we can "do" with them.

In the preceding paragraphs, we have described the medical humanities as historically tied to a traditional, disciplinary-bound discourse that separates each discipline by content, methods, and epistemologies that result in fairly predictable curricula across various settings. In contrast, we would like to position the medical humanities as a series of competing texts, each reflecting different—and sometimes competing—discourses: medical humanities as historical text, as race/ gender/class text, as hermeneutical text, as postmodern text, as autobiographical/biographical text, as aesthetic text, and as ethical text.

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The curriculum as historical text. The medical humanities have wandered in different directions over the last 30 years. The way a medical humanities curriculum is conceived is highly dependent on historical moment. Indeed, the history of the primary professional organization—now the American Society for Bioethics and Humanities—reflects profound changes in how we think about the medical humanities and which of the disciplines therein are most valued. the medical humanities are tied to medical movements du jour: when initially conceived, who would have thought humanities inquiry would hitch its credibility to the language of outcomes?

The curriculum as race/class/gender text. The medical humanities explicitly address race, class, and gender issues in bioethics, literature, and other domains of inquiry. For example, these issues are addressed in assumptions made about the rational subject, the existence and content of the medicine and literature "canon," the "whiteness" of bioethics, and the intersection of multiculturalism and the medical humanities, not to mention the homogenized faculty engaged in the medical humanities in North America.

The curriculum as hermeneutical text. As Pinar (1995) notes, hermeneutics is the theory of interpreting oral traditions, verbal communications, written texts, and aesthetic...