Medical Humanities,COVID-19,and Global Healing:An Interview with Prof.Karen L.Thornber*

Karen L.Thornber QU Yang

Abstract:As a leading scholar in the fields of comparative and world literature and environmental humanities,Professor Karen L.Thornber has recently published a major scholarly monograph,Global Healing:Literature,Advocacy,Care (Brill,2020),which is a monumental work on medical and health humanities as well as a timely publication in a pandemic age.In this book,she discusses how literature and literary scholarship not only highlight the importance of shattering disease stigmas,humanizing healthcare,and prioritizing care partnerships,but also remind people of the value of providing comfort and understanding for those who have lost loved ones,or who are caring for loved ones.In this interview,Professor Thornber shares her thoughts on the writing of this book,the field of medical/health humanities,and the COVID-19 pandemic.

Keywords:medical humanities; global literature; COVID-19; structural violence

QU:Thank you very much,Professor Thornber,for accepting our interview and congratulations on the publication of your new bookGlobal Healing:Literature,Advocacy,Care(Brill,2020),which is not only a monumental work on medical/health humanities but also a timely and much-needed publication in this exceedingly volatile and disturbing time amid a global public health crisis.Prior to this book,you have published two scholarly monographs,as well as multiple (co) edited volumes and articles.How did you navigate your interests through such a broad range of topics,and what prompted you to write this book?

Thornber:There were many inspirations behindGlobal Healing,now available for free download from Brill.Most powerful—following my previous two single-authored major academic books on environmental humanities (literature and environment) and on transculturation and imperialism,respectively,as well as my multiple (co) edited volumes and dozens of articles on a broad range of topics—was the desire to draw attention to and analyze heretofore unexplored resonances among literatures from Asia,Africa,the Americas,Europe,the Middle East,and Oceania regarding the global imperative of reducing the suffering caused by social responses to disease,suffering that often is more intense than that caused by the physical processes of the diseases themselves.

Regarding navigating interests through a broad range of topics over the course of my career,it’s been a challenge,but one of the wonderful things about Harvard is the support for precisely this kind of interdisciplinary work.When I was finishing up my Ph.D.at Harvard in 2006,I had plans for several books along the lines of what became my first single-authored book.But then just a year out of the Ph.D.,in 2007,I quite by chance learned about the field of ecocriticism (literature and environment studies),and for the first time I recognized that I could combine my scholarly interest in literature with my at that time more personal interest in environmental degradation.So even as I continued to do considerable work on East Asian transculturations in broader context (my book also addresses transculturation outside of East Asia),I began publishing in environmental humanities,most notablyEcoambiguity:Environmental Crises and East Asian Literatures(2012),available during the COVID-19 crisis for free from the University of Michigan Press,and then a co-edited volume I did with my husband Tom Havens in 2016,Global Indigeneities and the Environment.Since earning my Ph.D.I’ve published several additional (co) edited volumes and more than 70 articles in a broad range of fields—thanks to the wonderful support I’ve received from colleagues at Harvard and globally.

QU:The first part of your book,“Shattering Stigmas,” is particularly helpful in understanding the broader social stigmatizing of individuals under the COVID-19 pandemic.Even though your research focuses on individuals with adverse health conditions such as leprosy,HIV/AIDS,and dementia,particularly Alzheimer’s disease,much of the prejudicial attitudes and discriminatory behaviors depicted in those narratives could be applied to the stigmas and fears of stigmas surrounding COVID-19.However,as Osterholm and Olshaker distinguish inDeadliest Enemy(2017),unlike health conditions such as leprosy and Alzheimer’s,which do not have the potential to foster social-political instability,infectious diseases such as AIDS and COVID-19 we are facing today could affect people collectively,sometimes on a mass scale,and they have the capacities to ultimately halt the normal functioning of societies.Certainly,AIDS and COVID-19 are completely different kinds of diseases—they have different symptoms,infection rates,and ways of transmission—but the stigmas and discriminations surrounding them are comparable,especially after Trump repeatedly labeled COVID-19 as the “Chinese virus.” What are your thoughts on this unprecedented global crisis since WW2 and how would you write about COVID-19,its stigmas,and global trauma,inGlobal Healing?

Thornber:I submitted the final version ofGlobal Healingto Brill in September 2019,well before the coronavirus,or at least before the first public reports of a novel virus.Even when I submitted the corrected page proofs ofGlobal Healinga few months later,the coronavirus had not yet hit Asia beyond Wuhan,China,nor had it hit Europe,the United States,or other parts of the world.For its part,China had just reported its first death.Information available to the public did not reveal that this was an epidemic,much less a pandemic in the making.

Things of course changed very quickly in the weeks that followed.Were I to be wrapping upGlobal Healingnow,I’d certainly address the parallels between the stigmas surrounding COVID-19,including the racism that we’ve witnessed in the United States and in other parts of the world against Asians and individuals of Asian descent.I’d also call our attention to the social suffering caused by this disease more generally.One of the many things that distinguish the suffering caused by the social response to COVID-19 from the suffering caused by the social responses to other epidemics,including HIV-AIDS,is that it encompasses even larger swathes of our population.I write in the book that “inequality and other injustices continue to contribute significantly to large scale health problems.” This is even more the case now than it was in mid-January 2020.Moreover,I wrote:

Literature persistently reveals that no matter how sophisticated our medical technology and treatments,tremendous suffering will persist unless we shatter disease stigmas,humanize healthcare by fully implementing person-focused care,and prioritize care partnerships.Literature’s frequent focus on individual anguish amid broader economic and social dynamics (including inequality and violence) uniquely positions it to reveal the deeply penetrating damage caused by current practices and the pressing need to transform how we all prepare for and respond to crises in health.1Karen L.Thornber,Global Healing:Literature,Advocacy,Care (Leiden:Brill,2020),xi.

This too is even more the case now than it was in mid-January 2020.And the literature that’s been coming out of China and more recently Italy (I’m thinking here of Chinese writer Fang Fang’sWuhan Diary,and works from Italy such as the anthologyAndrà tutto bene:Gli scrittori al tempo della quarantena) is making this all too clear.

QU:Identity politics and the rise of right-wing populism have been critical issues in recent years,and since the outbreak,we have witnessed increasing cases of racism and hate crimes targeting not only Chinese but also Asian Americans and Southeast Asians,and many worried that Trump’s irresponsible remarks would only exacerbate the current situation.How can individuals resist stigmatizing when racism is so inherently structured on a national and institutional level?

Thornber:Resisting the human impulse to stigmatize,to scapegoat,to blame has proven incredibly difficult.Part of the challenge is that the messaging is inconsistent and that our leaders—at every level—do not tend to prioritize fighting back against stigma.In fact,in many cases our leaders,again at every level,tend to exacerbate and even encourage stigma.At the very least,stigmatizing already vulnerable groups—whether by race,ethnicity,sexuality,religion,socioeconomic status,age,or other factors—entrenches inequalities and intensifies structural violence.Individual efforts and broader grassroots efforts against stigma have proven helpful.But if we think about how adverse health conditions such as Hansen’s disease/leprosy and HIV/AIDS continue to be so stigmatized in many parts of the world,despite the fact that the former is curable (and has been for decades) and the latter is now manageable as a chronic disease,we begin to understand just how entrenched stigma remains in our lives and our societies.

QU:In a recent article in theNew York Times,Thomas L.Friedman regards COVID-19 as our new historical divide:B.C.as “Before Corona” and A.C.as “After Corona.” Do you think this global pandemic has forever changed the ways people live their lives and write their history?

Thornber:Speaking on April 13,2020,it’s still too early to tell whether this global pandemic has “forever changed” how we live our lives; but few if any of us have not been changed by this disease.When I think of the aftermath of COVID-19,one of my fears is that the inequalities of our societies,the great divide between the “haves” and the “have-nots,” will only intensify.We’ve already seen just how disproportionately COVID-19 has affected those who already are the most vulnerable in our society,on account of their ethnicity,their race,their socioeconomic status,their age,their comorbidities.On the other hand,COVID-19 has made extremely clear just how important it is,for the health of society as a whole,to embrace universal health coverage,offer paid sick leave and family leave,and pay a living wage,all of which will keep people healthier and better able to survive subsequent novel diseases.

QU:Much of the second part of your book,“Humanizing Healthcare,” focuses on narratives that expose the dangers of dehumanizing and damaging medical treatment that impede patients’ healing and wellbeing,yet,just as you have written,understanding the difficulties faced by health professionals trained and expected to cure conditions and prolong life at all costs is equally important.Violence against medical professionals and healthcare workers is an important and urgent social issue.In China,just weeks before the COVID-19 outbreak,there were two cases of aggravated assaults against doctors.One of them was fatally stabbed and the other one was gravely injured.These cases have raised much social concern over the safety of medical professionals as well as the possible ways to help build and sustain a healthy doctor-patient relationship.As medical professionals are working tirelessly to save patients from COVID-19 these days,many of them have suffered from nervous breakdown and severe depression.Apart from the patientfocused narratives that rightly recognized the importance of prioritizing the needs and desires of the patient,how could medical humanities help address the wellbeing of medical professionals,the healing of their traumatic experience over this outbreak,as well as the challenges of communication between them and patients?

Thornber:Reporting on COVID-19 has revealed the tremendous vulnerability of health professionals globally:the failure of governments and health systems to provide even such basic protective equipment as face shields,masks,gloves,and gowns,resulting in health providers becoming among the hardest hit by COVID-19,both physically and psychologically.Countless health professionals have already spoken out.I expect that in the months and years following this pandemic,many will write more extensively about their experiences on the front lines.The medical and health humanities can and should pay close attention to these narratives and advocate for the health and wellbeing of health professionals,so that societies more fully support their demands for better preparedness.Regarding communication,given the physical distancing required by COVID-19,health professionals have become quite literally go-betweens,in some cases using their own phones and tablets to connect patients with their families.This is not to say that communication hasn’t broken down—in many cases it has,given the surge in patients.But the medical and health humanities are in a strong position to provide new insights into how to improve communication even under the worst of circumstances.

QU:The last part of the book,“Prioritizing Partnerships,” provides much-needed guidance for all of us,amid this ongoing pandemic crisis.Companionships and partnerships from families and friends are instrumental for both the physical and mental wellbeing of patients.The narratives you analyzed in this section have shown how important it is for people to be equipped with sufficient emotional,financial,and social support in order to foster family care partnerships and to avoid the potentially devastating consequences.As the pandemic grew rapidly in countries such as Italy and Iran,many people were forced to deal with the loss of their loved ones,within a short period of time; and due to the highly infectious nature of COVID-19,many of the deceased did not receive proper funerals or farewell ceremonies that were accustomed to their cultural and religious traditions.How could literature and medical humanities help enhance societal and familial care for patients to alleviate their suffering and foster their wellbeing,while providing comfort and understanding for those who have lost their loved ones?

Thornber:Literature and scholarship on literature (i.e.,the medical and health humanities) can highlight not only the traumas faced by the survivors but also new methods of coping,of making meaning.As you note,the exigencies of the present make many conventional practices impossible.We can and should give ourselves space to mourn the loss (however temporary) of these practices.And we can and should give ourselves space to find new ways of making meaning,new rituals and practices.At first these might seem awkward,or impossibly inferior.But over time,we can and should give them meaning.Literature and scholarship on literature also remind us of the importance of providing comfort and understanding for those who have lost loved ones,or who are caring for loved ones—these narratives remind us what it really means to be “all in this together.” We’re not all in this together given the great disparities and inequalities of our societies,but we are all in this together in that we are living now in a world where so many are losing so much.We can turn and look away,or we can lean in and at the very least be there for others who are not so fortunate and at the very,very least not propagate the stigmas and other injustices that continue to plague us relentlessly.

QU:The concept of structural violence,which is discussed in-depth in your book,is also essential and relevant to the current dearth of appropriate healthcare in countries where the COVID-19 pandemic is severe.As you have written,millions of people in the United States do not receive the care they need because of their ethnicity,gender,immigration status,race,religion,sexuality,or socioeconomic status,and other pre-existing conditions.The unequal access to health care resources not only presents critical challenges for containing and eliminating the disease but also impedes healing and thwarts wellbeing even after the disease is cured.During the COVID-19 outbreak,we have seen numerous narratives that decry and highlight the difficulties in accessing even basic care.These narratives,broadly understood as literature,not only include nonfiction and journalistic writings,but also take the form of poems,novels,essays,memoirs,short stories,and other creative genres.Literature as such spans a broad range of societies,languages,and experiences across cultural,geographical,and linguistic boundaries,yet they repeatedly explicate the deeply traumatic experience surrounding the stigmas,the lack of care,and the fear over COVID-19.How shall we make sense of these narratives,especially when the intensity of suffering is so severe and the anguish is so expansive and ubiquitous? What are the challenges for scholars of medical and health humanities,in the age of global trauma?

Thornber:You’re so right to point out the difficulties of doing this field now.Usually,when we write about writings about illness,we can establish at least a bit of distance between ourselves and the topic of our study.Even if we have close personal connections with the topic of our research,much of the “outside” world does not,and there is some relief,or at least temporary relief to be found there.One of the great challenges of COVID-19 is that it is so all-encompassing.Even if we can’t “see” it from our homes,even if the flora are bursting into springtime right in front of us,and we’re seeing more wild animals than ever before,as they take advantage of the reduced human presence outdoors,we can feel the presence of COVID-19—most of us now know someone who has or had COVID-19,or who knows someone who does,or have heard of someone who has or had this disease.There are far fewer distractions than before; we can’t meet up with friends,go to the movies,or the theater,or church,or a sporting event,or even sit inside and watch a live or recent event.

That being said,as students and as scholars of the humanities and social sciences we have a vital role to play in educating,in discovering and then saying what’s not being said,in emphasizing what needs to be emphasized but so often is not.Humanists and social scientists also have a vital role to play in bringing to light the stories of those who are suffering the most—whether because they themselves or a loved one has fallen ill,or because they are not being provided with the protection they need (e.g.,everyone from physicians to grocery store clerks to anyone else deemed essential who cannot practice physical distancing because of the nature of their profession),or because they have lost their source of income and have no safety net.These stories put human faces on all the statistics,the numbers,the curves.They humanize the tragedies that are currently unfolding.They also help us understand better where our priorities need to be going forward.

QU:As a prolific author on world literature,in this book,you shifted your focus to the concept of global literature,which you defined as “narratives that grapple with challenges and crises that have global implications or counterparts globally”2Ibid.,10..Even though Shu-mei Shih proposed this idea as early as in 2004,it did not gain as much momentum in the academic landscape as world literature.Would you please tell us more about why you chose to engage with this concept,and what advantages does it provide over other theoretical frameworks?

Thornber:Literature that tackles challenges and crises with global implications or with counterparts globally often can provide great insights into these challenges and crises.As I write inGlobal Healingand elsewhere,literature and other writings can readily disrupt,even shatter our assumptions and change consciousness concerning our planet’s greatest challenges.In the case of illness,by bringing together and analyzing writings from multiple perspectives on diverse experiences of illness,scholarship on literature can identify key areas of particular urgency,make an even stronger case for change,and inspire advocacy and activism across borders.To be sure,formal changes in matters of health and wellbeing often occur at the level of policy,with policymakers,legislators,bureaucrats,lobbyists,and pharmaceutical and healthcare executives all exerting significant power.But it is less a matter of literature and literary criticism directly reaching those in power—although ideally it should,and in some cases it does—than literature and literary criticism motivating a broad public audience,including medical professionals,to advocate for transformational change.

QU:You have criticized the inherent and persistent Eurocentrism in the field of world literature as well as its lack of relevance over matters of global significance such as disease,poverty,migration,etc.How do you think the idea of global literature addresses and tackles these problems?

Thornber:So much global literature (as I define it) is also world literature (as is commonly understood).There is tremendous space for scholars of world literature to turn greater attention to how this literature addresses challenges and crises with global implications or with counterparts globally.

QU:Lastly,a number of scholars consider the emergence of this term as the aftermath of neocolonialism and neoliberal economic expansion.Do you think global literature is necessarily a product of globalization; and do you think the conceptual framework provided by global literature is also capable of examining premodern literary works and traditions,for instance?

Thornber:The term “global literature” has been used in a variety of ways.In my understanding,global literature is not necessarily a product of globalization.I absolutely agree that the conceptual framework provided by global literature can help us better understand premodern literary works and traditions,which is why I include inGlobal Healingdiscussion of early writings on leprosy,Sophocles’sTrachiniai,as well as other premodern texts.

QU:Language has been one of the major barriers that prevent scholars from engaging their works in a global context.In this book,you have employed and translated primary sources written in more than ten languages,including Chinese,French,German,Japanese,Korean,Indonesian,Italian,Portuguese,Spanish,Swahili,and Swedish.As a result,you are able to engage with literature from a very wide range of communities,cultures,and periods,ranging across Asia,Africa,the Americas,Europe,the Middle East,and Oceania.How did you select these sources as you started researching for this book?

Thornber:Global Healingbegan as a study of world literature and health,with an emphasis on how literature that engages with diseases and other adverse health conditions has been translated and circulated,particularly along under-recognized modern and contemporary cultural pathways within and among diverse regions of Asia and among the regions of the Indian Ocean Rim (East Asia,Southeast Asia,South Asia,the Middle East,Africa).I also planned to address the continuing biases of the field of world literature.But it quickly became clear that confining my focus to world literature meant that I was silencing any number of narratives that highlight the significant hurdles confronting those who themselves or whose loved ones have been diagnosed with or have (had) visible signs of an adverse health condition,hurdles that frequently exacerbate suffering,impede healing,and render wellbeing nearly impossible to attain.

The more I read,and I read very broadly,the more patterns and connections became visible,and the more it became clear how each story fit into a broader global context,despite local and regional circumstances often being quite distinct.

QU:Did you learn any new languages just to be able to read certain key texts?

Thornber:Yes.I took several years of Hindi/Urdu and studied elementary Swahili and Indonesian to be able to access key texts.

QU:Apart from written sources,you also cited and analyzed a number of films.Do you “read” them in the same way as texts?

Thornber:In some ways,yes,in that for the purposes ofGlobal HealingI was most concerned with how the films engaged with the issues that literature brought to light.But it goes without saying that films are very different from literature,and film specialists would likely interpret the films I discuss in different ways.They’d also analyze a much broader corpus of films.

QU:What role do films play in your research for this book?

Thornber:The book was already so long that I didn’t have the space I would have liked to give to film.Films play a mostly supportive role inGlobal Healing,casting light on the issues that literature raises.Perhaps someday there will be a companion book toGlobal Healingon the role of film in exposing the deeply penetrating damage caused by current practices and the pressing need to transform how we all prepare for and respond to crises in health.

QU:The next question I have is about interdisciplinarity.Even though comparative/world/global literature and medical/health humanities are at the heart of your discussion,Global Healingalso draws on scholarship from a wide range of fields,including anthropology,sociology,history,history of medicine,history of science,etc.In writing this book,what kind of research strategies did you employ to go beyond disciplinary or methodological boundaries?

Thornber:I began with the creative texts,but then just as you say,engaged with these creative texts in the context of insights from multiple fields.At first,I didn’t consciously set about trying to include so many fields,but in striving to learn as much as I could about different writers,their settings,the diseases they discussed,and similar phenomena,I found myself reading a tremendous range of sources.I grew up in a family of scientists,and my parents are both Caltech Ph.D.’s in theoretical physics,so I’ve always been surrounded by a diverse array of publications and aware of the absolute need,in attempting to understand broad issues,to go far beyond one’s own specialty.

QU:While there are a number of distinguished scholars of medical humanities at Harvard,such as David Jones,Arthur Kleinman,and Allan M.Brandt,there is yet to be an institute or department for this particular field of research here.However,various fields of medical humanities are growing rapidly in Chinese academia.Peking University’s Institute for Medical Humanities (北京大學醫(yī)學人文研究院) was established in 2008 and is now known as the School of Health Humanities (北京大學醫(yī)學人文學院); Peking University Press has also been publishing the journalChinese Medical Humanities Review(中國醫(yī)學人文評論) since 2007.On the institutional level,what kind of support and resources should be available to encourage scholars of medical humanities to engage in interdisciplinary and comparative studies?

Thornber:Increasingly,institutions in many countries are developing programs in the medical humanities and the health humanities.I list some of these inGlobal Healing.But even without such support and resources at their own institutions,scholars can take advantage of the programming at other institutions,much of which can now be accessed online.At Harvard,even though we don’t have a department or institute devoted to the medical humanities or health humanities,we have working groups,seminar series,and similar endeavors that involve Harvard faculty members in collaboration with faculty members from other institutions,so there are many opportunities for students and faculty members interested in these fields.

QU:There are an increasing number of graduate students and junior scholars who are planning to enter the fields of environmental,medical,and health humanities,especially after this global crisis.What advice would you give them,as a leading scholar in these fields? Lastly,would you please recommend some scholarly books or articles of medical humanities that would help us better understand this COVID-19 pandemic?

Thornber:The environmental,medical,and health humanities have all expanded greatly in recent years,but there is much work to be done,and many opportunities for graduate students and junior scholars to help develop these burgeoning fields.I’d encourage graduate students and junior scholars (and senior scholars) with interests in these issues to pursue research in one or more of these fields,even as a secondary specialty.If you’re a graduate student and there’s no one at your university working on these topics,then seek out a faculty mentor at another institution.If you’re a junior scholar,then in many cases you’re going to want to see your current project through,so that you get your research published in time for tenure,but you can also start reading in these fields and make a topic in these fields the focus of your second project.(This in fact is exactly how I entered the environmental humanities even as I was finishing up my first book on imperialism).Regarding readings,there are many articles being published now about the coronavirus from a medical/health humanities perspective.Books,too,are beginning to be published,as are their translations—one that comes immediately to mind is Italian Paolo Giordano’sHow Contagion Works:Science,Awareness,and Community in Times of Global Crisis.