On the Cusp of Medical Corporatization

"Preface: On the Cusp of Medical Corporatization" Foreword by David T. Mitchell One of the most characteristic aspects of work in the literature of the Medical Humanities is the ascendancy and centrality of the physician as healer. The treatment doesn't always work and loss of life often runs high, but the physician remains the focal point through his or her (primarily his) suffering on behalf of the patients.  Consequently, the patient is at best secondary and often little more than a collection of symptoms that the physician abstracts from the dynamic life they conceal.  What this emphasis often results in is a rendering on behalf of the author into an anonymous "universal" suffering subjecthood for patients (disabled-people-in-the-making) that leaves them as murky existences in the shadow of the physician figure as paramount concern.  I would suggest at the start here that our age is made for work that populates the Medical Humanities (particularly in the West) as the rise of commercial advertising centering on the heroics of physicians and medical staff over-populate television and social media. We see the chronic "small print" disclaimers made on the audio track about possibilities of mortifying secondary conditions such as heart attack, cerebral hemorrhage, depression, suicide, etc. Sharon Snyder and I have commented elsewhere that this mode of representation might be referred to as the contemporary segmentation of the body into failed and/or failing constituent parts. Thus, parts of bodies can be sectioned off and sold cures/treatments as a critical aspect of selling off the private to the public within neoliberal orders.  Further, in the current covid epidemic age, celebrations of medical heroics are made as cultural thank yous even though they are actually advertisements for corporate medicine and Big Pharma such as Johnson & Johnson, Pfizer, among others. In these commercial depictions physicians and nurses are the titular protagonists as well and the West assures itself with sentimental narratives of its own overcoming through citation of medical industries. The sentimental narrative of neoliberal medicine is that key enjambment of telling viewers “they are falling apart” while counterbalancing that message with “we’ll take care of you – just buy our products.” In this collection, which may be observed to be somewhat removed from Western contexts with its interests planted firmly in India, Haris Qadeer assembles a variety of "short life" pieces that evoke a wide array of medical contexts and cultural traditions.  The multiplicity of India is on display in their portrayal of a variety of medicalized approaches to disability and interrupted health status.  The physicians in these works retain their paramount status and thus make the collection recognizable as a gathering of Medical Humanities-based texts.  Yet, the patients being treated arrive more developed and often in excess of their diagnostic symptoms.  Here, what these stories communicate to the reader is the intimacy of urban and country medical practices and the intimate connection with a less corporatized medicine that characterizes post-industrial cultures such as the UK, US, Australia, Canada, etc. Qadeer's selections avoid the anonymity of so many major traditions within Medical Humanities.   To a significant extent the difference that makes this collection so important as an addition to the field is Qadeer's introduction which provides a compelling history of works on mass death and the deterioration of the social order in the literature of epidemics.  The historical scope of Qadeer's commentary extends the more characteristic myopathy of the vast majority of stories analyzed so often by Medical Humanities approaches. The story of medical heroics -- unlike, for example, Kafka's The Plague that Qadeer analyzes substantively -- misses the dynamics of human interaction that medicine so often entails yet is increasingly lost as medicine industrializes and corporatizes delivery of care. Without the investment in a withholding of idealizations of medical deliverers the works of Medical Humanities miss the individuation and wide-ranging historical placement of its works of central interest. This individuation is what comes through in these stories and mark them as departures from the canon of works in the field as most commonly considered. The next issue that I want to take up is what tensions exist between Disability Studies and the Medical Humanities in order to enable readers to assess the stories to come. The two fields would seem to make comfortable bed fellows on the surface.  Disability Studies in the US can be argued to come out of Medical Sociology the close cousin discipline of today's Medical Humanities through the works of Robert Murphy in memoirs such as The Body Silent and Irving Zola's voluminous body of work (Ordinary Lives, Missing Pieces, Meaningful Relationships, Disabling Professions with Ivan Illich, etc.) not to mention Irving Goffman's work on asylums as total institutions.  What all of these works bring to readers' consideration was a shift in focus on the experience of the academician as patient and their downgrading of medical personnel to a more secondary role.  Thus, one could argue that Disability Studies was, at least, a counter-discourse to the utopic myth of modern medicine with its cures, treatments, and professionals minus the mortality, poor outcomes, ease of opting for the less successful surgery to save money and lower expectations of expertise, as well as the prison house atmosphere set up by so many medical gatekeepers. Whereas Medical Humanities work tended to enshrine the myth of the magical medical healer, early Disability Studies flipped the script and focused on an investigator turning their own experience of the medical industry into fodder for critical thinking about failures of medical caregiving and neglect of treatment of secondary conditions.  Thus, Disability Studies tends to view "the medical model" (reduction of disabled persons to sets of medically-interesting, yet deindividuated pathologies) with a great deal of skepticism, with its idealization of medical providers at the expense of the recipients of healthcare, and with its abstraction of individual humanity into the impartial, universal catalog of symptoms to be treated in the future of increasingly bureaucratized, alienated, and under resourced medical industries sold off to private corporations.   In the stories collected here in Medical Maladies, one can feel the coming threat of a more corporatized medical practice lurking on the horizon of the still individualized nature of care in India as portrayed. Pathologies are not yet fully abstracted from the dynamic nexus of patients and thus an interaction between physician and patient still play a central role in the delivery of care.  Neutrality has not yet been fully adopted as a desirable state of empiricism where individual investment in well being can be placed aside. Disability Studies rightfully worries over the stress on medical "neutrality" for several competing reasons: 1) neutrality abstracts disability/disease and the humanity of the patient is jettisoned like a stage in the ascent of a rocket into the invisibility of space; 2) "neutrality" (or lack thereof) often result in Western healthcare in neglect of secondary conditions as if the primary disabling condition is the singular source of all other health situations and thus disabled people often die of inattentiveness to other aspects of their health; third, "neutrality" tends to disguise responsibility of the medical staff in poor outcomes in the way that Max Weber analyzed decentralization as the primary output of corporatized bureaucracies where no "one" is answerable to the negative outcomes of corporate labor, product manufacturing, erroneous advertising, workplaces as producers of disabilities among laborers, etc. These are the serious give-and-take concerns at stake in work in the Medical Humanities where disabled people tend to find themselves more commonly subject to the excesses and neglect of medical care in the contemporary world. Hopefully, Medical Maladies can help skirt some of these problems in its variegated attention to subcultural medical treatment and its remaining fingernail grasp on the humanity of the patients as active participants in the healthcare scenario. Much depends on this collection and future work as the Medical Humanities moves to Asia and applies its too easy enshrinement of medical caretakers to those it seeks to turn into objects of care. 1