Cool intimacies of care for contemporary clinical practice

Abstract

The practices of medicine across history and culture illuminate the centrality of the physical intimacy of touch in the expression of the healer's care. Yet much of modern western medicine diminishes the value of intimacy in the expertise of the clinician, and marginalises emotionally inflected practices into categories of care that are separate from the expertise of the clinician. Can such a divide between the objectifying clinical gaze and the intimacy of emotional care be made without losing something vital to the therapeutic processes of healing? To reinvigorate debate about the place of intimacy for contemporary clinical practice, we look back to medieval literature, which illuminates two traditions in understanding intimacy and its inter connections with healing. One of these traditions has become dominant in modern health care; we call for a re-engagement with the second in contemporary clinical practice.The physical intimacy of touch held special power in the medieval period, and perhaps this is unsurprising since at this time medicine was limited almost exclusively to palliative care. In the medieval world, not only were cures rare but also illness itself was perceived as deeply mysterious, often attributed to supernatural causes. Medical texts mainly comprise treatises rooted in classical humoral theory, compendia of ailments and treatments, and collections of remedies. It is literature, and especially Romance literature-the imaginative fiction of the Middle Ages-that offers insights into cultural attitudes and ideas.Medieval writing reflects the hope for divine intervention or medical marvel in its repeated images of healers possessed of holy or magical powers. Touch is the instrument in all these cases, reflecting both its importance in palliative care and its prominent role in the healing miracles of Judaeo-Christian tradition. Expressions of the intimacies of the healing touch are, however, subtly differentiated. The connection between touch and the intimacy of personal attachment is repeatedly emphasised in medieval Romance, where women tend and heal the wounds of their beloved knights. Sir Thomas Malory in his Le Morte Darthur (1485) emphasises the conjunction of medical knowledge and romantic love in describing how Sir Tristram's wounds are healed by his lady, La Beale Isode, who is "a noble surgeon". By contrast, Malory depicts the healing of the poisoned wounds of Sir Urry as effected not through the personal attachment of the healer, but through a more abstract intimacy between the healer as instrument of the divine and the human sufferer. Of all King Arthur's knights, only "the beste knyght of the worlde" Sir Launcelot succeeds, and the miracle of healing reflects his spiritual perfection. This spiritual perfection comprises an intimate connection to the divine and an abstract love for his fellow knight, and is manifest emotionally through his virtue and humility. The degree of personal involvement with the * S.J.Atkinson@durham.ac.uk.

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