There is much talk these days about “the medical humanities”, although we still await agreement on its meaning and importance. I think the key lies in appreciating how medicine and the humanities share in an endeavour larger than either alone — the endeavour of understanding the human condition. In this, medicine and the humanities have much to offer each other. My framework begins with an observation about knowledge, scientific and otherwise.

All knowledge is to some extent concerned with the knower: our attempts to know things about the natural world are also part of a much larger attempt to understand ourselves (Box 1). Sometimes, this is obvious. For instance, in economics, the laws of supply and demand tell us about how we, as consumers, can be predicted to behave. It is still more obvious in the arts and humanities. Knowledge — about musical forms, the rise of impressionism in painting, Aristotelian influence on medieval Church scholars, or the ambiguous role of the narrator in the psychological novel — is knowledge about how people have tried to make sense of the world, how they saw themselves in the natural order, whether they liked what they saw, and whether they were going to “come along quietly” or were going to struggle.

This is true in the natural sciences as well, even if only implicitly. When physiologists study the relations between form and function, when scientists of virtually any discipline attempt to create models of the world, they construct knowledge which not only tells us something about the world, but also something about us. They disclose and specify our need for explanation and prediction: our material need to govern our environment and to harness Nature, and our inner compulsion to understand, dissect and demystify it (Box 2).

Enquiries in the natural and life sciences also raise questions about us. What is the nature of observation? How can we contain observer bias? Why do we crave simple explanations? Why do we derive such pleasure from making satisfying theoretical models?

This relationship between the known and the knower has important implications for medicine’s role in our culture. Following Raymond Williams, 20th-century pioneer of cultural studies,1 I take “culture” to be the stock of meanings and purposes and shapes in a particular society (which we learn in our education and upbringing) and also the process of challenging these meanings and purposes, and making new ones. So, a “cultural good” is something that helps us learn the meanings, purposes and shapes that our society already embodies, or that helps us create new meanings, purposes and shapes. Medicine itself has a big role in this today.

If knowledge implies something about the knower as well as the known, then equally a society’s meanings and purposes tell a story about that society and its members, collectively and individually. Medicine today makes a powerful, uncomfortable and as yet unchallenged claim to supplying part of that story. For me, this conclusion emerges from analysing medicine as a “cultural good”, by which I mean something that gives us resources in reflecting upon ourselves, or in articulating or expressing ourselves, or in developing ourselves, or in criticising ourselves, or in encountering ourselves — all key aspects of what it is to “tell our story”.

Art or literature, history or philosophy, politics or theology are initially more obvious resources for doing these things. For instance, to reflect upon ourselves we might read a psychological novel, or study the conventions of classical Greek tragedy. To articulate or express ourselves, we might turn to social history, or to popular music, or to newly commissioned writings or public art. To develop or to criticise ourselves we might cultivate a taste for philosophy, or study the work of dramatists from Aristophanes to Arden. To encounter ourselves we might grapple with expressionist painting, and so on.

Western cultures are partly defined by our habitual turning to these particular resources or cultural goods. However, I think that less obvious resources are all around us in scientific and other practices — but they are usually overlooked. And the practice that strikes me most forcefully in this regard is modern technological medical and health care (hereinafter “medicine”). So, how does medicine do these things?

Reflecting upon ourselves: Modern medicine has given us new models of our own nature, seen in molecular genetics and in biological psychiatry’s story about our behaviour and character traits. Public health and preventive medicine purport to prescribe our “proper” conduct and spell out our individual responsibility, in line with the unargued assumption that good health is a self-evident benefit, rather than a contingent or instrumental one. The values that medicine presumes — such as the absolute benefit of health — show its heritage and its potency as a “cultural good”.

Articulating or expressing ourselves: Medical practice has given us abundant material for artistic, literary or other creative purposes, arising, perhaps naturally, from the linear and “narrative” form that illness, disability, treatment and recovery seem to take. Thanks to the episodic form that clinical medicine acquires in individual clinical cases, intimate and compelling aspects of the experience of being human are explored in literature as diverse as Chekhov’s A case history,2 Camus’ allegorical The plague,3 and John Sayles’ film Passion fish.4 Of course, medicine is not unique in providing material for creative reflection on life’s conditions: all of lived experience does this. I simply want to note that medicine amply satisfies this characteristic of a “cultural good”.

Developing ourselves: By contrast with the dominant theological determinism of earlier ages, according to which bodily suffering was seen as a necessary part of our journey through “this vale of tears”, medicine apparently offers a reassuring alternative, placing us within a flawed but eminently improvable natural world, from which we could in principle remove the deadlier stains, be they smallpox or polio or, in utopian mood, congenital anomalies. If, for most humans, life in the time of Thomas Hobbes was truly poor, nasty, brutish and short,5 medicine has already improved the odds and has ambitions to do vastly more. In the process, it has extended the range of stories we can tell about ourselves and about the human condition. It confirms our development beyond fatalism (Box 3).

Criticising ourselves: Medicine has given us a vocabulary of criticism, whereby we draw on health, sickness, diagnosis and treatment for images that capture larger areas of our experience — think of “the body politic”, of “healthy” and “unhealthy” behaviour, societies or subcultures. The general idea of “diagnosis” has colonised human affairs, giving us a model of what it is to function well or badly in the social and cultural arena; we commend processes, teams and institutions for their “organic” development, and condemn them for their atrophy, decay or paralysis. Of course, this — sometimes dangerously — implies a rhetoric for action:6 to call one thing a treatment, remedy or therapy is to impugn some other things as a pathological problem in need of change. We now have “remedial” processes in education, in management, in urban regeneration. Certainly, there are grievous problems in these areas, but the vocabulary of remedy and therapy spuriously distinguishes expert agents from lay “patients” in matters where public dispute ought to remain legitimate.

Encountering ourselves: This final aspect is perhaps the most interesting and suggestive. One of the conceptual foundations of medicine is the assumption that what lies beneath, or inside, holds the key to what lies outside or on the surface. Gross clinical pathology is explained by disruptive processes at the cellular or even molecular level. The once-astounding optical microscope now seems no more than a feeble and naive beginning: the slice-by-slice scanning of computed tomography, and the “unpeeling” made possible by magnetic resonance imaging, give us a new visual vocabulary for human nature (Box 4). By making the invisible become visible, we invert surface and substrate, seeming to locate the truth about ourselves at the level of physiology and neurology — rather than at the level of the ordinarily visible face and whole body, where we as selves ordinarily function and experience. The “medical body”7,8 is itself a substantial, if incomplete, story of encounter with the human condition, and one that invites critical interpretation and imaginative response.

In all these respects, modern medicine is indeed a “cultural good”. The challenge that we face is to find an adequate response to the persuasive power of its reductionist picture of human nature and the human condition. Today, in the West, this picture is virtually unopposed by earlier claimants for our adherence: religious, Marxist or psychoanalytic world-views.

We have an opportunity to reinvigorate enquiries into human nature within the established humanities disciplines — prominent among them being philosophy, recently rather coy about asking the real “meaning of life” questions.9 As a philosopher, it seems to me that coyness is no longer a serious option in the face of a story of human nature rooted at the molecular level. If we are to create a more satisfying conception of the human condition, it is time we recognised the need for a re-engagement between the humanities and medicine.

All illustrations reprinted with permission from The illustrated history of medicine, by Jean-Charles Sournia. Published by Harold Starke.