Mitigating the Madness of King Us

PWC: The following article appeared on the web site “The Conversation”, https://theconversation.com, sometime this past week, along with an invitation to republish. Since the general thrust of what is said there reflects what I have been trying to say, I am doing that.

I first took part in a multidisciplinary academic project in 1971 and have, to the extent possible, been practising the approach in my own research and management ever since. Multidisciplinary or interdisciplinary is certainly better than monodisciplinary in dealing with broad humane issues, although I believe transdisciplinary or holodisciplinary to be an even higher ideal, and what senior managers of all kinds struggle to be when they are trying to act humanely. Each academic discipline has its own particular lens, ground so as to illuminate the questions that discipline likes to ask. The task of humane senior management, in all fields, is to find a lens for its questions, which are often broad and complex. Too often, in my experience, when they try to put everything together, they end up flying by the seat of their pants, without any help from the disciplines who are, in fact, often critical of their decisions, sometimes aggressively so, on the grounds that they have given insufficient weight to one disciplinary perspective or another. It is easy to state general principles on how such weighting ought to be done. They are the commonplaces of decision theory and the philosophical principles behind it. Plugging the numbers into the formulas and dealing with the stochasticities surrounding them is another matter altogether.

When I advocate for “Fourfold Vision”, I mean a way of thinking, a cast of mind, that includes and transcends particular academic disciplines to create a holism greater than the sum of their parts. Whether that can be done in any except general terms remains to be seen.

The University of Toronto’s project, described here, is commendable. Any comments I might make, interleaved in italics below and marked “PWC”, are intended to build on what the authors have said and not to detract from their ideas in any way. They and their project are on the right track, in my opinion. I would simply like them to go beyond interdisciplinary into that even higher intellectual, perceptual, and practical realm where Fourfold Vision prevails.

My comments will evolve gradually in the days ahead.

Here is the article in question:

‘How to live in a pandemic’ is the type of university class we need during COVID-19

PWC: Why only in university class? It is what we all need. The Madness of King Us, in this context, is the strident chorus of particular perspectives all trying to tell us what to do. The most common theme, in my limited viewing range, says that we should all be “kept safe”, meaning we should not catch the current virus. Whether the things we must do to achieve that in some global way do in fact “keep us safe”, or even “keep our children safe” (the idea behind much immediately current discourse) is another matter. “Safe” is one of those easy four-letter words that is a lot more complicated than appears on the surface.

Health is a complex issue that requires an interdisciplinary approach to study and teach. (Shutterstock)

Andrea Charise, University of Toronto; Ghazal Fazli, University of Toronto; Jessica Fields, University of Toronto; Laura Bisaillon, University of Toronto, and Nicholas D. Spence, University of Toronto PWC: These are the authors of this article. I salute them, and will try to contact them directly.

Currently, we are all bombarded with headlines on the latest research related to COVID-19. The COVID-19 pandemic has demonstrated that health is a deeply interdisciplinary issue, demanding expert responses from a cross-section of fields: the arts, public health, social work and K-12 education among them.

As an interdisciplinary collective of academics trained in a range of fields from the arts to social science to clinical sciences, we have witnessed first-hand a crucial problem in how health is taught and communicated at the post-secondary level. What is often missed, but is critical to contextualizing scientific findings, are examinations of the assumptions and methods used to conduct health-related research.

This omission reflects a problem in Canadian colleges and universities, which generally deliver post-secondary curriculum using a single-discipline approach. A single-discipline approach to health education does not engage the full picture nor provides the groundwork for innovative, equitable solutions in the future.

PWC: Health is of course only one element in the complex of contemporary human needs and desires which I believe to usefully expressed by the following tetrad: Prosperity + Health + Security + Contentment. These authors are dealing with the complexities of diverse perspectives about health. Each of the other elements in the tetrad present the same order of complexity, and can be approached in a multi-disciplinary way with equal validity. The larger human problem is to put all the elements together, with all their complexities, in order to decide how to live, and how best to conduct public affairs.

Multidisciplinary approaches

At the post-secondary level, for example, a microbiology course might focus on lab-based methods used to diagnose whether someone has developed antibodies to a disease like COVID-19, while a typical public health course might focus on the mechanics of contact tracing.

Deeper understandings of health require a co-operative investigation of the various frameworks, techniques and assumptions that guide research practices and how they are communicated.

Universities must fundamentally change their approach to teaching health-related knowledge. It is time to commit to what we call “radical interdisciplinarity”: a sustained inquiry into interactions between biography, arts, culture, history and societal organization that contributes to debates about political, social and economic determinants of health.

Complex issues, complex research

From local to global health issues, traditional, single-discipline approaches are inadequate training for our future carers and health workers. Along with the specialized, deep knowledge that characterizes most undergraduate education, we need to train students studying health issues to respond to the interdisciplinarity of health itself.

The ongoing coronavirus pandemic can be used to illustrate this radically interdisciplinary approach; such an approach informs a new team-taught course, “How to live in a pandemic,” being offered at the University of Toronto Scarborough’s department of health and society.

Quantitative approaches, which focus on numeric data, are suited for research focused on the development of treatments using experimental designs, particularly randomized controlled trials. Projecting the number of infections and deaths resulting from the virus is done by statistical models of infectious disease, using secondary data.

Qualitative approaches, by contrast, are best suited for examining the experience of, for example, racialized women working as front-line service providers. In this case, one-on-one in-depth interviews capture the meanings and interpretations of their circumstances, particularly in light of the impact of systemic racism on health.

Beyond qualitative and quantitative approaches, arts-based health research methods are gaining traction. Creative arts — including music, theatre, writing and visual arts — have been increasingly integrated into more conventional forms of health research and education.

Canada’s first undergraduate program in health humanities was launched in 2017 at the University of Toronto Scarborough. Integrating these insights with arts-based methods can further illustrate the diverse expression of these issues in the creative lives of everyday people.

Social distancing and health inequity

One of the challenges of the current pandemic is addressing how COVID-19 is experienced differently by individuals and communities. Lessons from previous epidemics show that we are not created equal in terms of exposure to and consequences of disease: racialized, poor and sexual minorities are examples of communities that have suffered disproportionately.

It is crucial to disentangle the social, environmental and economic influences of the COVID-19 pandemic across different age, gender and class lines. For example, during the COVID-19 pandemic, social distancing, self-isolation and other practices aimed at controlling viral transmission may have a particular impact on the mental health of lesbian, gay, bisexual, transgender, queer, two-spirit and intersex (LGBTQTSI+) people.

Members of LGBTQTSI+ communities are particularly vulnerable to the negative consequences of social isolation. These contribute substantially to higher reports of mental illnesses such as anxiety, depression, suicidal ideation and acts, self-harm and controlled substance dependence.

Sociological and public health research indicates LGBTQTSI+ people have less access to socioeconomic resources, employment opportunities, health care and other forms of social support that are available to their cisgender heterosexual peers.

Better understanding the impact of responses to COVID-19 on the mental health of LGBTQTSI+ people can help ensure that all members of our society — regardless of sexual and gender identity — receive culturally appropriate and inclusive care.

Living and learning in a pandemic

As university-based health researchers and educators, our approach to the study of COVID-19 differs from conventional health education approaches. We lead with the principle that it is valuable, and in fact ethical, to commit to radical interdisciplinarity inside and outside the classroom.

A basic understanding of the research methods generating the body of pandemic scientific knowledge is essential to critically appraise the evidence, by recognizing the methodological strengths and limitations of any specific disciplinary approach.

Universities must find ways to model the multi-sectorial, interdisciplinary solidarity required to face the escalating complexity of 21st-century global health. The COVID-19 pandemic gives us a moment in time to overhaul health education — and perhaps to teach us all how to better prepare to live in the midst of this and future pandemics.

Andrea Charise, Associate Professor, Department of Health & Society, University of Toronto; Ghazal Fazli, Lecturer, Interdisciplinary Centre for Health and Society, University of Toronto; Jessica Fields, Professor and Chair, Health and Society, University of Toronto; Laura Bisaillon, Assistant Professor, Interdisciplinary Centre for Health and Society and the Social Justice Education Department, University of Toronto, and Nicholas D. Spence, Assistant Professor, Sociology and Health and Society, University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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