Dr Marie Allitt is Humanities and Healthcare Fellow at the University of Oxford, on the project ‘Advancing Medical Professionalism: Integrating Humanities Teaching in the University of Oxford’s Medical School’. For this blog, we invited her to tell us more about her work on the senses in First World War medical-military spaces:
What is your research about?
My research focuses on spaces and senses in healthcare and medicine, examining caregivers’ life writing and illness narratives. Lately, I’ve made initial steps to explore the weight of the senses in remembered and imagined, literal and figurative medical spaces. My current employment in medical education has made me increasingly aware of the senses in the medical school.
The majority of my research up until now has been developing my PhD thesis, which focused specifically on First World War caregiving with the emphasis on experiences and articulations of spaces and senses. By exploring the experiences of doctors, nurses, stretcher bearers, orderlies, and ambulance drivers, and crucially the ways they represent those experiences, I examine the complexities that accompany both the experience and the attempt to articulate and communicate it. The content of such work is typified by proximities, touch, odour, cries, so it is saturated with sensory cues. This research intersects with trauma and mental health; memory and witnessing; truth and authenticity; the struggle to articulate, and the failures and possibilities of language, so these considerations are never far from my mind. This has been an interdisciplinary project: rooted in literature, it is influenced by history, human geography, and medical humanities.
Tell us about the book you are currently writing.
I’m currently developing the monograph that stems from this PhD research. The central aspect of this book, and in terms of its greater contribution, is the way in which I utilise geographies. Specifically, ‘geographies’ in the plural, encompassing spatial, sensory and sensuous, phenomenological, textual, affective, and psychological. I make the case for a specific spatial lens for critical medical humanities, as a way to understand different structures of experience that influence health and clinical experiences, for both patient and caregiver. I’ve found that engagement with concepts from human geography and spatial theory have been most useful in this research, allowing me to develop conceptual frameworks that I hope to expand to other contexts.
Over the course of the book I address questions concerning: the identification and characteristics of military-medical spaces; the relationship medics have with their specific environment; how medics represent their encounters with wounded bodies; how they write their roles as witnesses and articulate their complex roles as caregivers. I have sought to centralise the medical figure in the context of the First World War, applying a literary-critical approach to the role and writings of medical personnel in order to shed an important light upon their perspectives, and establish the value of their own words, as both testimonies and representations of experience.
Who should read it and why?
First and foremost, this book will be of most interest to medical humanities researchers, especially those looking for an explicit literary slant. The spatial focus will be an important contribution to the direction of medical humanities, with the field’s increasing focus on objects, spaces, and emotions. This work strives to develop from the centralisation on the doctor-patient encounter, to consider the seemingly innocuous and non-human aspects that hover in the background of clinical/medical/health encounters. The book will also appeal to those interested in First World War narratives and military medicine.
What got you interested in this research area?
I arrived at the focus on senses and spaces following my interest in both First World War literature and medicine/medical humanities. My MSc by Research focused on the traumatised body in First World War literature, and by this point I knew that my research going forward would be both a focus on spaces and senses, and medicine more specifically. This was quite an obvious trajectory for me, in terms of topic.
My explicit interest in the senses in this context was influenced by Santanu Das’ Touch and Intimacy in the First World War (Cambridge University Press, 2006), which in turn introduced me to Paul Rodaway’s Sensuous Geographies: Body, sense and place (Routledge, 1994). I could very quickly see that the senses and spaces had been overlooked in the medical experiences, but that there was significant and vital work to be done through this lens. Since embarking on this research route, I am further convinced of the importance of a spatial and sensory lens, as well as a focus on the senses and spaces in their own right.
Where and how did you locate sensory experience in historical sources?
My background and disciplinary position in literary studies means that my engagement with the material is principally literary analysis. The specific primary sources I use for this research are rich in description and reflection on their surroundings, often mentioning what they see, smell, hear, and touch. Opening up the idea of ‘senses’ to complement and incorporate multiple geographies has been an effective approach, and allowed me to access the sensory experiences in greater depth.
For example, through a focus on the somatic and sensuous situation of the medic, I have been able to explore how bodies in war necessarily adapt to ongoing changing landscapes, a need which is especially heightened at the intersection of military and medical spatial geographies. The medics’ bodies are mutually implicated in the landscape and with the bodies of the patients. The experience demands an intensely multisensory attention and hypersensitivity: haptic, auditory, and olfactory geographies become integral to the negotiation of space.
Why do you think the ‘sensory’ is a useful way of examining or understanding your topic?
When it comes to the body, there is no denying the centrality and importance of the senses. It is precisely what connects the body, the selfhood, and the surrounding world. I approach the senses in a similar vein to Rodaway: ‘the senses both as a relationship to a world and the senses as in themselves a kind of structuring of space and defining of place.’ The senses structure and help mediate our world, and are heightened when medicine and health are involved. The caregiving experience (perhaps all caregiving contexts to varying degrees) is crowded with senses: proximities of bodies, the touch that is necessary and challenging; the pervasion of odours; the sounds of the body, that transmit signs and signals.
For me, the sensory cannot be extracted from the spatial, so I very much hold the two together. I maintain that we cannot understand (individually, intellectually, conceptually) the spaces without paying attention to the senses. The senses are vital sources of knowledge, providing networks of stimuli and information, deriving from multiple directions. Spaces make us just as much as we make spaces.
From this research, what have you learned about the role of the senses in the making of healthcare environments?
This research has confirmed that medical spaces are shaped by the experiences that take place in them, and in turn those spaces shape experiences. The sensory involvement of the caregiver tends to be overlooked, perhaps because it is assumed that the medic is only doing their job, so their experience of the space is not all that interesting. This research has reinforced that this is not the case, as even the seemingly most mundane aspect of the work is infused with complex sensory and spatial engagement, to which we need to pay more attention, in order to better understand past, current, and future healthcare environments. The stretcher bearer who clears blood from the patient’s eyes; the nurse who adds more gauze and pressure to a sudden haemorrhage; the surgeon who wipes his saw ready for another amputation, are deeply embedded in the sensory and spatial landscape of medicine.
It has also revealed how close the embodied senses are to other modes of engagement: it is difficult to separate the affective from the sensory. For example, in focusing on wound care, touch, smell, sound, and sight are directly entwined with disgust, fear, and sometimes anger.
What key text would you recommend to somebody interested in your research area?
In terms of primary sources, I recommend Mary Borden’s The Forbidden Zone, which was first published in 1929 and republished in 2008. It has become a popular text to look at in terms of nursing experiences, and women’s war writing. A quick look at this text demonstrates some of the richness of such sources; it, and many others, are shocking, graphic, gruesome to some, demonstrating the depth of insight into caregiving experiences. For secondary works, the aforementioned Touch and Intimacy in the First World War (2006) by Santanu Das, as the title indicates, provides detailed focus on touch in relation to First World War combatant experiences, and offers some initial discussion on nurses’ experiences. Both of these sources can provide a sense of the textual landscape in this area, and demonstrate the value and richness of the sensory approach.
What can your research tell us about current-day challenges or concerns in healthcare design?
This explicit research into First World War medicine, and the specificity of my sensory and spatial approach, demonstrates the perpetual role of the surroundings and environments in which treatment, care, and medicine is enacted. Simultaneously, it illustrates the importance of the caregivers’ own experiences, articulated through their own words.
One of the strands of this research has focused on temporary and improvised hospitals and medical spaces. Perhaps we’ve been complacent that such a concept is so heavily a thing of the past, and yet recent events have demonstrated that there will always be a need to erect emergency medical provision; whether in the form of fully formed temporary hospitals, re-appropriated field hospitals; bases for first aid, or contingent sites for first responders.
In the current context of COVID-19, medical spaces have become a major concern, arguably more than ever before. Not only are we all having to negotiate spaces in different ways, the acts of caregiving have had to adapt to new ways of giving care. For example, the improvisation of isolation rooms, or the careful negotiation between infected and non-infected persons, demonstrates the delicacy of bodily movement, and how much of our experience is fundamentally shaped by the senses. When it comes to reading the future stories and accounts of caregiving in the time of coronavirus, we will not be able to miss the emphasis on spaces – and more importantly, the manifold geographies of such experiences (whether caregiver, patient, or family).
Looking closely at historical medical experiences and histories of medicine actively contributes to our understanding of what makes a medical space: what makes it workable, bearable or unbearable; how does it feel to work in a crowded environment; how does the proximity of other patients impact the act and quality of caregiving. Such research contributes not only to healthcare design, but also clinical cultures and medical practice.
 Paul Rodaway, Sensuous Geographies: Body, sense and place (New York and London: Routledge, 1994), p. 4.
Featured Image. Credit: World War I: stretcher bearers of the Royal Army Medical Corps (RAMC) lifting a wounded man out of a trench. Painting by Gilbert Rogers. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)
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