Using Literature to Teach Social Justice and Activism

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Using Literature to Teach Social Justice and
Activism

• Martin Donohoe

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William Butler Yeats

• Education is not filling a bucket, but lighting
  a fire

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• Stories

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Perspectives

• Tumbling in the Hay
• Oliver St John Gogarty
• An Old Horse
• William J Kornrich

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Background/Rationale

• Social, economic and cultural contributors to
  health of individuals and populations
  under-emphasized 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

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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.

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The Role of Literature

• Vicarious experience
• Explore diverse philosophies
• Promotes empathy, critical thinking, flexibility,
  non-dogmatism, self-knowledge
• Encourages creative thinking
• Allows for group discussion/debate

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Why Use Literature

• 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

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Margaret Sanger

• Books have been to me what gold is to the miser,
  what new fields are to the explorer.

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Rudolph Virchow

• You can soon become so engrossed in study, then
  professional cares, in getting and spendingthat
  you find too late with hearts given away that
  there is no place in your habit-stricken souls
  for those gentler influences that make life worth
  living

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Uses of Literature

• Pedagogy
• Therapy
• Psychoanalysis
• Promote communication

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Goals

• Educate students and practitioners about social
  justice issues
• 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

• Promote activist-oriented research and writing
• Translate knowledge into practice through
  volunteerism and service
• Encourage lifelong, interdisciplinary learning
  and collegial practice

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Issues

• Access to care
• Racial, sexual and SES discrepancies in outcomes
• The effects of poverty on health

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Issues

• Violence against women
• Human subject experimentation
• Environmental degradation
• War, peace and human rights

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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
• Faculty development

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Stigmatization

• John Updike
• From the Journal of a Leper.
• Am J Dermatopathol 19824(2)137-42

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Homelessness

• Doris Lessing
• An Old Woman and Her Cat
• From the Doris Lessing Reader (New York Knopf,
  1988)

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Human Subject Experimentation / Human Rights
Abuses

• Shusaku Endo
• The Sea and Poison
• (New York Taplinger Publishing Co., 1972)

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Poverty

• 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.
• 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.
• Eighner, Lars. Phlebitis At the Public Hospital.
  In Travels with Lizbeth. New York St. Martins
  Press, 1993.

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Chekhov on Sakhalin

• Sakhalin is a place of unbearable
  sufferingsWe have let millions of people rot
  in prison, destroying them carelessly,
  thoughtlessly, barbarously

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Chekhov on Sakhalin

• A woman on Sakhalin is not exactly a human
  beingand not exactly a creature even lower than
  a domestic animal, but somewhere between the
  two.
• All of us are to blame

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Fyodor Dostoevsky

• A society should be judged not by how it treats
  its outstanding citizens but by how it treats its
  criminals

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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

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Mental Illness

• Anton Chekhov
• Ward Number Six
• in Chekhov A. Seven short novels (New York
  Bantam, 1976)

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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)

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Domestic Violence

• Michael LaCombe
• Playing God
• In LaCombe M, ed. On Being a Doctor.
  Philadelphia American College of Physicians, 1994

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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)

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The Humanities and Social Sciences

• Literature
• Art
• History
• Law
• Philosophy
• Photography
• e.g., Margaret Sanger, W Eugene Smith
• Others

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Activist Journals

• American Journal of Public Health
• Public Citizens Health Letter
• PNHP Newsletter
• Mother Jones
• Harpers
• Z Magazine, The Progressive, In These Times
• Dollars and Sense

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Activist Journals

• Rachels Environmental Weekly
• Bulletin of Atomic Scientists
• Multinational Monitor
• Hightower Lowdown
• Some articles in NEJM, JAMA, JGIM, SSM, Policy,
  Politics, and Nurs Prac, others

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Additional Resources

• NYU Literature and Medicine On-line Database
• http//endeavor.med.nyu.edu/lit-med/lit-med-db/top
  view.html
• Public Citizens Health Research Group
  Activist-oriented courses
• http//www.citizen.org/hrg/activistcour/index.cfm
• On-line syllabus exchange projects e.g., ASBH
• Syllabi, reading lists available from MD

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Rudolph Virchow

• Father of pathology
• 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

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Rudolph Virchow

• Advocated
• Public provision of medical care for indigent
• Prohibition of child labor
• Universal education
• Free and unlimited democracy

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Rudolph Virchow

• Instituted programs for
• Improved sanitation
• Stricter food inspection
• Revamping ineffective hospital policies
• Enhanced nursing education

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Rudolph Virchow

• Typhus, cholera, tuberculosis, scurvy, some
  mental diseases, and cretinism are among those
  maladies that result from the unequal
  distribution of civilizations advantages

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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

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Günter Grass

• The first job of a citizen is to keep your mouth
  open.

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• First They Came for the Jews
• Pastor Niemoller

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Contact Information

• Public Health and Social Justice Website
• http//www.phsj.org
• martindonohoe_at_phsj.org