Humanities Strengthen Science

August 14, 2014

“Would you like to see the brain collection?” my guide asked, as we finished our tour of the Yale School of Medicine. What scientist could resist?

I was expecting an impersonal chamber crammed with specimens and devices. Perhaps a brightly lit, crowded, antiseptic room, like the research bays we had just been exploring. Or an old-fashioned version, resembling an untidy apothecary’s shop packed with mysterious jars. 

But when we entered the Cushing Center in the sub-basement of the Medical Library, it was a dim, hushed space that led through a narrow opening into an expansive area for exploration and quiet reflection. As my guide noted, it looked remarkably like a posh jewelry store, with lovely wooden counters, closed cabinets below and glass-enclosed displays above. 

And such displays! Where I had envisioned an imposing, sterile wall of containers, with disembodied brains floating intact in preservative fluid, there was instead a long sinuous shelf of jars just above eye level, winding around the room. Each brain lay in thick slices at the bottom of its square glass container, the original owner’s name and dates on a handwritten label. Muted light glinting off the jars, and lending a slight glow to the sepia-toned fluid within, gave the impression of a vast collection of amber. 

In frames leaning from countertop to wall or resting in a glass-topped enclosure set within the counter were collages of photos and drawings. Surprised, I stepped closer, glimpsed human faces, and found extraordinary science therein.

I had anticipated spectacle: materials displayed in a manner that entertains, yet distances the audience and makes what is viewed seem exotic and alien. Instead, I experienced science in its most human manifestation: specimens arranged to emphasize the reason they were of interest to their original owners, those who had studied them, and those now viewing them.

A typical collage showed photographs of an individual living human being alongside Cushing’s exquisite drawings of the person’s brain, as dissected during surgery or after death. The photographs were posed to show the whole person as a unique individual – and also, in many cases, revealed the presence of the brain tumor they were then living with, through the shape of the skull or as a lump beneath the skin. The drawings revealed the location and anatomical details of the tumor. The very brain that had animated the person and suffered the tumor reposed in its jar nearby.

One could not walk away unmoved.

On the personal level, I was reminded of various individuals I have known whose deaths were caused by brain tumors. The first, decades ago: an admired college mentor. The most recent pair, within the last year: the vivacious wife of one colleague, the young child of another. I remember them as people who enriched others’ lives with their grace and strength of character and I am grateful for the medical advances that gave them extra time to be part of their families and communities.

As a scientist, I was reminded viscerally that this is exactly what we mean when we say all science exists within a human context. Cushing’s work, memorialized so effectively in this small museum, began at a time when neurosurgery was crude and ineffectual, and hope for those with brain tumors was practically nonexistent. By his career’s end, he had introduced diagnostic and surgical techniques that lowered the surgical mortality rate for his patients to an unheard-of ten percent, a rate nearly four times better than others achieved.

The human patients on whom Cushing operated were everything to him, simultaneously providing motivation, subject, object, and methods for his research. In endeavoring to find cures for their conditions, he studied their lives and symptoms, operated on and sketched their tumors, and used what he learned from each case to improve his effectiveness. The purely scientific aspect of his work (advancing the surgical treatment of brain tumors) was inextricably linked with its humanistic aspects (understanding the histories and fates of the individual members of his clinical practice). Indeed, it was his methodical linking of the clinical and human sides of medicine that made his contributions of such lasting significance. Cushing himself stressed that “a physician is obligated to consider more than a diseased organ, more than even the whole man – he must view the man in his world.” 

Seen in this light, the juxtaposition of images inside the museum’s frames carries dual meanings. 

First, the combined images document the course of medical history, forming what the biographer Aaron Cohen-Gadol calls “the diary of neurological surgery in its infancy.” The very format of these still photographs, hand-drawn sketches, and carefully stained glass slides reminds us that Cushing worked in an era before radiological methods for brain imaging and, initially, an era when even still photography was rather cumbersome. Indeed, his own artistic talent and training was crucial for accurately recording the outcomes of his surgeries. The contents of the images capture the conditions of patients when they came to see Cushing, the treatment, and the aftermath. Collectively, they show how neurology and neurosurgery were practiced in Cushing’s day and how these fields evolved year by year throughout his career.

Second, the combined images directly influenced the course of medical history. Cushing deliberately correlated, through the information in the photographs, anatomical sketches, and medical records, the external indicators of otherwise hidden medical problems within the skull. This led to improvements not only in how neurosurgeons operated but also in how readily other doctors could recognize early external indications of brain tumors and send patients for prompt treatment. As Cushing’s biographers note, “Each patient is of historical significance now because our discipline of neurological surgery evolved through his or her care.” Moreover, because he trained a generation of neurosurgeons in these methods, Cushing helped ensure the continuing development of the field; a number of these junior colleagues, in turn, were instrumental in the creation of the museum that now makes the images publicly visible.

The juxtaposition of Cushing’s images therefore represents the very essence of how the humanities and sciences are intertwined: achieving his medical breakthroughs depended directly on his active depiction and analysis of human experience. 

As an educator, I find that the displays in the Cushing Center encapsulate why young scientists need to study their fields in historical and social context. Isolated technical proficiency would not have enabled Cushing to become the originator of modern neurosurgery; his intense focus on the human condition was essential. Indeed, Cushing mused in a letter to a fellow physician that he “would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.” Similarly, to fully prepare for careers in science, it is essential that students grasp how the impetus for scientific work arises from the world in which the scientist lives, often responds to problems the scientist has personally encountered, and ultimately impacts that society and those problems in its turn. 

A very few scientists may be largely self-taught and spend their entire careers working on abstract problems in isolated research institutes without ever teaching a course, writing a grant or giving a public lecture. Even they, however, are influenced in their selection of research problems by the results that other individuals have previously obtained. And even they must communicate their results to other people in order to impact their field. Most of us interact far more directly with other people in our scientific endeavors:  they inspire our choices of major or thesis topic, pay taxes that support grants for our facilities and students, run companies that underwrite our applied investigations, propose legislation that regulates how we share data and maintain lab safety.

Some might argue that these considerations apply mainly to the life sciences, where the human connections are most tangible. They might think, for instance, that my own work as a theoretical physicist is too abstract to be influenced by societal context. After all, the field-theoretic equations I manipulate have no more race or gender or politics than the subatomic particles they describe. Yet my choice of research questions has unquestionably been affected by the contingent historical details of my own professional life: the compelling lectures that enticed me to switch fields during graduate school, the inspiring discussions with my doctoral adviser that established symmetry as a guiding principle, the discovery of certain subatomic particles at the start of my career and the decades-delayed confirmations of others. My sense of how science operates on both philosophical and practical levels has also unmistakably been influenced by my long-ago experiences as a graduate teaching assistant for History of Science courses and my ongoing conversations with scholars in Science Studies.

This is why programs that deliberately train scientists in the humanities are so essential to educating scientists effectively.  Every nascent scientist should read, think, and write about how science and society have impacted one another across cultural and temporal contexts. Not all undergraduates will immediately appreciate the value of this approach. The first-year students in my own college have been known to express confusion about why they must take that first course in the history, philosophy, and sociology of science. But decades later, our alumni cite the “HPS” curriculum as having had a profound impact on their careers in science or medicine. They remember the faculty members who taught those courses vividly and by name. They tell me the ethical concepts absorbed in those courses have helped them hew more closely to the scientific ideal of seeking the truth.

In the wake of C.P. Snow’s famous Rede Lecture on the Two Cultures of the sciences and humanities, academic programs were founded in the late 1960s and early 1970s (e.g., Michigan State University’s Lyman Briggs College and Stanford University’s Science, Society, and Technology program) with the express aim of immersing students in the deep connections between science and society. Decades later, those programs are thriving – and the impact of the ideas they espouse may be seen in changes that pre-professional programs in medicine and engineering have been embracing.

For example, the newest version of the Medical School Admissions Test (MCAT2015) incorporates questions on the psychological, social, and biological determinants of behavior to ensure that admitted medical students are prepared to study the sociocultural and behavioral aspects of health. Similarly, in 2000, ABET modified its criteria to emphasize communication, teamwork, ethical professional issues and the societal and global context of engineering decisions. An evaluation in 2002 found a measurable positive impact on what students learned and their preparation to enter the workforce.  

While pre-medical and engineering students are being required to learn about issues linking science and culture, most students in science fields are still not pushed to learn about the human context of their major disciplines. We faculty in the natural sciences have the power to change this. Many of us already incorporate “real world” applications of key topics in our class sessions or assignments; introductory textbooks often do likewise. But we can extend this principle beyond the classroom into the world of intellectual discourse and practice. As colloquium chairs and science club mentors, we can arrange regular departmental talks on topics that stress the interdependence of science and society: STEM education, alternative energy, medical technology, gender and science. 

As academic advisers we can nudge science students towards humanities courses that analyze scientific practice or towards summer internships with companies and NGOs as well as traditional REU programs. As directors of undergraduate or graduate studies, we can highlight science studies topics, interdisciplinary organizations, and non-academic career paths on the department website. Making these connections part of the life of the department can better prepare our students for their futures as capable scientists responsible to and living within society.

In the end, Cushing’s brain collection vividly reminds us why it is crucial to immerse natural science students in interdisciplinary science studies that incorporate the social sciences and humanities. It is not merely because hot new fields are said to lie at the unexplored intersections of fields whose borders were arbitrarily codified decades or centuries ago (though that is true).  It is not merely because the terms interdisciplinary, cross-disciplinary, and trans-disciplinary are presently in vogue (though that is also true).  It is because such cross-training produces scientists who are both more capable of extraordinary breakthroughs and more mindful of their broader impacts. The humanities truly strengthen science.

Bio

Elizabeth H. Simmons is dean of Lyman Briggs College, acting dean of the College of Arts and Letters, and University Distinguished Professor of Physics at Michigan State University.

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