Medical Detachment: Past and Present
By Charlotte Dewarumez (Université de Toulouse)
Medical detachment is a central concern in medical practice. On the one hand, we expect medical practitioners to show empathy toward us; on the other, we demand sufficient emotional detachment for them to treat us effectively. How can these two expectations be reconciled? Where does the notion of medical detachment come from and why has it, in some contexts, come to prevail over the idea of care? This workshop, supported by the Medical Humanities Hub, brought together scholars from multiple disciplines to explore these questions.
The first panel, “A History of Medical Detachment”, highlighted that, although this concept was not explicitly articulated in the nineteenth century, the idea that physicians should see their relationship to bodies and patients through a rational lens coincided with the emergence of clinical medicine, the institutionalisation of medical education, and the rise of the notion of scientific objectivity during this period.
Eleanor Kerfoot (Faculty of History, Oxford) focused her presentation on the shift from a spiritual understanding of the living body in the early modern period to a biological approach that emerged from the nineteenth century onward. In the former framework, the body was understood as animated by a soul that departed at the end of life, whereas the latter sought to explain life, death, and disease through increasingly rational and scientific terms. From this perspective, contemporary critiques of medical detachment may reflect that, while medicine addresses patients’ physical needs effectively, their spiritual needs are no longer adequately cared for.
Martin Robert (Institut Catholique de Paris) examined the evolution of medical education and the evolving place of dissection within it – from a punitive practice targeting criminals and “inferior bodies” (including the poor, disabled people, psychiatric patients, prostitutes, etc.) to a contemporary system in which individuals voluntarily leave their bodies to science. This epistemic shift suggests a reconfiguration of medical detachment: whereas, in the nineteenth century, a lack of empathy could be justified by the fact that physicians neither respected nor identified with the cadavers they worked on, contemporary practitioners may instead find reassurance in the donor’s consent. Therefore, he highlighted the ambiguous status of cadavers, which, despite being dead, continue to be understood in relation to the identities of the individuals they once were.
Finally, I (Charlotte Dewarumez, Université de Toulouse) explored the ways in which nineteenth-century anatomical illustration consistently relied on visual conventions that appear to create a distance between the viewer and the dead body. However, this tendency to avoid causing discomfort is difficult to reconcile with the expectation that medical doctors remain at ease when confronted with cadavers. This tension led me to emphasise the complexity of medical detachment and its potential conflicts with other cultural paradigms and cognitive processes.
The second panel, “Negotiating Empathy and Distance in Contemporary Medicine”, explored the complexity of medical detachment for contemporary medical students and practitioners. Paquita de Zulueta (Imperial College London) argued that both the healthcare system and medical education, in different ways, tend to suppress empathy in doctors. Indeed, the healthcare system prioritises efficiency and productivity, while also undergoing increasing bureaucratisation. Medical education, in turn, may expose students to toxic or unethical behaviours that become normalised. In both cases, these highly hierarchical and high-pressure environments leave little space for feelings and care.
Felicity James (Stoneygate Centre for Empathic Healthcare, Leicester) and Jim Harris (Ashmolean Museum) both presented programmes they are currently running in their respective institutions that use literature and works of art to foster discussions among medical students. They highlighted how engaging with objects that carry an emotional dimension can facilitate discussion and encourage students to reflect on how they might approach emotionally charged situations in their future careers.
The two panels, despite addressing very different contexts, revealed numerous points of connection. The presentations, together with the discussions that emerged during the Q&A, helped us better understand the multifaceted nature of medical detachment. It appears to be both a value (an expectation of how doctors should behave and feel) and a cognitive process (an emotional distance shaped by repeated encounters with death and suffering). It was emphasised that these forms of detachment are learned and culturally situated.
Similarly, empathy can be learned and actively cultivated – not only towards patients and families, but also in relation to colleagues. Discussions seemed to point to a need to replace emotional detachment with emotional regulation: namely, the development of skills that enable students and practitioners to engage with suffering without becoming overwhelmed by distress. In fact, many aspects of medicine are profoundly challenging: not only exposure to death and pain, but also the fear of making mistakes, feelings of powerlessness, encounters with angry patients and family members, and the demands of long working hours. It is therefore essential to foster environments that protect both doctors and patients.
In this sense, scientific approaches to the body and objectification are not necessarily negative processes, nor are they synonymous with dehumanisation. The challenge, however, is that care requires time, and that fostering greater empathy in healthcare may require a reconfiguration of the priorities that currently shape healthcare institutions.
