Alan Bleakley

We have previously argued that empathy is a multidimensional, context-modulated attribute, and that the Western unidimensional ‘one size fits all’ approach to empathy is inadequate particularly in intercultural settings. We called for relational empathy characterized by qualities such as curiosity; cultural and epistemic humility; bidirectional engagement; relational consciousness/ubuntu. In a paradigm shift from dominant models of ego-based empathy as projected content, here we describe a model of empathies or multiple ‘local stories’ that are process-based, fluid and context-dependent. Such empathies are not ‘given’ but ‘generated’ as an emergent property of social engagement based on a dialectic of democracy. Establishing such Intercultural Relational Empathies demands a shift from singular ‘content’ empathy to multiple ‘process’ empathies produced through sensitive, democratic encounter. We thus distinguish between ‘settled’ empathy as an individual trait and ‘nomadic’ empathies as negotiation in social settings. While the former describes empathy as ego-based content, the latter describes empathy as process and eco-centric – specifically, an emergent property of a nonlinear, open, dynamic, complex system that is an active social collective. We focus on the collective of an intercultural healthcare setting common to contemporary global healthcare - multicultural healthcare teams treating a range of patients. We describe ‘nomadic’ empathies as produced through dialectic and negotiation, both collaborative and competitive. We suggest that the globally dominant modernist model of content-based, ego-driven empathy is grounded in the values systems of individualism common to high-income countries. This affords a ‘grand narrative’ or dominant value, but one size does not fit all.

Medical humanities teaching in UK medical schools has lacked cohesion, having developed opportunistically in different locations. Cohesion is necessary to develop an identifiable community of practice, but within that community there can be multiple readings of what ‘medical humanities’ are and how they may develop. This article details discussions held by medical humanities scholars teaching in UK medical schools at a workshop in January 2025 at the University of Oxford covering five key areas: the role of humanities scholars in medical schools, patients as partners in medical education, core curriculum teaching, intercalated teaching, and assessment. Our discussion highlights opportunities and challenges facing humanities teaching in UK medical schools today and calls for the creation of a community of medical humanities scholars working in UK medical education embracing diversity of opinion and practices. The article is specifically written as a synopsis of a brainstorming symposium.

This introduction provides an overview of the edited collection, placing the work in historical and pedagogical contexts. A root author and root metaphor are identified, where the Canadian physician EP Scarlett (from 1936) suggests, ‘A physician should be a kind of poet’. The metaphorical window is provided by the phrase ‘a kind of poet’, inviting us to see poetry and poets as placed on a wide spectrum of types and products. We enter the linked houses of medicine and poetry through this window, rather than the conventional front door, as slantwise observers of a tradition in which expert clinical and poetic practices share intensive production of metaphor. We note that medicine without an awareness of metaphor is zombie medicine – functional or instrumental, as the evidence-based application of reductive biomedicine. There is no escape from metaphor. But, of course, medicine is more than this – it is a culturally and historically-specific practice going beyond the instrumental to embrace ethical, aesthetic, political, and transcendental values. Every one of our authors, as we summarize in this chapter, has grappled deeply with such enriching translations from the literal to the metaphorical, to create a stimulating and controversial collection of essays re-defining relationships between medical cultures, clinical practices, medical education, and poetry.

The Routledge Handbook of Medicine and Poetry draws on an international selection of authors to ask what the cultures of poetry and medicine may gain from reciprocal critical engagement. The volume celebrates interdisciplinary inquiry, critique, and creative expansion with an emphasis upon amplifying provocative and marginalized voices. This carefully curated collection offers both historical context and future thinking from clinicians, poets, artists, humanities scholars, social scientists, and bio-scientists who collectively inquire into the nature of relationships between medicine and poetry. Importantly, these can be both productive and unproductive. How, for example, do poet-doctors reconcile the outwardly antithetical approaches of bio-scientific medicine and poetry in their daily work, where typically the former draws on technical language and associated thinking and the latter on metaphors? How does non-narrative lyrical poetry engage with narrative-based medicine? How do poets writing about medicine identify as patients? Central to the volume is the critical investigation of the consequences of varieties of medical pedagogy for clinical practice. Presenting a vision of how poetic thinking might form a medical ontology this thought-provoking book affords an essential resource for scholars and practitioners from across medicine, health and social care, medical education, the medical and health humanities, and literary studies.

In December 1936 and January 1937, Earle Parkhill Scarlett (1896–1982) published a two-part article, meticulously researched, titled ‘Medicine and Poetry’. Outwardly, the article catalogues physicians who were also major or minor poets, but read closely, Scarlett’s glosses on such poets reveal an uncanny psychological insight into a form of sensibility. Physicians educated in reading the body could also read the world. In other words, they were experts in close noticing, and their medium for such sensate work was the abstraction of the metaphor. Not quite ‘abstract’, for metaphors are always embodied, but the transition from the literal to the metaphorical is cognitive – and not, say, the work of the surgeon’s knife to which John Keats refers in Scarlett’s careful reading of the English surgeon who abandoned medicine for the Word. As Keats said to a friend, my last operation was the opening of a man’s temporal artery. I did it with the utmost nicety, but, reflecting on what passed through my mind at the time, my dexterity seemed a miracle, and I never took up the lancet again. The opening of the temporal artery may have prevented loss of vision in Keats’ patient, but this moment provided Keats with a vision and a confirmation of calling as a poet. The Word became Keats’ patient that he treated with extraordinary care and sensuality.

In this two-part chapter, we ask: ‘Why poetry in medicine and medical education? What’s the point? Why don’t we stick to instrumental biomedicine and clinical and communication skills’? Poetry has concerns beyond the instrumental, engaging aesthetic, ethical, political, and transcendental values. Biomedicine too should embrace such values, engaging with a language rich in productive metaphor to shape a medicine of qualities as well as quantities. In its contact with medicine, we call ‘for poetry itself to deepen its reach and possibility’. In the face of global issues such as the climate crisis, medicine is improving people’s lives. Why, then, tamper with how medical students and doctors are educated? This chapter calls for continuous quality improvement – we can always do better. More, current medical education can be seen to hamper the learning of a humane medicine. If poetry does anything, it produces a concentrate of medicine called ‘metaphors’. They are life enriching. This chapter urges that you treat the contents of the Handbook as medicinal, beginning with the health of the imagination. Our authors have collected a range of chapters to produce what the poet Yeats would have called ‘A Vision’. Let’s indulge such a Vision.

This chapter frames a ‘complex conversation’ between radical psychiatry, poetry, and curriculum reconceptualization. Several movements converged in the 1970s that framed forms of neurodiversity as both poetic (as reinvention of language) and political (as reinvention of power relations). These movements included Stuart Montgomery’s ground-breaking Fulcrum Press that focused on cutting-edge poetry (Montgomery later qualified as a psychiatrist), the ‘anti-psychiatry’ movement, and radical pedagogies such as the curriculum reconceptualization movement (William Pinar). Where the contemporary medicine curriculum can be seen as a poetic field, we can reconceptualize medical education as a series of poetic gestures in the knowledge that the structure of clinical reasoning and poetic composition are isomorphic. Both involve space-based work within ‘fields’ of interest. The notion of such fields as professional ‘turfs’ is illustrated in an extended discussion of the work of the poet Peter Redgrove, who was also treated for ‘mental illness’. Redgrove – who termed himself a ‘scientist of the strange’ – saw poetry as his way of making sense of visions related to a strong connection with earth and weather and expressed through metaphors of matter. Through poetry, he found a cure for distressing symptoms that transformed those symptoms into a creative ritual.

Medical practice is performative, engaging roles and identities steeped in historical traditions, but also subject to reformulations. Modern medical work can be viewed as set in a tradition of oral recitation of epic poetry that dates to ancient, pre-Homeric times. Doctors learn standard scripts for recurring diseases related to specific patterns of symptom presentations. These are handed down from one generation of physicians to another through medical education. The key elements to such oral performance involve an interplay between scripted text/behaviour and improvisation; reliance on rhetorical devices designed to facilitate the art of memory (for example, repeated and visually arresting phrases), and style of delivery. While there are limits to the pre-Homeric analogy, this chapter reveals the ways in which medical education can be framed as engaged with performativity generally, and specifically with ‘impression management’ – how a doctor comes across to patients and colleagues.

PurposeTo articulate proof of concept in relation to a complex pedagogical values intervention for a range of medical education's historically accumulated symptoms.MethodsUsing a discursive approach, symptoms that hinder development of medical education are set out. Such symptoms rest with the instrumentality of current pedagogical approaches, supressing potential. A 'cure' is articulated - that the dominant values complex of instrumentalism is raised in quality through embracing ethical, aesthetic, political, and transcendental (meaning) values. Key to this is the use of language in clinical encounters, where the productive metaphor count is repressed in instrumental-technical approaches but multiplied in embracing other values and qualities. This 'Values Prism' model shows instrumentalism passing through an expansive educational prism to create expansion in types and qualities.Results and conclusionsProof of concept is achieved. The Values Prism model can be adapted for any undergraduate medicine curriculum as a process model - a set of values that permeate the curriculum beyond the dominant instrumental. The enhanced and expanded curriculum acts in a translational capacity.

Context: We argue that biomedicine at root is not primarily instrumental, but shares aesthetic, ethical and political values with poetry. Yet an instrumentalist bias in medical pedagogy can lead to frustration of biomedicine's potential. Such unfulfilled potential is exposed when making a comparison with poetry, a knowledge system that expressly engages a range of value systems. How then to recover biomedical language's riches for medical education's gain? Methods: We combine scientific and artistic approaches by positing a common frame to which both medicine and poetry can aspire: the ‘high‐water mark’ of language. Poetry's language is complex, intensive and connotative—concerned with mood, ambiguity, metaphor and embodiment. Biomedicine potentially engages with such linguistic complexities, particularly in metaphor production, yet persistently falls away from this high‐water mark of language, reducing connotative language to denotation or literal meanings. We describe such instances of frustrated potential as ‘trying to accelerate with the brake on’. This paradoxical state has become habitual in medical education. The resultant lack of productive metaphor insulates pedagogy from mood, separating it from the vernacular as a specialist tongue that ensures identification with the medical community of practice. Such language can alienate both patients and poets for the same reason: it is less human than technical. Conclusions: Using the example of clinical reasoning and attendant diagnostic work, we show that reductions from the connotative to the denotative not only mask but also contradict the complexity of implicit, embedded and distributed cognitive structures, creating a tension that medical education consistently fails to either resolve or draw upon as a resource. Further, poetry too has a complex set of implicit rules and formative structures that shape composition. These structures show symmetry, correspondence or even isomorphism with medical cognition, where both can aspire to activity that is aesthetically rich, intense and cognitively elegant.