August 4, 2020

Curatorial thinking about health histories: an educational framework

Dr. Madeleine Mant

Abstract

Health histories are complex intertwinings of bodies, moments, institutions, biology, and culture. They demand interdisciplinary thinking and challenge both educators and students to consider multiple entry points to understanding the past. In this piece I trace my personal journey to thinking curatorially and emphasize the multitude of ways a single artifact/photograph/event might inspire curatorial thinking. Curatorial thinking methodology empowers learners to consider the process over the product, encouraging critical examination of research materials and a consideration of the learner’s place in time and space. Six steps are proposed to help students think curatorially about questions of historical health: (1) Frame the topic under study through a public health lens; (2) Identify areas of overlap; (3) Create a taxonomy of questions to identify a contextual empathy for the time period; (4) Encourage engagement with Selection/Sifting methodology; (5) Determine the ideal means to display/share the learning products; (6) Celebrate learning by sharing students’ work. Curatorial thinking helps students view historical events and artifacts as the result of social, cultural, biological, economic, political, and interpersonal processes. 

Dr. Madeleine Mant is a Research Associate in the Anthropology of Health at the University of Toronto Mississauga. She was previously a Banting SSHRC Postdoctoral Fellow at Memorial University of Newfoundland. Her work incorporates bioarchaeological, medical historical, and medical anthropological research methodologies to investigate health experiences through time.

My journey to thinking and teaching curatorially started during my undergraduate summers, as a historical interpreter at Fort Edmonton Park, a living history museum in Edmonton, Alberta, representing moments in the city’s history from the 18th-century fur trade through to the 1920s. Each morning the staff arrived to change into our ‘uniforms’: historically accurate clothing created with care by costumers using historical patterns and temporally appropriate materials. Collars were starched, petticoats were donned, and hair was pinned into place as we shed our contemporary trappings to evoke and represent past lives. 

As an interpreter, I navigated between first-person, third-person, and flexible interpretation styles depending upon visitor engagement and comfort. Some visitors embraced the concept of stepping into the past and asked earnest questions about, for instance, the year’s harvest, tea etiquette, dance techniques, and how long it would take me to get dressed each day. First-person interpretation, staying entirely in character, allows for an invigorating improvisational experience. We all know what year it really is, but how refreshing to volley “well, it is 1885” and have a foyer full of visitors wearing shorts, sandals, and snapping cell phone pictures nod in acceptance. Other historical tourists engage best with the comfort of temporal detachment. Third-person interpretation supports their learning; an interpreter is still a guide to unlocking the past if they use modern pop culture references. Flexible interpretation, in practice, was my preferred mode of delivery, in which each encounter started in first-person character, but could flow seamlessly in and out, allowing for contextualized discussions that empowered the visitor to organize their understanding of the past. History is for everyone, and it was my task to help each visitor find their own way in. These experiences laid the foundations for my current teaching: different students have different learning needs. Their desire to take risks and engage with course material can change from moment to moment – flexibility and fluidity in teaching reward both the student and the instructor. 

Historical interpretation gets dirt under your nails and infuses your hair with the smell of smoke. For three summer seasons I embodied Edmontonians living in the year 1885 and spent one season as a nurse recently returned from her service overseas during the Great War. I gained skills refracted through time: building campfires lit with a flint and steel, cleaning and caring for a cast iron stove, and maintaining strong opinions about the 1888 Northwest Territories election. I first drove standard on a 1928 Ford Model A Roadster pickup truck and unironically shout “huzzah!” when feeling celebratory – history infiltrated my quotidian existence. Through exploring the past with thousands of visitors each year, I learned that the process was generally more valuable than the product. Ultimately, it mattered little if the loaf of bread baking in a campfire Dutch oven browned evenly, it was the meaningful discussions had with visitors around that campfire that were of value. This was my first lesson in curatorial thinking – carefully selecting which activities and artifacts best opened enthusiastic dialogues. 

Topics of health and medicine are ideal conversation starters – everyone has a body, and every body has a story. Interpreting in the doctor’s office on 1885 Street was a constant delight, where rows of gleaming surgical instruments yielded fruitful conversations and some dramatic reactions (“that went where?!”). My shortly cropped hair was often a topic of interest and if asked about it (while I was ‘living’ in 1885) I explained that I had recovered from scarlet fever last winter, but that my long hair had been cut off as a potential treatment. These associations – known with unknown – were my second lesson in curatorial thinking. Meaning-making using touchstones and frameworks already in a visitor’s possession establishes a sense of immediacy: the past persists into the present.

Conversations about health inspired personal reflection on my own interactions with biomedicine: how much worse would my childhood bouts of bronchitis and tonsillitis have been without the prescription of antibiotics? Could I develop osteomalacia (adult-onset rickets) if I were to wear my historically accurate clothing (covering all skin except my face) every day? How different might my life be (both in terms of childbearing and acne) if I did not have access to hormonal birth control? I was, at the time, considering these questions in a historical context, that is, what if I had been born a century earlier – how might my context have affected my body? But these were, of course, not only historical questions – they were equally personal, sociocultural, and deeply political, demanding contextual questioning. The answers could be incredibly different if I had not been born in the 20th century, absolutely, but more importantly if I had not also been born a cis-gendered heterosexual white woman, with the associated privileges therein. My third lesson: thinking contextually about one’s own position in time and space is a critical foundation to teaching others.

I have since trained as an anthropologist of health – working within and across the fields of bioarchaeology (the study of human remains from archaeological and historical contexts), medical history, and medical anthropology to examine microhistorical moments of people and their health through time. Excavating and studying human skeletal remains for signs of trauma and infectious disease makes it possible to ‘read’ the bones like texts, uncovering stories about health and wellness that literally get under the skin. Osteobiography, or the story of a person’s life as revealed through their skeleton, is a powerful tool for understanding individual lives. In other contexts, a past person’s life might be accessed best in the historical record by entries in hospital admission registers, prison or poorhouse intake papers, or a surgeon’s notes – these kaleidoscopic intertwinings of bodies, moments, health, and institutions drive my research program. I want to know: how did this person experience health or sickness? What were the effects of varied stressors (both biological and sociocultural) on the body? How did this individual get here – on a line in a hospital register or admittance certificate for a workhouse, in an anonymous grave in a cemetery. What happened during this person’s life (and perhaps after it) to bring them here?

All these questions demand context. Both intersectionality and syndemics can help us to access and understand the health experiences of past and present individuals. Intersectionality, a term coined by Kimberlé Crenshaw, is a theory drawing upon the work of Black feminist and law scholars outlining how the overlapping and interacting aspects of a person’s identity (i.e., their sex, gender, race/ethnicity, age, sexuality, ability or disability, etc.) create and preserve societal inequalities. An intersectional approach to health demands a comprehensive investigation of a person’s unique context, particularly when considering those who are marginalized within a given society. Syndemics, as coined by medical anthropologist Merrill Singer, emphasizes that in questions of health we consider not only the biological synergistic interactions of disease processes within a person’s body, but also how these diseases are influenced by the socioeconomic and sociocultural context: a person’s experience of stress, poverty, access to health care (both economic and geographical), etc. Everything is connected. People experience the world in vastly different ways depending upon how they view themselves and how they are viewed by the world. These frameworks can contribute meaningfully to curatorial thinking – the more forms of evidence considered, the more aspects of an individual’s experience in the world can be illuminated.

Researching and teaching about historical diseases, both acute and chronic, demands a broad curatorial means of thinking. Like a museum curator selecting items for public display and crafting didactic labels, teaching involves careful curation to ensure themes and context are clear. The lessons in curatorial thinking I have gleaned through my experience provide a framework for reflection before engagement with students is undertaken: (1) select which activities/topics are most likely to spark interest and creativity; (2) determine which entry points will encourage meaning-making for students; and (3) review and acknowledge one’s own position in time and space.

But how then do we do curatorial thinking about historical health, particularly in a synchronous online learning environment? The following framework proposes a way in:

  • Frame the topic under study through a public health lens. Syndemic thinking asks us to consider the sociocultural circumstances that affect (and potentially exacerbate) health concerns. Ask: how did this medical condition or disease affect the public through time? How did individuals’ identity affect their ability to seek quality medical care through time? What is different and what is the same today? Consider the World Health Organization’s definition of health – “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” – and how it might relate to the chosen topic. 
  • Identify areas of overlap. Using visual methods such as a Venn Diagram, list and investigate the intersections between the various areas of study that could contribute to an understanding of the health issue (e.g., social studies, media studies, math, biology). Challenge siloed thinking by acknowledging the inherent interdisciplinary nature of questions concerning health.
  • Create a taxonomy of questions to identify a contextual empathy for the time period. Students can challenge their temporal detachment by critically examining what their own lives might have been like (and how this might have affected their health) if they were born in a different time or place. A taxonomy of sociocultural questions concerning historical health, drawing upon intersectional and syndemic thinking could include:
    • Politics and Law (Social Studies)
      • Who was Prime Minister at the time? Who was in the cabinet? Who oversaw matters of health? 
      • What was the role of the local government regarding matters of health?
      • What rights were protected by law at the time?
    • Individual Opportunities (Health, History, Language Arts)
      • How might political, occupational, educational, etc. opportunities be affected by a person’s sex, gender, immigrant status, race/ethnicity, sexual orientation, etc. at the time under study?
      • What was the role of cultural or language barriers in accessing healthcare? 
      • How many hospitals existed? Who did these hospitals admit
    • Biology and Biomedicine (Biology, Chemistry)
      • What was the contemporary understanding of the human body? (i.e., where are we in time relative to humoural or germ theory, etc.)
      • Is this a retroactive diagnosis? What might we call this illness/disease/condition today? Has it changed? What do we know now?
  • Encourage engagement with selection/sifting methodology. Collaborate with students to identify the specific artifacts/primary source material/images/activities that best illustrate the topic under study. This step will take time – there is a wealth of material available. Ask the students why they chose these items, why they think these items might have already been selected in the past (that is, why have they survived?). (Selecting and Archiving).*
  • Determine the ideal means to display/share the learning products. Students may create a display, digital timeline, didactic labels for an online exhibition, etc. Empower the student to follow their instincts regarding what interests them and sparks their curiosity to contextualize. (Sense-Making).
  • Celebrate learning by sharing students’ work. Synchronous online learning allows for ready engagement with photographs and archival objects – each student will have access to their classmate’s selections and indeed, might share certain objects in their own work, emphasizing the interconnections. Ask them to outline their thinking process and to identify the multitude of factors involved in shaping an object/photograph/moment (Sharing).

Curatorial thinking champions multiple entry-points because each selected item can be viewed from a multitude of angles. A photograph of nurses serving on the Western Front in 1918 might be an entry-point for discussions of germ theory, uniforms (and contemporary fashion), military technology, and the changing social roles of women. An insulin bottle from the mid-1920s represents an intersection of biomedical technology, ethics of animal testing, patent law, Canadian history, social roles of scientists, and celebrity. One object, newspaper article, or photograph, viewed as a concatenation of social, historic, economic, political, and biological processes encourages students to see the interplaying forces that created the object/moment/idea. 

Thinking curatorially about questions of health challenges the learner to think about context, themes, and interdisciplinary sources of information. While fantastic projects will undoubtedly arise from engaging with this framework, encouraging students to do the work of curatorial thinking is the main goal. I have been privileged to learn about and interpret the past in epistemological and phenomenological ways – dressing in historical costume, excavating archaeological sites, and digging into health histories in archives have all impacted my teaching style and approach to historical questions. Encouraging students to view historical events and artifacts as the result of social, cultural, biological, economic, political, and interpersonal processes involves curatorial thinking. Making connections with existing understandings of the past, and helping students think through their own position in the world (and their own bodies) will create powerful connections and foster lifelong learning. As an educator, I think these possibilities certainly deserve a “huzzah!”

*Based on the Selection / Archiving / Sense-making / Sharing framework developed by Garfield and Laura Gini-Newman