Day: February 18, 2025

1. Introduction: The Disorganized Field of Faith and Medicine

• Research on faith and medicine has expanded significantly, yet it remains conceptually and theoretically disorganized (Levin, 2018).
• The field consists of two distinct meta-literatures:
  1. Faith as a problematic for medicine – studies investigating how faith influences health and medicine.
  2. Medicine as a problematic for faith – scholarship examining how medical practice is shaped by religious principles.
• Scholars from different disciplines have isolated approaches, preventing a cohesive discussion.

2. Historical Development of Faith and Medicine Research

• The study of religion and health has deep historical roots:
  • The U.S. National Institutes of Health (NIH) held its first conference on religion and health in 1995.
  • Theological discourse on medicine dates back centuries, with contributions from figures like Moses Maimonides (12th century) and John Wesley (18th century) (Levin, 2018).
• Research on religious factors in health started gaining traction in the 1980s and has grown into thousands of studies.

3. The Two Meta-Literatures in Faith and Medicine

A. Faith as a Problematic for Medicine

• This perspective views faith as a variable influencing medical outcomes, analyzed through empirical research.
• Studies have examined:
  • The role of prayer and spiritual practices in healing (Benson et al., 2006).
  • How religious participation affects morbidity and mortality (Koenig, King, & Carson, 2012).
  • Psychological and social benefits of faith-based interventions.
• Some studies, like randomized trials of distant prayer, have received skepticism due to methodological and philosophical concerns (Dossey, 2008).
• The challenge is the tendency to conflate distinct research methodologies, such as clinical trials with population-based studies.

B. Medicine as a Problematic for Faith

• This perspective evaluates medical practice through a religious or theological lens, shaping ethical and moral considerations.
• Key areas include:
  • Religious ethics in medical decision-making (Pellegrino & Thomasma, 1997).
  • The historical role of religious institutions in healthcare (Numbers & Amundsen, 1986).
  • Bioethics and debates on sanctity of life, euthanasia, and healthcare access (Dorff, 1998).
  • The integration of faith-based perspectives in medical training (Puchalski & Larson, 1998).
• Religious traditions have historically influenced healthcare, from Christian missionary hospitals to Islamic and Jewish medical ethics.

4. Conceptual and Theoretical Issues in the Field

• The discourse suffers from a lack of clear definitions:
  • Terms like “faith,” “religion,” “spirituality,” and “prayer” are often used interchangeably (Hall, Koenig, & Meador, 2004).
  • Medicine-related terms like “health,” “healing,” and “biomedicine” also lack precise distinctions.
• This conceptual confusion undermines the credibility of research findings and prevents interdisciplinary integration.

5. Competing Worldviews: Faith vs. Medicine as Lenses for Human Well-being

• Faith and medicine offer different paradigms for understanding human well-being:
  • Faith emphasizes transcendence, meaning, and moral responsibility.
  • Medicine is mechanistic, focusing on physical and empirical explanations of health.
• These conflicting perspectives create tensions in discussions on issues like faith-based healing, medical ethics, and spirituality in healthcare.
• Levin suggests that rather than viewing faith and medicine as opposing forces, integrating them could enrich both fields.

6. Challenges and Future Directions

• The field must address its theoretical and methodological weaknesses:
  • Better integration between medical researchers and religious scholars is needed.
  • Research should move beyond simplistic cause-effect models and consider broader frameworks like the social determinants of health.
• Faith and medicine discussions should be given more prominence within the broader field of religion and science.
• The ultimate goal is a balanced dialogue where both perspectives contribute meaningfully to understanding health and human well-being.

1. Discourse Theory (Michel Foucault)

• Concept of Competing Discourses

• Levin identifies two distinct “meta-literatures” in the discourse on faith and medicine:
  1. Faith as a Problematic for Medicine (scientific inquiry into religion’s effects on health)
  2. Medicine as a Problematic for Faith (religion shaping ethical and philosophical aspects of medicine).
• This aligns with Foucault’s notion that different epistemic communities produce competing discourses that shape how knowledge is constructed.
• “A closer look at the existing discourse on faith and medicine reveals that there are actually multiple discourses, which can be arranged under two large headings” (Levin, 2018).
• Power-Knowledge Nexus in Medicine

• The dominance of scientific medicine as an authoritative discourse positions faith-based perspectives as marginal.
• “Medicine holds the greater power, even where the faith domain defines the terms of engagement” (Levin, 2018).

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2. Structuralism and Binary Oppositions (Claude Lévi-Strauss)

• Binary Opposition between Faith and Medicine

• Levin presents faith and medicine as two contrasting epistemic frameworks, forming a structured binary similar to Lévi-Strauss’s notion of oppositional pairs in cultural narratives.
• “Faith communicates to us about the universe, and about human life and well-being, in characteristic ways distinct from how medicine does the same” (Levin, 2018).
• Faith represents a holistic, spiritual worldview, while medicine embodies a mechanistic, empirical framework.
• Interplay Between Science and Spirituality as Cultural Narratives

• Levin critiques the reductionist approach in scientific studies of faith, reinforcing the structuralist view that cultural narratives shape knowledge construction.
• “The reductionist models espoused by medical science may be incapable of accommodating the nuance required to competently address matters related to the existence and operation of ‘spiritual’ forces in relation to medicine” (Levin, 2018).

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3. Postmodernism and Epistemic Relativism (Jean-François Lyotard)

• Critique of Grand Narratives in Medicine

• Levin challenges the dominant biomedical model’s universalizing claims, aligning with Lyotard’s critique of “metanarratives” that claim to explain all aspects of human life.
• “Science and biomedicine have become lenses through which religion—something seemingly ephemeral, subjective, mysterious, and transcendent—can be rationalized and made reducible” (Levin, 2018).
• Multiplicity of Truths and Knowledge Systems

• Levin advocates for integrating faith-based perspectives with scientific discourse rather than privileging one over the other.
• “Faith has as much to gain through dialogue with medicine as medicine has to gain through dialogue with faith” (Levin, 2018).

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4. Sociology of Knowledge (Karl Mannheim)

• Faith and Medicine as Socially Constructed Epistemic Fields

• The two “meta-literatures” identified by Levin demonstrate how academic fields construct knowledge based on social and institutional contexts.
• “Academicians from divergent fields and disciplines work at advancing different agendas in isolation from each other” (Levin, 2018).
• Institutional Power in Knowledge Production

• Medicine, as an institutionalized discipline, exercises authority over health-related knowledge, often marginalizing religious perspectives.
• “Medicine, in the final analysis, calls the shots and jealously guards its turf, uneasy about sharing decision-making authority with faith” (Levin, 2018).

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5. Reader-Response Theory (Stanley Fish, Wolfgang Iser)

• Interpretative Communities in Faith and Medicine

• Levin implicitly applies the concept of interpretative communities, where different groups (scientists, theologians, medical practitioners) produce and consume knowledge differently.
• “Even the language used to describe the independent variable is unsettled…Religion, spirituality, faith, prayer, belief, and consciousness are often used interchangeably, as if these words imply the same thing” (Levin, 2018).
• Faith and Medicine as Competing Interpretations of Healing

• Different epistemic communities interpret the role of faith in health differently, mirroring Fish’s argument that meaning is constructed within interpretative communities.
• “Medicine defines the questions and the approach to answering the questions; faith is simply the source of variance” (Levin, 2018).

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6. Ethical Literary Criticism (Martha Nussbaum, Wayne Booth)

• Moral and Ethical Dimensions of Medicine

• Levin’s discussion on religious bioethics aligns with literary theories that explore ethical considerations in texts and discourse.
• “The faith–medicine conversation here is less about parsing a question of scientific cause and effect…and more about moral theology” (Levin, 2018).
• Narrative Ethics in Faith-Based Healthcare

• Levin’s discussion on faith-based health initiatives and religious bioethics reflects Booth’s view that narratives shape ethical frameworks in society.
• “Medical and public health missions to underdeveloped parts of the world, sponsored by Protestant and Catholic organizations, are historical examples of faith-driven healthcare” (Levin, 2018).

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Conclusion: Integrating Faith and Medicine in Literary Theory

• Levin’s analysis contributes to literary theory by demonstrating how medical and religious discourses function as epistemic frameworks that shape human understanding.
• His work supports Discourse Theory, Postmodernism, and Sociology of Knowledge by illustrating how power structures shape scientific and religious knowledge.
• The article aligns with Structuralism and Reader-Response Theory by showing how faith and medicine operate as distinct yet intersecting cultural narratives.
• By emphasizing moral concerns in healthcare, Levin’s work contributes to Ethical Literary Criticism, highlighting the ethical implications of scientific and religious perspectives.

• Lack of Empirical Distinction Between Faith and Medicine
  • Levin argues that faith and medicine represent two distinct meta-literatures, but he does not sufficiently delineate how they operate independently in empirical research.
  • Critics may argue that faith and medicine are often deeply interwoven in practice, making strict categorization misleading.
• Overemphasis on Conceptual Frameworks Without Sufficient Case Studies
  • While Levin effectively theorizes about the relationship between faith and medicine, the lack of concrete, detailed case studies weakens his argument.
  • A stronger inclusion of real-world examples could have enhanced the practical applicability of his framework.
• Limited Engagement with Medical Ethics and Policy Implications
  • Levin touches on bioethics and healthcare policy but does not deeply explore how religious and medical perspectives interact in practical decision-making.
  • The article would benefit from a more robust discussion on how faith influences clinical ethics and public health policies.
• Neglect of Non-Western Perspectives on Faith and Medicine
  • While Levin acknowledges non-Western healing traditions (such as Ayurveda and Chinese medicine), his analysis is primarily Western-centric.
  • A more balanced global perspective could provide deeper insight into the interplay between faith and medicine across different cultures.
• Insufficient Exploration of the Conflict Between Religion and Science
  • The article acknowledges but does not fully address the ongoing tension between medical science and religious belief, particularly in controversies like faith healing and medical refusal on religious grounds.
  • Critics may argue that Levin minimizes the conflict and presents an overly harmonious view of faith and medicine.
• Reduction of Religion to a Functionalist Perspective
  • Levin often discusses religion in terms of its utility for medical outcomes, which some theologians and religious scholars might see as reductive.
  • Faith is treated as a variable to be studied rather than as an independent, self-sustaining worldview with intrinsic value.
• Failure to Address the Political Dimensions of Faith in Medicine
  • The article does not sufficiently examine the political dimensions of religion in healthcare, such as debates over reproductive rights, end-of-life care, and faith-based medical refusals.
  • More engagement with policy debates would have provided a more comprehensive discussion.
• Tendency Toward Conceptual Vagueness
  • Critics might argue that Levin’s interchangeable use of terms like “faith,” “spirituality,” and “religion” lacks precision.
  • The article could benefit from clearer definitions and distinctions among these concepts to strengthen its theoretical foundation.
• Idealization of Collaborative Models Between Faith and Medicine
  • Levin’s discussion assumes that faith and medicine can coexist in mutual respect, but critics may argue that historical and contemporary conflicts challenge this assumption.
  • More acknowledgment of cases where faith-based beliefs directly oppose medical recommendations (e.g., vaccine skepticism, refusal of blood transfusions) would provide a more nuanced perspective.
• Limited Addressing of Secular Perspectives on Health and Well-being

• While the article extensively discusses religious influences on medicine, it does not sufficiently explore secular humanist perspectives on health, healing, and well-being.
• A more balanced approach would consider the contributions of non-religious ethical frameworks in medical discourse.

1. The Functional Role of Genre in Medical and Literary Texts

• Pethes argues that medical case histories are not just neutral records of scientific knowledge but are inherently “narratively organized” (Montgomery Hunter, 1991, p. 51).
• Case histories function as an “epistemic genre” (Pomata, 2011, p. 45), meaning they shape medical knowledge and create a scientific community through shared texts.
• Rather than just transmitting information, they contribute to how knowledge is constructed and communicated.

2. The Instability of Genre: Derrida’s Influence

• Pethes draws on Jacques Derrida’s concept of “The Law of Genre”, which argues that there is no fixed genre of genre (Derrida, 1980, p. 59).
• Medical case histories fluctuate between different textual forms, resisting rigid categorization.
• This instability aligns with literary studies, where genres evolve based on audience expectations and communicative needs.

3. The Evolutionary Nature of Genre

• Pethes applies Niklas Luhmann’s communication theory to argue that genres evolve through variation and selection, much like biological species (Luhmann, 1995).
• Franco Moretti’s “Graphs, Maps, Trees” model describes genres as branching trees rather than fixed forms (Moretti, 2005).
• Thus, medical and literary case histories are both shaped by reader expectations and historical context, rather than inherent formal structures.

4. Medicine and Literature as Interdisciplinary Fields

• Pethes suggests that literary and medical discourses intersect, rather than being separate domains.
• The “literary potential” of medical narratives has been explored by Epstein (1995) and Kennedy (2010), emphasizing how literature borrows from medical storytelling techniques.
• Conversely, medical case histories adopt narrative forms from literature, creating a mutual exchange rather than a one-way influence.

5. Empirical Reality and the Individual Case

• The 18th-century turn towards realism in literature aligns with empirical medicine’s shift from general theories to individual case studies.
• Gotthold Ephraim Lessing’s Essay on Fables (1759) argues that literature should focus on individual cases rather than general moral principles (Lessing, 1825, p. 92).
• Karl Philipp Moritz’s Anton Reiser (1785-1790) is both a novel and a psychological case study, emphasizing individuality as a source of truth.

6. Writing Against Generalization: Friedrich Schiller’s Contribution

• Friedrich Schiller, both a physician and a literary figure, described how focusing on individual cases “liberates the imagination from the bonds of reason” (Schiller, 1795, p. 676).
• The Criminal of Infamy (1786), Schiller’s case history of a criminal, reflects how medical and legal narratives were interwoven.
• This resistance to generalization also appears in medical case studies, which resist rigid classifications in favor of individual pathology.

7. The Role of Pathology in Literature and Medicine

• Literary case histories often focus on pathological individuals, similar to clinical case studies.
• Goethe’s The Sorrows of Young Werther (1774) presents Werther’s mental decline as a “sickness unto death” (Goethe, 1981, p. 48).
• Schiller’s “autopsy of vices” in criminal cases (Schiller, 1786, p. 15) mirrors the forensic and diagnostic elements of medicine.

8. The Spectacular vs. The Statistical: Literature’s Shift

• In the 19th century, medical case histories shifted towards statistical structures, as seen in Michel Foucault’s The Birth of the Clinic (1973, p. 102).
• Literature, too, shifted from spectacular individual cases to more routine, mundane medical observations.
• Adalbert Stifter’s My Great-Grandfather’s Notebook (1841) reflects this by focusing on ordinary medical records rather than sensational illnesses.

9. Conclusion: Writing Case Histories as Writing Against Genre

• The medical case history does not form a rigid literary genre but rather a mode of writing that moves between disciplines.
• Literature adopts the particularity and realism of medical cases, while medicine borrows narrative techniques from literature.
• Pethes argues that case histories serve as sites of genre transformation, challenging fixed categories in both literary and medical discourses.

1. Contribution to Genre Theory: Writing Against Fixed Genre Categories

• Challenges Traditional Genre Classifications
  • Pethes argues that case histories in both medicine and literature do not fit into fixed, typological genre definitions, making the case history a genre that constantly resists categorization (Pethes, 2014, p. 24).
  • “Writing case histories always means writing against genre—at least in the traditional sense of general typological schemes” (Pethes, 2014, p. 28).
• Expands Jacques Derrida’s “Law of Genre”
  • Pethes builds on Derrida’s claim that “there is no genre of genre” (Derrida, 1980, p. 59), emphasizing that medical case histories evolve without stable formal characteristics.
  • “The adoption of case-related structures in literature as well as of narrative patterns in medical writing always serves as an attempt to leave behind standardized modes of representation” (Pethes, 2014, p. 27).
• Supports Franco Moretti’s Evolutionary Model of Genre
  • Case histories, like literary genres, function as “trees with diverging branches” rather than fixed forms (Moretti, 2005, p. 136).
  • Pethes suggests that every case history adapts to shifting cultural and scientific expectations, demonstrating genre evolution as an adaptive process rather than a fixed taxonomy (Pethes, 2014, p. 26).

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2. Contribution to Narrative Theory: Medical and Literary Narratives as Hybrid Forms

• Reinforces Kathryn Montgomery Hunter’s Concept of “Narratively Organized Knowledge”
  • Medical knowledge is not simply scientific or cognitive, but narratively structured, following storytelling conventions (Hunter, 1991, p. 51).
  • “Medical observation is ‘narratively organized'” (Pethes, 2014, p. 24).
• Develops Meegan Kennedy’s Idea of the “Discursive Hybridity” of Case Histories
  • Pethes extends Kennedy’s argument that medical and literary case histories borrow narrative strategies from one another, shaping how both scientific and fictional texts construct reality (Kennedy, 2010, p. 2).
  • “The medical case history likewise borrows narrative forms and strategies from the novel, even after physicians establish a normative clinical genre” (Pethes, 2014, p. 27).
• Links to Roland Barthes’ Concept of Écriture (Mode of Writing)
  • Pethes aligns with Barthes’ rejection of rigid literary classifications in favor of dynamic, historically contingent modes of writing (Barthes, 1967).
  • “The case history is a genre beyond genre categories, while at the same time a style of thinking as well as a mode of writing in medicine and literature alike” (Pethes, 2014, p. 32).

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3. Contribution to Medical Humanities: Pathology as a Narrative Tool in Literature

• Expands Michel Foucault’s Idea of the “Birth of the Clinic”
  • Pethes connects the rise of modern literature with Foucault’s concept of medical discourse shaping individual subjectivity (Foucault, 1973, p. 97).
  • “Modern subjectivity, as created by fictional literature, is based on pathological observations” (Pethes, 2014, p. 35).
• Supports Rita Charon’s Narrative Medicine Approach
  • Case histories serve both medical and literary purposes, helping physicians and writers structure human experiences through storytelling (Charon, 2006).
  • “Instead of offering a typological pattern for epistemic genres, literary communication may participate in medical communication, and vice versa” (Pethes, 2014, p. 26).
• Extends Freud’s Observation of Case Histories as Novellas
  • Pethes highlights Sigmund Freud’s claim that medical case histories should ‘read like novellas’ (Freud, 1922).
  • “There is indeed a literary history of medical case histories to be discovered, in much the way criminal fiction emerged in close connection with the publication of legal case collections” (Pethes, 2014, p. 27).

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4. Contribution to Realism and Psychological Fiction: Case Histories as Literary Devices

• Reinforces Schiller’s Concept of the “Single Case” in Literature
  • Pethes links Schiller’s theory of literature to medical case histories, showing how both disciplines prioritize individual narratives over general theories (Schiller, 1795, p. 676).
  • “When we represent the species through an individual and a general concept through a single case, we liberate the imagination from the bonds of reason” (Schiller, quoted in Pethes, 2014, p. 31).
• Develops the Concept of Pathological Individualism in Literature
  • Many fictional characters (e.g., Goethe’s Werther, Moritz’s Anton Reiser, Lenz’s Zerbin) are framed as medical case studies, highlighting mental illness as a literary device (Pethes, 2014, p. 34).
  • “The striving toward individualism does not create rational moral subjects … rather, individuality can be expressed only by way of contradistinction against norms and therefore tends towards the pathological” (Pethes, 2014, p. 35).

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5. Contribution to Structuralism and Statistical Models of Literature

• Connects Foucault’s “Arithmetic of Cases” to Literary Normalization
  • Pethes argues that literary case histories mirror the statistical structures of modern medical records, turning individual stories into population-based data (Foucault, 1973, p. 103).
  • “Modern societies do not consider human beings as interesting individual cases anymore but rather as elements of average case series” (Pethes, 2014, p. 38).
• Supports Franco Moretti’s Use of Computational Literary Studies
  • Just as Moretti uses data visualization and distant reading to analyze genre evolution, Pethes suggests that literary case histories can be studied as statistical patterns (Moretti, 2005).
  • “These serial narrations may be boring, but by being so, they reveal the fact that empirical observation produces random details instead of essential conclusions” (Pethes, 2014, p. 40).

·  Overemphasis on Medical Diagnoses

• Some critics argue that the approach reduces literature to a case study in pathology, prioritizing medical interpretations over the literary, philosophical, or socio-political dimensions of the texts (Furst, 1991, p. 136).
• This can lead to oversimplification, where complex symbolic or thematic elements are reduced to mere symptoms of disease.

·  Lack of Collaboration Between Disciplines

• The methodology of “noncollaborative collaboration” means that literary scholars and medical professionals analyze the texts separately, rather than engaging in a genuine dialogue (Furst, 1991, p. 131).
• A more integrated approach might have led to richer, interdisciplinary insights rather than parallel commentaries.

·  Potential for Misdiagnosis of Fictional Characters

• Assigning real-world medical diagnoses to fictional characters can be problematic, as authors often use illness metaphorically rather than clinically (Furst, 1991, p. 140).
• For example, Milly in The Wings of the Dove is diagnosed with a physical illness, yet James provides no clear medical details, leading to speculative interpretations (Furst, 1991, p. 134).

·  Limited Theoretical Engagement with Literary Studies

• While the essay critiques Post-Structuralism and Deconstruction, it does not fully engage with contemporary literary theories, such as Psychoanalysis or Marxist Criticism, which might offer alternative interpretations of illness in literature (Furst, 1991, p. 137).
• The study leans more towards Medical Humanities than to mainstream literary theory, limiting its appeal to broader critical schools.

·  Bias Toward Realist Literature

• The focus on 19th-century realist texts assumes that realism provides the most accurate literary representation of illness (Furst, 1991, p. 137).
• This neglects more experimental or modernist depictions of disease, such as Kafka’s The Metamorphosis or Camus’ The Plague, which challenge traditional medical narratives (Furst, 1991, p. 132).

·  Gender Bias in Medical and Literary Interpretations

• The study acknowledges gendered representations of illness, particularly in The Yellow Wallpaper, but does not fully critique how medical discourse historically marginalized women’s suffering (Furst, 1991, p. 135).
• A deeper feminist analysis could highlight how medicine itself has been shaped by patriarchal biases.