On Cadavers, Misanthropy, and Cultivating Humanism in Medicine

During my first year of medical school during a student involvement fair, I saw a table sign for a student organization called “Humanism in Medicine.” This sounded great, evoking images of clinicians who deeply care about their patients, have good bedside manner, and take matters of life and death seriously. Thinking about it, I wondered about what they really mean by humanism. Is this something they had considered? Which humanism are they referring to? There are after all, varieties of humanism including but not limited to existential, Christian, Islamic, secular, Confucian, or Africana lines of thought on this.

Although answering the question “what is humanism in medicine?” could be done by articulating what a specific humanism might have to say about this, we could answer this question by looking at how we actually practice humanism in medicine. In this reflection, I draw from the Africana existentialist thinking that carefully considers dehumanization and misanthropy itself (in the context of antiblack racism especially) as a useful starting point from which what it means to be human can be understood, and how we might resist this misanthropy.

While in medical school, the Martiniquan revolutionary, philosopher, and psychiatrist Frantz Fanon wrote in Black Skin White Masks (1986) that he found himself nauseated during his cadaveric dissections. Asking for advice to deal with this problem, Fanon (2007) was told by an instructor:

In our early days as a medical student, after several nauseating sessions of dissection, we asked an old hand how we could avoid the malaise. He replied quite simply: “My dear fellow, pretend you’re dissecting a cat and everything will be OK."

The philosopher Lewis Gordon, a leading philosopher on Fanon’s thought and biography, uses this anecdote to put into context the degree to which Fanon loved humanity - it was such that Fanon was unwilling to separate the cadaver from the person. This was not Fanon’s first experience with the dead – Lewis Gordon (2015) says:

To show how his humanism comes in, it’s very important to understand this. When Fanon was a youth, he witnessed the autopsy of a woman who died in a car accident, and it so disgusted him that he realized he was a humanist. Why? Because Fanon could not separate the human from the cadaver.

Before my class had its first cadaver dissection session in the anatomy laboratory, our instructor spent time going over guidelines and rules with our cadavers, such as being respectful towards our cadavers, being clear that especially egregious behavior could be met with serious disciplinary action from the medical school. In our school’s auditorium, a “donor ceremony” for the cadavers was held, where students are asked to honor their cadavers, be mindful of the humanity of our cadavers, and consider the immense weight of choosing to donate one’s body to medical education. These cadavers were even called our “first patients.” In hindsight, being made to consider the humanity of the cadavers we were working was the opposite of being asked to pretend we were dissecting cats.

In an existentialist and psychoanalytic text concerning the effects of antiblack racism and imperialism on our minds, relationships, culture, and our very humanity, why does Fanon bring up this memory from his medical education? The passage from which “My friend, pretend you’re dissecting a cat” is drawn concerns the role our consciousness plays in delineating the reality we perceive. Fanon then makes a case for racist psychosexual beliefs and fantasies (specifically between white men and women and black men) being founded in irrational (contrary to evidence), yet conscious choices. One can consider Fanon’s use of this anecdote from his medical education is to remind us that to “pretend it’s a cat” is a choice we make.

Through a Donor Memorial Ceremony and setting strict rules of conduct for students in the anatomy lab, we design our medical education at this stage to resist the misanthropic tendency to pretend we are working on cats. The significance of this exercise in resisting misanthropy becomes more important further along medical training and practice. If one can find humanity in a cadaver, one will also find it in their unconscious, sedated patient on the operating room table or ICU bed, and perhaps one will also strive to find it in their screaming and biting patient in a manic-psychotic episode. 

In exercising these acts of resisting misanthropy, one will be especially prepared to do so when misanthropies in the forms of racism, sexism, homophobia, transphobia, ableism, or classism present in our conscious and living patients. I chose and repeat the word “exercise” or “exercising” carefully, because I do think that this is something that one learns to do, that it takes repetition and is crucially, therefore, a skill that can be taught.

In this reflection I have highlighted just one way in which we intentionally cultivate humanism in new healers. There are a few other ways we do this – consider how teaching motivational interviewing encourages student physicians to explore their patients’ own self-knowledge and ambivalence to empower them to change their health behavior. The act of collaboratively exploring ambivalence is an ethically profound one, as it requires believing that there is a subjectivity to explore – resisting objectification. Another example is the choice to teach the practice of trauma-informed care, encouraging student physicians to consider their patients’ subjectivities in the context of preventing psychological harm. This is especially profound when one considers that this is often in response to harm done to our patients by the misanthropic phenomena mentioned in the previous paragraph.

Although a medical degree typically takes about four years to complete, these seemingly small acts of cultivating humanism may yield far more than one may think. Consider this remark from Confucius:

[7:8] The Master said: “If a student is not eager, I won't teach him; if he is not struggling with the truth, I won't reveal it to him. If I lift up one corner and he can't come back with the other three, I won't do it again.” (Analects, 7.8; Legge 1960)

I bring up this passage because I want to draw a connection between the way we cultivate humanism in ourselves and a thought tradition deeply interested in this – Confucianism, with its emphasis on morals and virtue as teachable, is something I am regularly reminded of when thinking about how we try to be and mold more humanistic physicians.

This quotation has a couple upshots: First, that in the context of trying to cultivate morally upstanding people, there is nothing even a great sage can do to develop someone who is simply not interested in being moral. This means that cadaver donation ceremonies or discussions on trauma-informed care will likely fail to transform someone who has made deeply misanthropic commitments, or perhaps has become uninterested for reasons such as burnout. 

Second, the notion of showing just one corner and not all four as not only merely sufficient but optimal for cultivating humanism is significant. It brings to mind that it might be for the best that people figure out most of the matter for themselves after some initial guidance. Additionally, consider that there will always be at least two corners in a room such as in the case of a triangular room. Insofar as there are always numerous corners to find, repetition of this exercise is implicit in how this moral growth happens.

It is impossible to prepare student physicians for every possible way misanthropy might present itself in medicine. Unlike a typical four-cornered room, a room representing misanthropy in medicine likely has dozens. We and our patients exist in deeply complex social environments where matters like gender, race, ethnicity, class, culture, religion, caste, and sexual orientation create countless ways in which one can be human. Perhaps this is why there is great importance in these seemingly small acts of cultivating humanism - guiding students to just a few well-placed corners prepares them for lifelong journeys to find the rest. Resisting the urge to “pretend it’s a cat” was one such corner.

Notes:

Fanon, F. (2007). Black Skin, White Masks. United Kingdom: Grove Press, p. 145.

Gordon, L. (2015, June). Lewis Gordon presents "What Fanon Said." https://www.youtube.com/watch?v=UABksVE5BTQ&t=2206s

Legge, J., & Ride, L. (1960). Confucian analects, the great learning, and the doctrine of the mean. In The Chinese Classics, 1960a, Volume 1, 164. Hong Kong University Press. Section 7 述而 - Shu Er, Verse 8.