Using Literature to Teach Using Literature to Teach Social Justice and ActivismSocial Justice and Activism

Martin DonohoeMartin Donohoe

William Butler YeatsWilliam Butler Yeats

““Education is not filling a Education is not filling a bucket, but lighting a fire”bucket, but lighting a fire”

StoriesStories

PerspectivesPerspectives

Tumbling in the HayTumbling in the Hay

Oliver St John GogartyOliver St John Gogarty

An Old HorseAn Old Horse

William J KornrichWilliam J Kornrich

Background/RationaleBackground/Rationale

Social, economic and cultural contributors to Social, economic and cultural contributors to health of individuals and populations under-health of individuals and populations under-emphasized in health professions curriculaemphasized in health professions curricula

Schism between medicine and public healthSchism between medicine and public health Students idealistic/motivated, but grow Students idealistic/motivated, but grow

increasingly cynical and develop increasingly cynical and develop negative/defeatist attitudes as training negative/defeatist attitudes as training progressesprogresses

Harvey CushingHarvey Cushing

““A physician is obligated to A physician is obligated to consider more than a consider more than a diseased organ, more even diseased organ, more even than the whole man. He than the whole man. He must view the man in his must view the man in his world.”world.”

The Role of LiteratureThe Role of Literature

Vicarious experienceVicarious experience Explore diverse philosophiesExplore diverse philosophies Promotes empathy, critical thinking, Promotes empathy, critical thinking,

flexibility, non-dogmatism, self-flexibility, non-dogmatism, self-knowledgeknowledge

Encourages creative thinkingEncourages creative thinking Allows for group discussion/debateAllows for group discussion/debate

Why Use LiteratureWhy Use Literature

Encourage appreciation of non-medical Encourage appreciation of non-medical literatureliterature

Develop reading, analytical, speaking Develop reading, analytical, speaking and writing skillsand writing skills

Promote ethical thinking (narrative Promote ethical thinking (narrative ethics)ethics)

Identification with doctor authors (e.g., Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams)Keats, Chekhov, Maugham, Williams)

EnjoyableEnjoyable

Margaret SangerMargaret Sanger

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

Rudolph VirchowRudolph Virchow

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

Uses of LiteratureUses of Literature

PedagogyPedagogy TherapyTherapy PsychoanalysisPsychoanalysis Promote communicationPromote communication

GoalsGoals

Educate students and practitioners Educate students and practitioners about social justice issuesabout social justice issues Highly motivatedHighly motivated

Counter negative attitudinal Counter negative attitudinal changes and cynicism of traineeschanges and cynicism of trainees

Provoke thoughtful discussion Provoke thoughtful discussion about ethical and policy issues about ethical and policy issues related to social justicerelated to social justice

GoalsGoals

Promote activist-oriented research Promote activist-oriented research and writingand writing

Translate knowledge into practice Translate knowledge into practice through volunteerism and servicethrough volunteerism and service

Encourage lifelong, interdisciplinary Encourage lifelong, interdisciplinary learning and collegial practicelearning and collegial practice

IssuesIssues

Access to careAccess to care

Racial, sexual and SES Racial, sexual and SES discrepancies in outcomesdiscrepancies in outcomes

The effects of poverty on healthThe effects of poverty on health

IssuesIssues

Violence against womenViolence against women

Human subject experimentationHuman subject experimentation

Environmental degradationEnvironmental degradation

War, peace and human rightsWar, peace and human rights

IssuesIssues

HomelessnessHomelessness Substance abuseSubstance abuse Tobacco industryTobacco industry Privacy:Privacy:

Genetic testingGenetic testing Drug testingDrug testing

IssuesIssues

Corporatization of academic and Corporatization of academic and clinical medicineclinical medicine

The pharmaceutical and tobacco The pharmaceutical and tobacco industriesindustries

Conflicts of interest / Role Conflicts of interest / Role responsibilitiesresponsibilities

Where and When to TeachWhere and When to Teach

Elective coursesElective courses Incorporation into existing curriculaIncorporation into existing curricula Service learning; community-based Service learning; community-based

teachingteaching Ethics and Humanities Grand Ethics and Humanities Grand

RoundsRounds Interdisciplinary seminarsInterdisciplinary seminars

Where and When to TeachWhere and When to Teach

Clinical teaching roundsClinical teaching rounds Including at the bedsideIncluding at the bedside

Reading groupsReading groups Summer research/service stipendsSummer research/service stipends

Faculty developmentFaculty development

StigmatizationStigmatization

John UpdikeJohn Updike

““From the Journal of a Leper.”From the Journal of a Leper.”

Am J Dermatopathol Am J Dermatopathol 1982;4(2):137-421982;4(2):137-42

HomelessnessHomelessness

Doris LessingDoris Lessing

““An Old Woman and Her Cat”An Old Woman and Her Cat”

From the Doris Lessing Reader (New From the Doris Lessing Reader (New York: Knopf, 1988)York: Knopf, 1988)

Human Subject Human Subject Experimentation / Human Experimentation / Human

Rights AbusesRights AbusesShusaku EndoShusaku Endo

The Sea and PoisonThe Sea and Poison

(New York: Taplinger Publishing Co., (New York: Taplinger Publishing Co., 1972)1972)

PovertyPoverty

Orwell, George. Orwell, George. How the Poor DieHow the Poor Die. . In Sonia In Sonia Orwell and Ian Angus, eds. Orwell and Ian Angus, eds. The Collected Essays, The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Journalism and Letter of George Orwell, IV; In Front of Your Nose,Your Nose, 1945-1950. New York: Harcourt, Brace and 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.World, Inc: pp.223-233.

Checkhov, Anton. Checkhov, Anton. Letter to AF KoniLetter to AF Koni, January , January 26, 1891,26, 1891, Letter to AS Survivor Letter to AS Survivor, March 9, 1890. , March 9, 1890. In Norman Cousins, ed. In Norman Cousins, ed. The Physician in Literature The Physician in Literature PhiladelphiaPhiladelphia: WB Saunders, 1982. : WB Saunders, 1982.

Eighner, Lars. Phlebitis: At the Public Hospital. Eighner, Lars. Phlebitis: At the Public Hospital. In In Travels with LizbethTravels with Lizbeth. New York: St. Martin’s Press, . New York: St. Martin’s Press, 1993.1993.

Chekhov on SakhalinChekhov on Sakhalin

““Sakhalin is a place of Sakhalin is a place of unbearable sufferings…[W]e unbearable sufferings…[W]e have let millions of people rot have let millions of people rot in prison, destroying them in prison, destroying them carelessly, thoughtlessly, carelessly, thoughtlessly, barbarously”barbarously”

Chekhov on SakhalinChekhov on Sakhalin

““A woman on Sakhalin is not A woman on Sakhalin is not exactly a human being…and not exactly a human being…and not exactly a creature even lower exactly a creature even lower than a domestic animal, but than a domestic animal, but somewhere between the two.”somewhere between the two.”

““[A]ll of us [are to blame]”[A]ll of us [are to blame]”

Fyodor DostoevskyFyodor Dostoevsky

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

Race and Access to CareRace and Access to Care

Ernest J GainesErnest J Gaines

““The Sky is Gray”The Sky is Gray”

in Gray, Marion Secundy, ed. in Gray, Marion Secundy, ed. Trials,Tribulations, Trials,Tribulations, and Celebrations: African American and Celebrations: African American Perspectives on Health, Illness, Aging and LossPerspectives on Health, Illness, Aging and Loss. . Yarmouth, Maine: Intercultural Press, 1992Yarmouth, Maine: Intercultural Press, 1992

Mental IllnessMental Illness

Anton ChekhovAnton Chekhov

Ward Number SixWard Number Six

in Chekhov A. Seven short novels (New York: in Chekhov A. Seven short novels (New York: Bantam, 1976)Bantam, 1976)

Conflicting Responsibilities of Conflicting Responsibilities of PhysiciansPhysicians

Pearl S. BuckPearl S. Buck

““The Enemy”The Enemy”

In Far and Near: Stories of Japan, China, and In Far and Near: Stories of Japan, China, and America America (New York: The John Day (New York: The John Day Company, 1934)Company, 1934)

Domestic ViolenceDomestic Violence

Michael LaCombeMichael LaCombe

““Playing God”Playing God”

In LaCombe M, ed. On Being a Doctor. In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Philadelphia: American College of Physicians, 1994Physicians, 1994

Single Motherhood / The Single Motherhood / The Welfare SystemWelfare System

Grace PaleyGrace Paley

““An Interest in Life”An Interest in Life”

In In We are the Stories We Tell: The Best Short We are the Stories We Tell: The Best Short Stories by North American Women since Stories by North American Women since 19451945, Wendy Martin, ed. (New York: , Wendy Martin, ed. (New York: Pantheon Books, 1990)Pantheon Books, 1990)

The Humanities and Social The Humanities and Social SciencesSciences

LiteratureLiterature ArtArt HistoryHistory LawLaw PhilosophyPhilosophy PhotographyPhotography

e.g., Margaret Sanger, W Eugene Smithe.g., Margaret Sanger, W Eugene Smith OthersOthers

““Activist” JournalsActivist” Journals

American Journal of Public HealthAmerican Journal of Public Health Public Citizen’s Health LetterPublic Citizen’s Health Letter PNHP NewsletterPNHP Newsletter Mother JonesMother Jones HarpersHarpers Z Magazine, The Progressive, In These Z Magazine, The Progressive, In These

TimesTimes Dollars and SenseDollars and Sense

““Activist” JournalsActivist” Journals

Rachel’s Environmental WeeklyRachel’s Environmental Weekly Bulletin of Atomic ScientistsBulletin of Atomic Scientists Multinational MonitorMultinational Monitor Hightower LowdownHightower Lowdown Some articles in NEJM, JAMA, JGIM, Some articles in NEJM, JAMA, JGIM,

SSM, Policy, Politics, and Nurs Prac, SSM, Policy, Politics, and Nurs Prac, othersothers

Additional ResourcesAdditional Resources

NYU Literature and Medicine On-line NYU Literature and Medicine On-line DatabaseDatabasehttp://endeavor.med.nyu.edu/lit-med/lit-mehttp://endeavor.med.nyu.edu/lit-med/lit-med-db/topview.htmld-db/topview.html

Public Citizen’s Health Research Group – Public Citizen’s Health Research Group – Activist-oriented coursesActivist-oriented courseshttp://http://

www.citizen.org/hrg/activistcour/index.cfwww.citizen.org/hrg/activistcour/index.cfmm

On-line syllabus exchange projects – e.g., On-line syllabus exchange projects – e.g., ASBHASBH

Syllabi, reading lists available from MDSyllabi, reading lists available from MD

Rudolph VirchowRudolph Virchow

Father of pathologyFather of pathology Established cell doctrine, elucidated Established cell doctrine, elucidated

pathology of thrombosis, PE, pathology of thrombosis, PE, leukocytosis, and leukemialeukocytosis, and leukemia

Member of Prussian state and local Member of Prussian state and local government for over 30 yearsgovernment for over 30 years

Founded Journal “Medical Reform”Founded Journal “Medical Reform”

Rudolph VirchowRudolph Virchow

AdvocatedAdvocatedPublic provision of medical Public provision of medical care for indigentcare for indigent

Prohibition of child laborProhibition of child laborUniversal educationUniversal educationFree and unlimited democracyFree and unlimited democracy

Rudolph VirchowRudolph Virchow

Instituted programs forInstituted programs for Improved sanitationImproved sanitationStricter food inspectionStricter food inspectionRevamping ineffective Revamping ineffective hospital policieshospital policies

Enhanced nursing educationEnhanced nursing education

Rudolph VirchowRudolph Virchow

““Typhus, cholera, tuberculosis, Typhus, cholera, tuberculosis, scurvy, some mental diseases, scurvy, some mental diseases, and cretinism [are among] and cretinism [are among] those maladies that result those maladies that result from the unequal distribution from the unequal distribution of civilization’s advantages”of civilization’s advantages”

Rudolph VirchowRudolph Virchow

““Doctors are natural Doctors are natural attorneys for the poor … attorneys for the poor … If medicine is to really If medicine is to really accomplish its great task, accomplish its great task, it must intervene in it must intervene in political and social life…”political and social life…”

GGüünter Grassnter Grass

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

First They Came for the First They Came for the JewsJews

Pastor NiemollerPastor Niemoller

Contact InformationContact Information

Public Health and Social Justice Public Health and Social Justice WebsiteWebsite

http://www.phsj.orghttp://www.phsj.org

martindonohoe@phsj.orgmartindonohoe@phsj.org