Entangled traditions: Philosophical and cultural foundations of the health humanities in France and the USA

Abstract

This special issue of History of the Human Sciences offers a comparative exploration of the medical or health humanities in France and the United States, highlighting both convergences and divergences in their intellectual trajectories. While French thinkers such as Michel Foucault, Georges Canguilhem, and Paul Ricoeur are widely cited in Anglophone scholarship, the distinctively French traditions within the field remain underexplored. Conversely, the Anglo-American medical humanities gained visibility in France only in the late 2010s. This volume traces the evolution of the field in both contexts, emphasising the French focus on norms, vitality, and the negative, and the Anglo-American emphasis on hidden values, cultural determinants of health, the biopsychosocial model, and narrative. A shared commitment to the concept of care emerges as a key point of convergence. The issue includes contributions on the philosophical foundations of care (Lefève and ffrench), the linguistic and conceptual challenges of translating ‘care’ across traditions (ffrench), and the phenomenological and affective dimensions of caregiving (Pachoud and Schwering). It also features empirical and collaborative research on care practices (Aujoulat and Ricadat), a philosophical analysis of recognition and agency in clinical encounters (Rashed), and a critical gerontological perspective on narrative and ageing (Zimmermann). The final article (Vickers) offers a genealogical account of the narrative-based medical humanities (1980–1995), arguing for its foundational role in shaping the field. Together, these articles aim to foster greater cross-cultural dialogue and methodological pluralism, offering a critical ontology of care that integrates existential, social, and biological dimensions of health and illness.

This special issue of History of the Human Sciences offers a comparative history of the medical or health humanities in France and the United States (US). Although French thinkers are widely and respectfully cited by medical humanities scholars in the English-speaking world – one need only think of Michel Foucault, Pierre Hadot, Emmanuel Lévinas, or Paul Ricoeur – the specifically French traditions within the field are less well known. And in a parallel development, the English-speaking medical humanities came to wide notice in France only in the second half of the 2010s.

For the first 40 years of its institutional existence – which we date to the early 1960s – the medical humanities were largely, if not exclusively, a product of the US university system. Its French counterpart took off only in the 1990s and often refers to the work of the physician philosopher, Georges Canguilhem. In his ‘Preface’ to the English-language translation of Canguilhem’s most celebrated book, The Normal and the Pathological, Michel Foucault drew attention to ‘a line separating a philosophy of experience, of sense and of subject’ from ‘a philosophy of knowledge, of rationality and of concept’ (Canguilhem, 1979[1966]: 8). The former was represented by Jean-Paul Sartre and Maurice Merleau-Ponty, figures who have loomed large in the American version of the field from the very beginning (see e.g. Zaner, 1964). The latter was championed by Jean Cavaillès, Gaston Bachelard, and Canguilhem himself, figures who, while not unknown in the English-speaking world, are harder to square with its philosophic traditions. In France, the historical epistemology developed by Canguilhem has played a considerable role in philosophy and the social sciences, particularly as applied to medicine and health. It is significant that Foucault placed his own contribution alongside that of Cavaillès, Bachelard, and Canguilhem (Canguilhem had been his doctoral supervisor) – a point to which we shall return. Canguilhem formally entered the English-speaking medical humanities in the early 1990s when the social anthropologists of medicine at Harvard began reading him and writing about him (see e.g. Good, 1994; Kleinman, 1994).

The field in both cultures is too diverse for us to be able to represent its full richness here. The French field has been ably surveyed by Céline Lefève, François Thoreau, and Alexis Zimmer (2020), Claire Jeantils (2023), and Anna M. Elsner and Steven Wilson (2024). Instead, we have chosen to focus on the broadest concepts and questions each one has sought to address, for it is through them that the pattern of overlap and difference emerges most clearly: in the French tradition, the notions of norms, vitality, and the negative are prominent; in the Anglo-American, the hidden values underpinning our notions of health, the role of culture in shaping patterns of health and disease, the biopsychosocial model of health and disease (Bolton and Gillett, 2019; Engel, 1977), and narrative and entanglement as hermeneutic devices for drawing out the significance of all of the above are the salient features. The growing point of convergence between these two versions of the medical humanities lies in their shared commitment to the notion of care. Several of the articles in this special issue explore the resources of each in their attempt to develop this commitment. We hope it will serve as a kind of ‘critical ontology’ of the present (Foucault, 2000: 319), one that illuminates the existential, subjective, social, and environmental dimensions of health and illness.

There are, of course, powerful dissimilarities running through the histories. The role of the campus ministries in giving rise to the American version of the field and the power and prestige of theology within it have no parallel in France. The establishment of bioethics as a distinctive academic discipline – arguably the first practical consequence of the medical humanities – took the philosophy of medicine largely out of the field. In France, the philosophy of medicine, with the exception of its analytical branch, remains the central discipline, and increasingly takes the form of ‘field philosophy’, engaging directly with people, communities, and real-world contexts outside traditional academic settings. The English-speaking version of the field has been, we believe, more methodologically liberal, more empirically-oriented, and less concerned with foundational concepts than its French counterpart. The two traditions construe Foucault’s work (and therefore that of a host of others, such as Judith Butler’s) in strikingly different ways. And because the English-speaking version has had longer to establish itself and in more favourable funding circumstances, it has been marked to a far greater extent by wider developments in its component disciplines. Psychoanalysis is still a major force in the French field and while it continues to inspire some contemporary English-language health humanities scholars, it does not project the same degree of institutional power in the English-speaking context. Neil Vickers, Céline Lefève, and Patrick ffrench begin with a tour d’horizon of the two traditions (Vickers, Lefève, and ffrench, 2025). They argue that the American version of the field has passed through three distinct versions:

A version promoted by the Institute on Human Values and Medicine (IHVM) (1968–1981). For this group, the medical humanities were fundamentally about the values surrounding health, which they took to be largely hidden. Philosophy was its core discipline. In this initial phase, the field essentially functioned as an incubator of interdisciplines. Bioethics served as a model interdiscipline, while others included literature and medicine, and phenomenological ethics. The IHVM version of the field was steeped in phenomenology and psychoanalysis.

A version (1980–1995) grounded largely, though not exclusively, in developments in systems biology and in social anthropology which attempted to map the relationship between health and culture. For this group, the values underpinning health were not understood because culture and its impact on health were not understood. Two developments in allied fields were crucial for this second phase: the re-founding, along Geertzian lines, of medical anthropology in the late 1970s and early 1980s; and the elaboration of the biopsychosocial model of health and illness by Engel (1977) and others. It was characterised by a transdisciplinary effort to understand health and illness in relation to culture, using narrative methods. Any humanities or social science discipline could contribute to this effort.

A version anticipated by anthropologists (especially Paul Farmer) now quite prominent as a tendency in literature disciplines. This version of the field has been shaped by ‘the rise of identity as a social force in the twentieth century’ (Wiegman, 2012: 2) and by tendencies in critical theory oriented toward activisms of various kinds. The field has thus begun to align itself with social movements and to respond to the demand for representation of minorities, and for social and epistemic justice. In the United Kingdom (UK), this version is expounded as the critical medical humanities.

The French health humanities have points of overlap with all three of these configurations, but most especially with the second and third. A central feature of the French scene is 20^th-century vitalism, a philosophy focused on the presentation of life as the ‘spontaneous effort of defense and struggle against all that is of negative value’ (Canguilhem, 1979[1966]: 131), and much of the first article is devoted to surveying contemporary work extending Canguilhem’s paradigm. It culminates in an account of the difference between Foucault as he is perceived in the English-speaking world – as the marxisant critic of ideological apparatuses, acutely sensitive to medicine’s status as a power discourse that became supremely powerful in the era of biopolitics – and the ‘French’ Foucault, a scholar obsessed with the origin of norms, with the arbitrary nature of what we designate ‘pathological’ and, especially in his later work, with the individual and the body as transcendent counterweights to discourses. If the vital is in the end what power goes to work on, then Foucault should also be seen as a vitalist of sorts, as Deleuze suggested.

The richness of Canguilhem’s intellectual legacy is analysed in great depth in the next article, an interview with Frédéric Worms carried out by Céline Lefève and Patrick ffrench (ffrench and Lefève, 2025). The Director of the Ecole Normale Supérieure, a significant contemporary philosopher, and a specialist in 20^th-century French philosophy and in Henri Bergson in particular, Worms is one of the most distinguished French contributors to Canguilhem studies and to the medical humanities. Worms will perhaps be best known to Anglo-American health humanities scholars for his dialogue with Judith Butler, The Livable and the Unlivable (Butler and Worms, 2023). Worms sees care as a foundational concept – a ‘primary fact’ as he puts it – because ‘there is nothing further or higher in being or in life that could serve as a foundation for it’. Here, we run up against an interesting ‘temperamental’ difference between the two cultures. The French field is far less problem-driven than its American counterpart and is much more concerned with establishing the correct conceptual sequence for understanding the phenomena of life. For Worms, as for Canguilhem, life must be conceived of as the struggle of living beings (‘le vivant’) against everything that limits their creative and normative power. In this perspective, medicine is an extension of vital normativity, the form – indissociably scientific and relational – that life takes to combat the negativity of disease and death. However, Worms sees medicine as just one form of care among others, and defines care as a more primitive and more general relationship between human beings. Care aims to sustain life against illness and death, but also the individual life of humans, the individuation of subjects. Referring also to Donald Winnicott, subjects do not pre-exist care relationships but depend on them. Care ‘creates its own terms’ in the sense that ‘it creates the subject who is cared for, and that creates a new dimension in the subject who is caring, who has her or himself been cared for’ (ffrench and Lefève, 2025). Worms delineates two moral orientations inherent in any care relationship: one vital and the other social. The former seeks to provide assistance and protect life – understood not merely in biological terms but also as fundamentally shaped by human relationships – while the latter aspires to justice, recognising that human inequalities are inseparable from the conditions affecting biological life. In a controversial debate with the feminist ethics of care, care thus becomes a primordial norm, a criterion for assessing the creative or destructive character of any act or relationship. The notion of care thus makes it possible to conceive all the dimensions of health and illness we have mentioned without separating them.

The interview with Worms includes a fascinating account of the different theories to which the English word ‘care’ and the French word ‘soin’ have given rise. Few words illustrate the ‘rhizomatic’ nature of the medical humanities so powerfully. In his article ‘Care as Untranslatable’, Patrick ffrench observes that care and its cognate terms have ‘become an overdetermined word in the medical humanities’ (ffrench, 2024). This overdetermination has many sources, including ‘the status of medicine in relation to society and the individual’. ffrench offers a genealogy of the concept of Sorge and its related terms Fürsorge and Besorgen in Heidegger’s work, paying close attention to the way his French- and English-language translators have rendered this cluster into each language. At first glance, one might expect to find a high degree of convergence between soin and Sorge. Heidegger places it at the very heart of his philosophy – Sorge is the name for the ‘structural whole of Dasein’s everydayness in its totality’ – just as Canguilhem and his followers do. But as ffrench demonstrates through a series of meticulous readings, Heidegger’s assumptions about care tend to make it appear as something that can be revealed only by a strong effort of consciousness. The sort of help we routinely give one another in everyday life is a pale simulacrum of Dasein’s structural reality. From this perspective, the interpersonal and institutional forms of care invariably fall short of the fundamental relationality Heidegger proposes as foundational. ffrench’s argument thus resonates with Worms’s point, after Foucault, that social and institutional structures, including those of medicine itself, can constitute the very forms of the negative that are pitted against vitality.

The relationship between care and phenomenology is broached in a different way in the following two articles: Bernard Pachoud’s ‘The Duality of Care: Finding the Right Balance’ (Pachoud, 2026) and Karl-Léo Schwering’s ‘Beyond Empathy: Affect Attunement in the Care Relationship’ (Schwering, 2026). Discussing a recent work by sociologist Nathalie Zaccaï-Reyners (2023), Pachoud links care to the quality of the attention we dispose upon others, distinguishing a ‘convergent’ style of attention ‘which tends to minimize the attentional cost of accessing relevant information’ from a ‘divergent’ style which tends to be less preoccupied by the need to make sense of the other, ‘remaining open to all that is perceptible, while refraining from prejudging what might be relevant’. Here, she is clearly building upon the American psychologist J. P. Guilford’s (1967) distinction, although for Guilford, convergent thinking referred to the ability to find the single ‘right’ answer to a question leaving no room for ambiguity, while divergent thinking referred to perceiving analogical links where there was room for many interpretations. Pachoud shows how this distinction appears in many scholarly literatures. It underpins Hartmut Rosa’s (2019) sociology of resonance (divergence) and dissonance (convergence), for example, as well as Helmuth Plessner’s (2019) account of subjectivity and its necessary negation by the ‘eccentricity’ of human intentionality (so called because of the imperative to adopt a perspective other than our own, moving our own out of the centre), which is a source of vulnerability (because it makes us doubt ourselves). The duality of care introduced in Pachoud’s title is a reflection of this dichotomous faculty. Technological medicine favours the convergent style, but Pachoud argues that there are deep anthropological and ultimately evolutionary reasons to suppose that the divergent style is more important, especially as the global burden of disease worldwide tilts towards chronic (noncommunicable) conditions.

Karl-Léo Schwering’s paper, ‘Beyond Empathy: Affect Attunement in the Care Relationship’, turns to infant research to consider aspects of what Pachoud calls the ‘divergent’ mode in hospital care (Schwering, 2026). Taking his starting point in the work of Daniel N. Stern’s final book, Forms of Vitality (2010), Schwering argues that much of what we think of as resonance occurs at the implicit level in ‘attunement affects’. Attunement affects are emotional signs of responsive recognition. They communicate not just content – joy, sadness, and the rest – but also raw vitality. Shared intentional states require some awareness of the range and power of the vitality underpinning the affects in play. Schwering argues that misattunements are as important as attunements because they enable each member of the dyad to express his or her preferences, expectations, and demands. What is so creative and unusual about Schwering’s use of infant research is his account of what the infantile repertoire looks like in adult life. Attunement between adults takes place on a much more equal basis and does not require intimacy or even familiarity between interactants. Ultimately, the article calls for a de-idealised view of empathy, suggesting that affect attunement may be easier to obtain and just as humanising. It emphasises attention and engaged curiosity as mutual, empowering principles in care. Schwering concludes by advocating for further research into affect attunement as a precursor to empathy, offering a nuanced framework for understanding intersubjectivity in healthcare.

In ‘Collaborative Research in the Medical Humanities: The Case for Transdisciplinarity’, Isabelle Aujoulat and Elise Ricadat (2026) show how coproduced research carried out by qualitative researchers in hospital settings in collaboration with managers, clinicians, patients, and their loved ones might alter clinicians’ behaviour for the better and lead to positive change in institutional policies. Two studies are described, one on the impact on gender identity of a cancer diagnosis during adolescence, the other on the often-unrecognised feelings of powerlessness that accompany some chronic conditions. One of the most interesting questions broached by Aujoulat and Ricadat is how far this sort of research meets the criteria of ‘entanglement’ set out as the defining aspiration of the ‘critical medical humanities’ in a landmark paper by Des Fitzgerald and Felicity Callard (Fitzgerald and Callard, 2016). It certainly rests on

an intuition that some set of things, commonly held to be separate from one another (indeed, that define themselves precisely with reference to their separability) – science and justice, humans and non-humans, settlers and natives – not only might have something in common, but also, in fact, may be quite inseparable from one another. (ibid.: 39)

Mohammed Rashed’s (2025) article, ‘On the Relation Between Medicine and Medical Humanities: Negotiating Recognition and Influencing Practice’, also asks how the critical medical humanities might best engage with medical practice, with the aim of elaborating a critical medical humanities approach to the concept of care. Rashed proposes that it is essential for a critical approach to take seriously the self-understandings of all the agents involved in a medical consultation. ‘Successful agency’, he writes, ‘requires much more than sincerity; it requires participation in social interactions where my self-understanding and reasons for actions are tested and retested and by which they can be recognised or mis-recognised’. In order to strengthen everybody’s agency, Rashed makes the case for a type of philosophical analysis not commonly employed in medical humanities, namely the method of ‘sublation’, defined by the Oxford English Dictionary as ‘the process by which the conflict between two opposed or contrasting things or ideas is resolved by the emergence of a new idea, which both preserves and transcends them’ (Oxford University Press, 2001). Rashed shows how this dialectic might unfold in the case of a man who tells his psychiatrist that ‘for the past four weeks he had been in direct communion with God, that God had spoken to him telling him to get rid of his belongings, to give up his job, to go on a prolonged fast, and to change his life as a way of getting closer to Him’. Such a man would have to reject a psychiatric account of what was happening to him as surely as a psychiatrist would have to reject a religious explanation. Rashed shows how from these opposing starting points, they might find common ground.

The last two articles deal with narrative. Martina Zimmermann’s ‘An Agenda for the Medical Humanities and Ageing’ (Zimmermann, 2025) asks what critical gerontology has to teach the medical humanities today. Narrative was introduced into critical gerontology in the 1980s to supply ‘the nuance, complexity, contradiction, and incongruities’ of older age seldom captured in quantitative research. Because of the primacy of practice in critical gerontology, it was always used dynamically, eschewing the kinds of archetypal uses that became common in the medical humanities at around the same time (for a critique, see e.g. Woods, 2011). Zimmermann argues that it foreshadowed the trajectory of narrative studies in the health humanities today, which deploy narrative in a similarly practice-oriented and nuanced way. She goes on to argue that the field has been slower to learn another lesson it could usefully learn from critical gerontology, namely how to use biological research critically. Age studies could never put biology to one side to the extent that health humanities research sometimes has. It has to be understood in the context of evolution. Biology enables us to demonstrate the impact of social inequality on the ageing process like nothing else. The social critique of a biologically-informed version of the medical humanities would focus on the cascading impact of inequality across the life cycle, paying particular attention to the structural factors that contribute to distresses of all kinds in older age.

In the volume’s final article, ‘The Narrative-Based Medical Humanities, 1980–1995’, Neil Vickers (2025) offers what may be the first comprehensive historical overview of the field in its decisive second phase. Like Patrick ffrench, the approach he adopts is genealogical, aiming to identify and delineate the various narrative theories that were put to use, and the aims they were intended to serve. Vickers argues that the centrality of narrative thinking that took hold of the field in this phase enabled it to make unprecedented intellectual advances, and that nothing that preceded or followed it bears comparison with those achievements. Specifically, narrative thinking enabled the medical humanities to make a powerful and wide-ranging critique of biomedical rationality. The second half of his article discusses this critique. Vickers traces the intellectual roots of narrative thinking in the field to early sociological and anthropological traditions, particularly the work of Emile Durkheim. The article identifies four key disciplinary strands that shaped narrative-based medical humanities: social anthropology, cognitive anthropology, social psychology, and bioethics. Each used narrative to explore the lived experience of illness, emphasising the dynamic, interpretive, and culturally embedded nature of health. Influential figures such as Arthur Kleinman, Byron Good, Cheryl Mattingly, Elliot Mishler, Howard Brody, Jerome Bruner, Linda Garro, and Arthur Frank are examined for their contributions to narrative theory and its application in clinical and academic contexts. Vickers highlights how narrative served as a tool to reveal hidden contexts, capture dynamic processes, and document multiple coexisting realities. He argues that this period gave the medical humanities a coherent disciplinary identity and intellectual rigour, fostering interdisciplinary engagement and institutional growth. Vickers contends that this era laid the groundwork for the contemporary health humanities and remains essential for understanding the field’s evolution.

The editors hope that the range of articles presented in this special issue will encourage English-speaking health humanities scholars to engage more fully with the French field and vice versa. The present volume offers each a means of taking the first steps. The collection as a whole is necessarily partial, but we hope it will reopen and mobilise fresh perspectives. And more than that, the editors hope that scholars new to the field will find fresh meaning in a small but highly significant part of its history.