The house sits at the foot of a spring-green mountain, painted over with long cascading strokes of darker green, giving the impression of a verdant and peaceful setting. Contrast this to the brown ridge where the figure is sitting, huddled in a long sleeve jacket, hands tucked into pockets. The ridge is barren except for a single tree that is mostly bare branches with sparse pale-pink leaves.

Matthew Wong was a rising young painter who died of suicide on October 2, 2019. In a moving obituary by the New York Times, his mother explained that Mr. Wong “was on the autism spectrum, had Tourette’s syndrome and had grappled with depression since childhood.” This helps to explain the sense of isolation and longing in the painting, depicted by the solitary figure on a barren ridge, looking back at a house in lush green surroundings. The figure also appears to be physically cold, wrapped in long sleeve coat, hands tucked in pockets, with no skin showing, but is sadly separated from shelter by an icy white distance. This dynamic, amidst a landscape of majestic mountain rising into star-crowded sky, gives a sense of melancholy beauty and loneliness.

The title of the painting, “See you on the Other Side,” can be interpreted in numerous ways. Mr. Wong is known for incorporating mythical elements into his work, so is this the beginning of the hero’s journey? If the tree in the foreground is interpreted as being laden with pale pink flower buds, there is a sense of hope and promise that the figure is leaving home and will return triumphant on the other side. But the tree can also be seen as a representation of fall transitioning into winter, hanging onto a few withered leaves, as the last bright red autumnal leaf blows away. Is the figure heading away from the verdant house and mountain into winter, the season that classically symbolizes death? Does the other side refer to an afterlife? A third interpretation to consider is that the figure is not leaving the house, but actually trying to get there. In this case, on the other side would refer to crossing the vast white expanse where no path is marked and no help is in sight.

View the painting at Museum of Fine Arts Boston ➔

Matthew Wong’s Biography: www.matthewwongfoundation.org/biography
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image from www.matthewwongfoundation.org/

Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

Dégas’ brilliant rendering of perspective pulls the viewer into the mystery of what has taken place in what appears to be a woman’s bedroom. At the foot of the single-width bed, a coat is thrown over the metal bedpost frame. In the right foreground a bearded man leans against a closed door. His shadow looms behind him, large against the door. His shadow is generated by the single small lamp set upon a small round table near the center of the room. On the floor next to the table lies a piece of cloth or clothing (said to be a corset, p.674 of reference below). 

Turned, bent away from the man, partially kneeling on the floor at the other side of the room, is a young woman whose left shoulder and upper back are bare. The short sleeve of her white dress (nightgown?) hangs off her shoulder. She clutches to her body a blanket or drape. In contrast to the man, who stands in semidarkness, the woman’s back is bathed in the light of the nearby lamp. 

Clothing strewn on the floor and the looming man posted against a door suggest an assault. Although early 20th century critics did indeed perceive the painting as depicting the aftermath of a rape, that interpretation is not a foregone conclusion. The Philadelphia Museum of Art notes that Dégas referred to this work as “my genre picture” (a picture showing everyday life). The museum states further that “an annotation in a notebook used by Degas in this period provides a clue as to his intentions: ‘Work a great deal on nocturnal effects, lamps, candles, etc. The fascinating thing is not always to show the source of light but rather its effect.’ ” For another discussion of this painting, see Body, Place, and Self in 19th-Century Painting, by Susan Sidlauskas (Cambridge University Press, 2000). 

Web image from wikicommons

Pusey, a talented and enthusiastic guide, provides the backstory to Coram’s project. Coram, a man with a history of supporting good causes, is shocked by seeing the multitude of abandoned children on his visits to London. Parents who are unable to care for their (mostly out-of-wedlock) babies have few options; as many as a thousand of these children a year are left in the streets. While other European cities have well-established institutions supported by the Catholic Church, many Londoners initially believe that caring for them is tantamount to condoning sin and debauchery. In 1737 Coram petitions the King to support the construction of a “hospital” (not in the contemporary sense of the term, but more like an orphanage). His persistence finally pays off, and he even manages to turn his idea into a fashionable cause that receives the support of London society.  

Something that is unique about the Foundling Hospital is that Coram also allies from the start with many of the leading artists of the day. These include artist William Hogarth and composer George Frideric Handel. Hogarth, motivated perhaps by his own impoverished background, becomes a Governor of the Hospital and is active to the extent that he and his wife even foster several foundlings. He executes a portrait of Coram which he donates, and encourages other artists to do the same, so that in due course “the hospital [becomes] England’s first public art gallery and establishe[s] itself as a ‘destination venue’ for fashionable Londoners” (Foundling Museum: An Illustrated Guide, p. 16).  

Because I am a classical music fanatic, I cannot wait to see the famous Handel scores and artifacts that the museum is known for. There is a precedent for a composer to ally himself with a charity; Antonio Vivaldi’s career is deeply linked to Venice’s Ospedale della Pietà, a convent, orphanage, and music school. Handel becomes involved when he is invited to conduct a benefit concert in 1749 to raise funds for the completion of the Hospital chapel. For the occasion, he composes the Foundling Hospital Anthem, which proves to be his last piece of English church music. The text, adapted from Psalm 41 and the Book of Job, begins “Blessed are they that considereth the poor and needy: the Lord will deliver them in time of trouble, the Lord preserve them and comfort them. They deliver the poor that crieth, the fatherless and him that hath none to help him. The Lord will comfort them.” Since Handel is the most famous composer in England, his name ensures there will be a capacity crowd paying high prices for tickets. The following year, Handel conducts a benefit concert of his Messiah in the chapel. The event is so successful that Handel is made a Governor, and performances of Messiah become annual events. When Handel dies, he bequeaths orchestral parts for Messiah to the Hospital in his will so that the tradition can continue. Handel’s will is now on display in the top floor of the Museum. During the London Blitz, the precious document was removed by the curator’s wife who put it in her purse and left the building. When she returned, the room holding the will had been destroyed by a bomb.   

An equally impactful group of artifacts is on display on the first floor of the Museum, along with the following description:

The Foundling Hospital was relocated outside of the city in the 1920s. The earlier site was eventually turned into a children’s playground called Coram’s Fields. Gradually, as Britain moved away from the institutionalization of children and towards adoption and foster care, the Hospital closed. The Museum occupies a building in the same neighborhood as the 18th-century original and incorporates some of its interiors and architectural details. The magnificent Court Room, where the Governors conducted their business, is one of the best surviving Rococo interiors in the city.  

The spirit of the Foundling Hospital endures in the charity now known as Coram, one of the foremost voluntary adoption agencies in the UK. The Hospital’s tradition of receiving support from artists also continues. The Museum’s temporary exhibitions and commissions provide a space for contemporary artists to “enter into a dialogue with their eighteenth and nineteenth-century forebears” (ibid, p.81). Lastly, the establishment of Foundling Fellowships named after Coram, Hogarth and Handel (the recipients of which have included such illustrious artists as Julian Lloyd Webber and Emma Kirkby) ensures that the legacy of the institution will live on.  

References: 
https://medicalmuseums.org
This site contains a wealth of information about London’s medical museums, including the Foundling Museum, as well as information about Richard Pusey’s medical history tours.

From the closest bus stop, the shift in focus is immediately apparent. A walk along the Avenue de la Paix (Peace) takes one past sculptor Daniel Berset’s monumental broken chair statue, conceived to encourage a multi-national ban on anti-personnel mines and cluster munitions. In the background, stands the European headquarters of the United Nations in the beautiful Palais des Nations (originally built in 1929 to house the League of Nations). A bit farther on, a statue of Gandhi greets passers-by, adorned one recent day with tributes to the late Russian political activist and prisoner, Alexei Navalny.  

The Red Cross/Red Crescent museum itself sits at the foot of the International Committee of the Red Cross (ICRC) headquarters, a large white building atop a hill. A modern glass and steel structure houses the collection where visitors are invited to learn more about the organization’s origins, as well as the long-standing alliance between individual Red Cross and Red Crescent national societies that provide humanitarian relief around the world. 

While the organization of exhibits in the museum’s permanent collection is not strictly chronological, a sculptor’s dramatic all-white rendering of Henri Dunant seated at a desk—and accompanying text—explains the Geneva resident’s role in the founding in 1863 of what is now the International Red Cross. Dunant, who was first inspired to create a relief effort to alleviate the suffering of soldiers after witnessing the 1859 battle of Solferino, Italy, also participated in the framing of the original Geneva Convention of 1864. On display in a nearby case, copies of that document contain language that reflects the authors’ optimism, “Ambulances and military hospitals shall be recognized as neutral…Wounded or sick combatants, to whatever nation they may belong, shall be collected and cared for.” Subsequent versions that expanded on the protections outlined—thereafter referred to as the Geneva Conventions—were drafted respectively in 1906, 1929, and 1949, with the lattermost document still remaining in effect.  

To safeguard both those providing care and wounded soldiers, the Convention “established a universally protective symbol: a red cross on a white background.” (There has been some debate about whether the white cross on the emblem was intended to carry religious significance or was simply chosen as a readily recognizable symbol, i.e., the inverse of the Swiss flag.) A little more than a decade later, use of the red crescent—a symbol more readily recognizable to Muslim soldiers—was initiated, with formal adoption of this symbol in 1929. Today, the red crystal emblem is used by allied societies in regions where the population does not identify with the cross or the crescent.  

Throughout the museum, the response of the Red Cross and the Red Crescent to humanitarian crises around the world is documented through a variety of materials including photographs, artifacts, and facsimiles of official records. The experiences of survivors in more recent conflicts and natural disasters are brought to life through additional media, including music, graphic representation, and recorded testimony. A striking example is found in the Hall of Witnesses where visitors can sit face-to-face with greater-than-life-size videos of survivors describing their experiences—among them, a former child soldier, a civilian who lost his legs but now works with other amputees, and a woman who experienced multiple displacements from her home country. 

The youngest victims of conflict come into focus in a haunting display of photographs posted along the wall of a nearby room; the accompanying text explains that the children portrayed are survivors of the 1994 Rwanda Genocide. Separated from their relatives at such an early age many did not know their family identities, or even their own names, making reunification difficult and sometimes impossible.  

Fortunately, there is hope to be found as well. In the Restoring Family Links section of the museum, more testimony may be viewed and heard, describing instances in which families separated by conflict have been reunited by the Red Cross and Red Crescent. Stories of recovery and resilience, even among individuals who might have given in to despair, amaze and inspire. 

In another gallery, a display of artwork crafted by prisoners and made primarily from found materials serves as testament to the desire for creative expression among those who have yet to attain their freedom. Among these works: a locomotive made by a French prisoner in Germany in 1941; a set of playing cards drawn by a Moroccan prisoner held by the Polisario Front (a group seeking independence in the Western Sahara) in 1998; and a miniature palace put together by Lebanese prisoners in Israel in 1999. (A book of this artwork is available in the museum shop.) 

With not all threats to human dignity stemming from civil wars, nationalist movements, repressive governments and militia, the Red Cross and Red Crescent also work to prepare vulnerable populations for natural disasters. A small area of the museum is devoted to this work, while a newer threat, cybersecurity is addressed at the Data Detox bar, where a pick-and-choose your own cocktail metaphor is used to provide “…steps you can take to control your digital privacy, security, and wellbeing”; cards that summarize this information are available to take home. 

Leaving the exhibits behind, in the lobby of the museum, the departing visitor is reminded of the power of literature and art to communicate our moral obligation to alleviate human suffering, as well as our capacity to do so. A quote from Dostoevsky that runs along one wall recalls our universal responsibility to one another, while nearby, observers are invited to add their own bit of weaving to artist Zahrasadit Hakim’s tapestry-in-progress, an example of how the cumulative efforts of many changes, supports and enhances the whole. 

The Museum of the International Red Cross and Red Crescent
https://redcrossmuseum.ch/
Av. de la Paix 17, 1202 Genève, Switzerland.  

Photo of the Red Cross/Red Crescent museum from wikicommons

Unni–Dr Unnikrishnan Pulikkal–was my classmate and dorm-mate during the medical course. He had a keen interest in the arts right from his student days during MBBS, our undergraduate medical course, and was a wonderful painter. He told me about his switch to photography, though he continued to paint and make sculptures and other artistic creations. And In addition to creating art, he has created venues to display art; Unni, who hails from Kodakara in Thrissur district of the southern Indian state of Kerala, has started two museums in his hometown, in close proximity to the town’s hospital.  

The Art Museum of Love is one of the few museums in the world devoted to representations of love in art. When I said I wanted to visit, Unni gave me precise directions about reaching the place; it is located at the Azhakam service road about a kilometer from Kodakara town. The early December afternoon was hot. The climate has become warmer over the last three decades; temperatures over 40 degrees Celsius are now common during the summer. Climate change has hit Kerala hard.  

The art museum is delightfully air conditioned. I interacted with the two ladies managing the reception desk who told me that before I went in, I had to take off my shoes. I liked the design of the museum. Plenty of planning and thought had gone into the layout and the display rooms. The rooms are small and provide you with an intimate experience; the lighting is superb and highlights the exhibits. There are also spaces to sit and relax. You can read and reflect. The display boards provide detailed information about the exhibits, which were tastefully designed.  

Various types of love are addressed. Most of us are very familiar with romantic love. The love of a family, love between siblings and love between parents and their children and love of an extended family and society are also explored. Spiritual love is common in the Indian tradition. I could see a few of Unni’s paintings and photographs on display. Other art forms were also included in the exhibit. There were river stones sculpted by nature and others carved by skilled human hands on display. The driftwood sculptures fascinated me; in Nepal, I had a good friend, Dr Awate, who was fond of collecting driftwood as he hiked the hills of western Nepal. He mentioned that with some tender loving care some of these can become works of art.  

Ancient India had a liberal approach to romance and love. Traditional paintings had strict rules and regulations. Within these boundaries you were free to explore your creativity. Depictions of the Hindu God Krishna were prominent in the museum. Different traditional art forms from South Asia depicting Lord Krishna were on display. Artists consecrated their work to the lord, and Lord Krishna has been depicted in art forms and styles of painting throughout India. The diversity of these art forms makes them an interesting area of study. Tanjore paintings from Tamil Nadu are renowned for their rich colours and extensive use of gold foil. These have more detailed and regal patterns. Madhubani paintings from North Bihar (the Mithila region) use earthy colours and are usually done in geometric patterns with bold outlines (I was gifted a Mithila painting by Darbhanga Medical College in Bihar, India; the painting still hangs in my old office in Nepal). Rajput paintings are known for their opulent colour.  

Pattachitra is a vibrant art form that originates from the holy place of Jagannath Puri, Odisha, in eastern India. It is also extensively practised in West Bengal. Traditional Warli paintings– the Warlis are a tribe in Maharashtra near the border with Gujarat–of Lord Krishna were also on display as were Gond paintings of love.. Looking at these paintings I was struck by the cultural unity within diversity in India.  

The art museum has two floors and also has a section on erotic art that has a warning about the explicit nature of the material on display at the entrance door. Till today the public has been very accepting of this section of the museum. The museum also has a community space at the side where events can be organized. Several events have used this space; for example, the museum held a competition for letters and poems expressing love to be sent to the museum’s postal address, and some of the winning entries were on display. The Art Museum of Love has created Instagrammable objects and locations for selfies and social media postings. The website of the museum (Sneha Museum in Malayalam, the native language of the southern Indian state of Kerala) is https://lovemuseum.life/. The museum is also on various social media. 

I went with Unni to another museum he curates and manages. Photomuse is the museum of photography. Photomuse was inaugurated by Herbert Ascherman Jr., a renowned US photographer who mainly works in black and white and the rare art of platinum photography. He is the mentor and guide of Dr Unni and has contributed several pieces of his work to the Art Museum of Love and to Photomuse. This museum was in operation at a different location for a few years and in early 2024 shifted to a permanent location at Mattathur near Kodakara. The website of the museum, which has multiple features and offerings (including collections mainly devoted to cameras and photo equipment, a journal, programs, and a gallery showcasing various exhibitions previously mounted at the museum, among others), is https://photomuse.in/. During my visit the first gallery was hosting an exhibition titled “Silence & Chaos.” The exhibition had photographs by different photographers, some depicting silence and others depicting chaos. The major gallery hosts cameras and photographic equipment from various generations and time periods. The old pin hole camera, bellows camera, the auto focus film cameras, polaroid camera and SLRs using film are all on display. Each camera has a small descriptive note providing more information about the object. The pride of the collection is the large format Vageshwari cameras that were manufactured in India and were among the best field cameras in the world. My friend Sanjay Mhatre, an architect, had introduced me to large format cameras and these always fascinated me. The extensive collection is also documented online at https://photomuse.in/index.php/collections 

The museum holds exhibitions of photo collections periodically and these can also be accessed online. Photomuse has a good collection of old photographs; the museum has 1,765 antique prints in its collection. There are a few depicting the birth of independent India. I was intrigued by the photo of the old Cochin Forest tramways, which operated from 1907 to 1963 and enabled the transport of wood from the Parambikulam forest to Chalakudy town. The museum also publishes a journal both in print and online at http://journal.photomuse.in/  

The small town of Kodakara near the Thrissur-Ernakulam highway has two museums that are cultural icons and social gathering places. Dr Unni also has created an open-air art gallery on the premises of the hospital he runs in the same location. Unni, through his arts initiatives, reminds us of the close connection between art and medicine. There are several educational institutions around Thrissur and health students can learn about the close interplay between art and medicine at the museum. These museums and galleries have put Kodakara on the international arts map. So, the next time you visit Kerala, which some have called God’s own country, please do plan a trip to Kodakara. The place is not difficult to reach. The museums are open from 10 am to 6 pm Tuesday to Sunday (closed Mondays). In an increasingly bitter and divisive world, come discover the gentle and healing power of the arts and of love!  

Interview with the Uber-Talented Unnikrishnan Pulikkal, MD

Ravi Shankar Aug 6, 2024

Dr. Unni, a medical practitioner and artist, discussed his rural upbringing, passion for painting and photography, founding PhotoMuse, and balancing art with medicine.

The renowned English social realist and portrait painter, Luke Fildes (rhymes with “childs”), created The Doctor in 1891 after Henry Tate commissioned a painting from him for his new museum, the Tate Britain. The subject of the painting was Fildes’ choice. Despite a poor reception among art critics when it was first exhibited, the painting quickly became iconic as the physician ideal. Over its 133-year history, the painting has been used for a variety of purposes, including inspiration, education, propaganda, and politics. During that time, the ways in which the painting represents the physician ideal changed. We talk about these aspects of the painting with Hannah Darvin from Queen’s University in Kingston, Ontario, Canada. She has conducted extensive research into the painting and its creator.

Links
Image of The Doctor from the Tate Britain Museum.
About Hannah Darvin at Queen’s University.
Hannah Darvin’s description of her research for the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
John Brewer Eberly’s diptych rendering a modern version of The Doctor in which computer technology is interjected between doctor and patient. 

Feature image from Wikicommon

Cold Eye, Warm Heart: Medicine and Anton Chekhov  

Jack Coulehan Aug 6, 2025

A moving portrait of Anton Chekhov, whose dual life as physician and writer reveals the deep interplay between healing and storytelling.

JC: Well, it’s great to see you, Alan, and thank you for agreeing to this interview. It’s been a long time since I saw you in person. I remember when we first met in 1992 at the Society of Teachers of Family Medicine meeting in San Diego. It was at a poetry reading, and we were both presenting our work there.

I’d like to begin by quoting an article that I saw in the Amherst student magazine from 2008. You had just received an honorary doctorate of science there. It goes like this, “AB’s combination of his education, his love of art, his passion for medicine and his wonderful sense of humor have made him a great warrior in the fight against smoking. Dr SmokeBuster offers an alternate view in the seemingly strict discipline of medicine. He embodies the philosophy of the liberal arts, using a variety of disciplines to communicate his message. Most importantly, AB brings poetry and artistic splendor to the often overly calculated role of science.”

I think that really describes your ability to merge your love of the arts and humanities with humor and your passion for medicine, as well as your public health activism and your career-long campaign against cigarette smoking. So how do you look at that? How do you view those interdigitating components?

AB: First of all, this is so unbelievable. If you told me that when I was struggling to figure out what to do in life, that I’d be interviewed by Jack Coulehan, I’m just really appreciative that you would take the time to do this.

I had great fortune in my upbringing and growing up on the periphery of New York City.

It was really a marvelous time. I thought New York City was where moms took their kids to go to see plays and museums on weekends. I didn’t realize people actually live there. Where I was born, at Rockaway Beach Hospital in New York, you could see the ocean from the hospital. My father, Leon Blum, MD, was an intern there and then a member of the medical staff. He was a general practitioner for 37 years in the very town in which he’d been raised, Rockaway Beach. And that’s where Jonas Salk spent his summers. And Burrill Crohn was from there, of Crohn’s disease fame. So it has a rich heritage. I grew up in a low middle income community, nearby Far Rockaway, where my father, Leon Blum, MD, knew everybody.

My dad was very literary. He would do the Sunday New York Times crossword puzzle, which I could never do. And I had great opportunities to experience culture. Of course, I thought museums were mostly about dinosaurs. I never realized that there were art museums. That was the awakening I got when I went to my first National Conference of Family Practice Residents meeting in Kansas City.

It was pretty boring. So I started walking around Alameda Plaza, and I came across this beautiful building that looked like a Greek temple, and it turned out to be the Nelson Gallery. And that was really my awakening in art.

JC: And you also had an early commitment to activism. It’s remarkable that even as a resident in the late 1970s at the University of Miami, you had already begun, kind of this dual career as a regular practicing physician and as a family practice resident, you organized a campaign against smoking and other unhealthy habits among adolescents. What was the origin of the idea for the Doctors Ought to Care movement?

AB: I think everything I’ve ever done is irony and humor, and even the title of my undergraduate thesis on Robert Frost was called “The Way of Understanding is Partly Mirth” (from a line of one of his poems). I don’t think I would have been able to get through being fired a couple of times, not getting into this or that school, not getting this or that job, missing the deadlines for exams that I had to take, and so forth had I not had a sense of humor.

I was about a 7-year-old watching Brooklyn Dodgers games on TV with my father in the afternoons when he would rest after his 9 am-to-noon and 1 pm-to-4 pm clinic before his after-dinner office hours in our house, where the living room became the waiting room. We loved the Dodgers, and one day he said, “Look at that Lucky Strike commercial. Why don’t you take out our tape recorder and record it, because one day nobody’s going to believe that they would associate sports and cigarettes.” And sure enough, it only got worse as the decades went by. Meanwhile, I had begun an interest in smoking because my father had had a heart attack in his 40s, when I was 5 years old. He started smoking Chesterfields as a medical student and continued through his service in the Army in World War II in New Guinea. It just stuck with me that when and if I ever got to medical school, I’d learn a lot more about that. I never did. Only about 30 minutes of education at Emory was devoted to smoking, and it was a part of a lecture on lung diseases by Dr Brigitte Nahmias. She juxtaposed ads for cigarettes next to pictures of her patients with occupational lung disease and some who smoked. I thought that was a good way to demonstrate the contrast between the macho men in the cigarette ads and the wrecks that she cared for. So with the help of a pathology professor at Emory, I decided to create my own slide presentation of all the smoking-related diseases. By the time I was in my residency, I began speaking in elementary, middle schools, and high schools to try to talk to kids about not taking up smoking and other killer lifestyles that were being promoted to them in the mass media.

At a meeting of the National Conference of Family Practice Residents in Kansas City in 1977, I tried to share this work with the other attendees but was initially rebuffed. I was finally given a room after the main proceedings ended. It was filled to overflowing. Over 50 people came, and one of them was Rick Richards from South Carolina, who told me “You know, I’m going to go back to Spartanburg and do the same thing you do, and I’ll see you next year.” Well, by that next year, we’d organized several chapters, and we were asked to give the main talk at the conference. So DOC, or Doctors Ought to Care, became known for not just lecturing on the dangers of smoking, but also for ridiculing, satirizing and parodying cigarette advertising and the way in which the tobacco companies were getting away with murder. We were the first and only physician organization to confront the tobacco industry itself, and not just angrily, but using humor and MAD Magazine-style satire such as the Barfboro Man and the Emphysema Slims tennis team. These were some of the things that we created when the American Cancer Society was saying, “Oh no, no, you can’t do that. You’re going to get sued.” Well, we were sued, and that only brought more attention to us. We did a t-shirt parody of Miller Lite Beer, whose original slogan was, “Miller Lite. We’re having a party.” Our slogan had a guy with his arm around a toilet saying, “Killer Lite. I’m grabbing a potty.” Miller Brewing, which was owned by Philip Morris at the time, sued us in state and federal court. We won the case, but it was no fun being involved in litigation with the world’s largest cigarette company.

JC: That makes me want to jump ahead to some of the exhibitions in the Center for the Study of Tobacco and Society. I was reviewing the website last week and the whole thing is so impressive, but the humor and the irony in the titles and the text of some of your exhibitions is amazing.

So to get into that, let’s move to the beginning. I believe it was 1997 when you began the Institute for the Study of Tobacco and Society at the University of Alabama, let’s go back to Doctor Ought to Care.

Alan: DOC was started in 1977. I was in internal medicine after my graduation from Emory, and I loved my internship at McGill’s Royal Victoria Hospital in Montreal, but I kept on running into family practice residents at Montreal Jewish Hospital who seemed to be loving their experiences even more than I was. So when I was on vacation in Miami, I thought why not look up family medicine?

I walked into the Department of Family Medicine at Jackson Memorial Hospital of the University of Miami, and there was Irwin Redlener, who was actually a pediatrician. Irwin was filling in at the request of the chairman Lynn Carmichael. It turns out that this was the first family medicine residency in the United States. Lynn also helped found the Society of Teachers of Family Medicine and became the first editor of its journal Family Medicine. The residency had features found in few other training programs of that era such as sports medicine, podiatry, integrative medicine, pastoral care, an annual symposium on sexuality, extensive community outreach, a resident-run evening clinic, and a monthly book group to discuss The Person: His and Her Development Through the Life Cycle by Theodore Lidz. It was just amazing timing for me, and I never looked back.

Lynn tolerated me pretty well for my activism on tobacco after initially chastising me for trying to convince his secretary to stop smoking. He eventually admired what I was trying to do, which was to bring our knowledge about health into the community to try to make up for the health and socioeconomic disparities in the neighborhoods around the inner-city hospital.

Dr. Richards and I were soon joined by another family physician, Dr. Tom Houston, and through the National Conference of Family Medicine Residents we were able to disseminate our activist approach to tackling the killer habits. In the 1980s we wound up having close to 100 chapters of

DOC in medical schools and family medicine residency programs, some of which still exist. Our approach was to use humor and satire, as opposed to all the staid organizations like the American Cancer Society, the American Heart Association, and the American Lung Association, which still relied on pamphlets, posters, and unpaid public service ads on TV that usually aired at 3 in the morning. DOC was the first health group to purchase counter-advertising space on billboards, bus benches, TV, and radio. No one else had ever done that. We were also the first to involve teenagers in our work and to tap the highest level of creativity and commitment of every family physician we could find. In 1978, I co-hosted a conference with a junior high school student that was attended by 150 students from 30 schools in South Florida to train them to help raise the awareness of their peers about the targeting of young people by the purveyors of cigarettes, alcohol, and junk food.

Flash forward to 1997 when I was on the faculty at Baylor College of Medicine. I was invited to give the family medicine residency graduation address at Tuscaloosa. I shared my sketches and stories of patients and also gave a grand rounds on the physician’s role in ending the tobacco pandemic.

Afterwards, the chairman, Jerry McKnight, asked me if I wanted to stick around. I thought he meant going for a beer, but he wanted me to apply for a new endowed chair position in family medicine.

When I moved to Alabama two years later, I started the Center for the Study of Tobacco and Society. DOC was still going, but I also wanted to do something different such as researching the history of smoking and efforts to counteract it.

I began to organize the vast amount of material that I had amassed over the years through what I called a daily biopsy of the smoking pandemic – the largest collection on the tobacco industry, cigarette marketing, and anti-smoking advocacy at any university. This was all pre-internet and pre-ebay. I had tens of thousands of items, and the University of Alabama was kind enough to provide some space. I thought of this as both a museum and an archive, and for the next 15 years I hired graduate students from the School of Library and Information Studies to start cataloguing the collection.

The main work product of the Center is exhibitions. We began with an exhibition at the annual convention of the Association of American Editorial Cartoonists called “Cartoonists Take Up Smoking!” It took ten years to research and involved acquiring over 300 original artworks from the nation’s newspaper editorial cartoonists. The exhibition then went to the National Museum of Health and Medicine in Washington for a year and traveled to ten other venues. So we had a great opportunity to share our work, but then it dawned on me in 2015 to do online exhibitions to reach a much larger audience. We’ve now done nearly 40 exhibitions, and I’ve never looked back.

JC: And I think that that those online exhibitions, each of them, seems to be a massive enterprise with so much richness in the visual material, in your text, comments and so forth. It’s remarkable that you have been able to collect this much essentially social history and curate it in such innovative ways.

Alan: Well, here comes the trigger warning, because I do this mostly for me, partly because. I don’t think most people understand the smoking issue. I really don’t. I don’t think there’s much to cheer about, in spite of the progress that we’ve made in reducing adult smoking from over 40% in 1964 to less than 15% today. Just this year, an investigative report was released about how low-tar cigarettes are bigger than ever in China, because they’re still pushing the absurdly fraudulent notion that there can be a safer cigarette. Even the Journal of the American Medical Association bought into this for awhile back in the 1970s. It’s such a tragic history in this country that I cringe whenever I hear public health people saying that the reduction in cigarette smoking is the greatest public health triumph of the 20th century. Not at all. In my opinion, it’s just the opposite. 

We learned everything we needed to know about smoking by 1964 when the Surgeon General’s report came out. My dad taught me everything I think I needed to know when I was much younger than that. I wrote my first article on smoking when I was editor of my high school newspaper, The Woodmere Academy ECHO. And I think I’m the longest running individual on this issue, because I’ve been doing this with a passion for over 60 years – – fortunately, I haven’t had to earn my living from my anti-smoking work. And that’s where my trigger warning comes in, because it’s hard to imagine how thoroughly the field has been professionalized. You have to have a Master of Public Health or a Doctor of Public Health degree to get a job in it, as compared to the hundreds of grassroots activists from all walks of life across the country who led the way for decades in passing local clean indoor air laws. And guess what it’s called now: “Tobacco Control.” Of course, it’s not about controlling tobacco. It’s about curbing smoking and its promotion. This issue is something that medicine hadn’t addressed before, because unlike an infectious disease it’s a human behavior that’s taught to us by an industry that’s making an enormous profit. So I believe my contribution was to shift the focus away from lung cancer and smokers and instead onto Marlboro and the people in the tobacco industry who promote it. I think that was an exponential leap from where we were before then.

There were quite a few health care professionals who were opposed to smoking. Thoracic surgeons Alton Ochsner and Michael DeBakey were warning that cigarette smoking caused lung cancer beginning in the late-1930s. For their trouble, they were ridiculed by the medical profession. Organized medicine didn’t want anything to do with fighting smoking. (For one thing, their medical journals accepted lucrative cigarette advertising revenue until well into the 1950s; for another, two-thirds of physicians in the 1940s smoked.) So what I think we did in DOC was to shift the focus to monitoring the tactics of the tobacco industry. Our strategy gave permission for everybody else to point the finger at the industry as the source of the problem. But the federal government never devoted any funding to fight smoking, and there was relatively little effort. So leading the way was that band of people who hated going into restaurants or getting on airplanes and breathing tobacco smoke. It was that activist group of people– – not the public health people, not the physicians – – who started the nonsmokers’ rights movement. And then there was a guy like me who was looking at the advertising and promotion of tobacco products. But most of those working in this field today are focused on regulation and legislation, even in this non-legislative era. Then there are the full-time smoking cessation researchers, who are practically studying nicotine receptors on toenails rather than looking at the larger picture. They’ve medicalized and “pharmacologicalized” smoking cessation. As a result, physicians no longer take an extra minute or so to encourage their patients to stop smoking. They just prescribe a drug. And I don’t think that most people in tobacco control are looking at the fact that we could have done so much more in these 60 years. For example, the first time the government ever spent a penny on paid advertising to fight smoking was in 2012.

In 1998, the state attorneys general forged a $206 billion settlement with the tobacco industry which sounded great. But although most of that money was supposed to go to fight smoking, only 2% of that has been allocated by state legislatures for tobacco use prevention and cessation. It’s all about the money.

JC: It’s all about the money.

Alan: An internist colleague, Ed Anselm, made this marvelous comment, “The most addictive thing about tobacco is money.” And he wasn’t just talking about the tobacco industry, but also about the people who say they’re fighting smoking but are really just fighting over the grants to write policy papers telling legislators what to do about smoking.

It’s a dark field.

JC: It sounds, from what you’re saying, you know, the image I have is Socrates, as a gadfly in Athens talking about the gods and so forth, and his questions threatening the status quo. One thing has improved though, you haven’t been convicted. You haven’t had to take the hemlock.

Alan: No, I was arrested, though. I’ve been arrested a couple of times for demonstrating (but never charged), once with a city councilman in Houston when we went to the Astrodome to protest a Cinco de Mayo festival sponsored by RJ Reynolds’ Camel cigarettes. Let me just give you an example of the absurdities I’ve experienced: I was fired as editor of the New York State Journal of Medicine after three years, having produced the first theme issues on smoking at any medical journal, and which brought national attention to the Journal. As editor, I had to attend the monthly board meetings of the of the Medical Society of the State of New York (MSSNY), which published the Journal. To paraphrase the Borscht Belt comedian Henny Youngman, the average age of the board members was deceased. I was about 20 years younger than the next youngest person in the room, and all they were talking about were economic matters like the high cost of malpractice insurance. It was not at all about health and medicine and helping people, in my opinion. But I’m grateful to MSSNY for having had the opportunity to do these theme issues on tobacco problems. Following the second one, though, I was fired for having spent too much time on smoking.

JC: I think we can agree that that money talks, and we lived in the mid-20th century in a culture in which smoking was not only acceptable, but it was really highly touted. For example, most doctors smoked Camels, but on the other hand, don’t you feel that that your campaigning, and your creativity has contributed to cultural change, even though it’s been at a slow pace?

Alan: I did a teaching fellowship in family medicine at the University of Miami after graduating from the residency program. And what I learned was how to give a good presentation and how to write learning objectives. These skills may seem simple, but that’s deceptive. First, there is the cognitive objective (imparting information), which 99% of lecturers think is the entire lesson they are supposed to teach. Then there’s the behavioral objective, which can teach learners how to do a procedure or demonstrate a skill. But what they’re missing, I think, is the attitudinal objective. I came away from that fellowship understanding that every presentation, every paper, every research poster I would ever do would have the reader, viewer, or the listener going away saying, “Gee, I never thought about it like that before.” That’s an attitudinal objective. I wanted to change the way people looked at an issue.

It’s something that stays with me every time I advise a resident on giving a presentation. I also do this in my exhibitions on tobacco in the hope that the viewer can see the ironies and learn the lessons from decades of foot-dragging by organized medicine, the public health community, and academia – and their fear of confronting the tobacco industry – that can be applied to tackling other challenging health problems such as gun violence, obesity, emerging and re-emerging viral diseases, and digital media addiction. There are many ways we can look at the smoking issue. Our failure to address it for so many decades is a metaphor for how we’re dealing with the wired epidemic of kids having the attention span of a fig.

JC: In 1964 when the Surgeon General came out with his first report, I believe 45% of adults in the US smoked, and now it’s approximately 11%, and the images that you have in your in your exhibitions show how trendy and culturally appropriate smoking was at that time. Now, you have to admit that there is a significant cultural awareness that smoking isn’t the thing to do, and that at least if you do smoke, you have to go out to the back, and you can’t smoke here or there, and there’s a certain kind of negativity against it. I consider that a cultural change. And of course, all of the tobacco corporations have had the time over those 60 years or so, to adapt to these new conditions and to spread their tentacles elsewhere. But it seems to me, it does constitute a change.

Alan: Jack, we look at our time now as an age of disinformation and regression, and dare I say, the word “retribution,” because we have willful ignorance that I haven’t seen in my lifetime. I lined up at my school in Woodmere, Long Island, to get my polio vaccine as a five-year-old. I was in the original Polio Pioneer trials. We have people today who are saying they’re “doing their own research” as to why they won’t get a Covid vaccination that has saved millions of lives even though these vaccines were developed in record time, thanks to our knowledge of previous epidemics, especially SARS in the early 2000s. Most of the time developing the vaccine for Covid was taken up with the trial, not with the development of the vaccine.

I think the missing element today in countering this horror is humor, and that’s why I like to think that MAD Magazine was my leading medical journal for many decades. I actually got to meet the editors and the publishers of MAD because I wrote a letter to publisher Bill Gaines and editor Al Feldstein when I was editor of the New York State Journal of Medicine. I asked, “Why don’t you resurrect those great parodies of Marlboro and other cigarette brands?” And they invited me to have lunch with them in New York City? It was fun. And they then resumed doing those parodies.

I had a lot of other influences growing up. On the radio, Jean Shepherd (best known as the author and narrator of “A Christmas Story”) was kind of every adolescent’s hero. Every night, he would tell stories of his time growing up in Indiana, and I think that’s how I got a lot of my storytelling ability.

And reading newspapers. I would often buy all nine New York dailies on a Saturday just to see the different sportswriters’ take on the Dodger games and to see the sports cartoons by Willard Mullen in the World-Telegram & Sun. Some of these were resurrected in my exhibition, “Cartoonists Take Up Smoking!” .Also, I was a magician growing up doing birthday parties and school assemblies, inspired by my father who would do little tricks for his patients. I really loved that. Once I even got to open for pianist Peter Nero at the Rheingold Music Festival in Central Park. I wasn’t very good that night, but I still get to say I performed for 3000 people.

JC: Well, it’s clear that we take ourselves too seriously. We’ve lost the ability to look at ourselves and our culture with that kind of ironic distance. And in addition to that, when you were talking about the development of the Covid vaccine, the disinformation, to me, seems to be a malignant outgrowth of some of the technologies that we’ve developed and we’ve made accessible to the world, and the ability of people to spread disinformation with such great facility and power.

Alan: I think that we need to match the reality of the society that we’re living in with the strategies to counteract it, and I don’t think we’re doing that. We’re too ideologically split, and I don’t know where common sense has gone. I don’t think the media have risen to the occasion. Our newspapers are gone. I don’t do social media. But I just am horrified. I used to think I wasn’t very literate because I looked at all my fellow English majors, like you, Jack. They were omnivorous. I did pretty well, but I just never felt that I was that knowledgeable about poetry and literature. And I see now that I was pretty good compared to what people are spending their time doing today. There are no humanities to speak of in medical schools, except for the honors courses for the self- selected students who are already interested in humanities, and you and I have spoken about the fact that out of 22,000 entering medical students today only around 500 majored in a non-STEM field. It’s mind-boggling. It’s terrible.

JC: That brings up a point I’ve been meaning to take up in this interview, and that is, we’re both medical school professors. I’m emeritus. You’re still active. In my career, I have tried to imbue in students a love of humanities, the use of the arts and humanities to develop empathy, to develop reflectiveness and resilience. And of course, I’ve gotten a lot of feedback on that, or blowback, I guess I should say, because people say, well, that’s not going to work. It doesn’t matter. These guys are going out into a different medical world in which they are going to be subjected to stresses, to constraints and so forth. So even if they go into this with that kind of humanistic perspective, they won’t be able to effectuate it in their practice. And of course, having looked back on my career, it’s kind of difficult to hear that. I’m not sure that I believe it, but I wonder what your thoughts are on that matter.

Alan: Ann Walling has an excellent review article on ageism in the July 2024 issue of American Family Physician. She compiled a checklist of questions to ask an older person. She wrote it because she was struck by many of her older patients telling her how they did not feel respected by some of the younger physicians. But I noticed she didn’t include “How do you spend your time?” or “What was your occupation?” A person’s identity is paramount. I don’t think they consider their identity is being a patient.

I find that students are trained to be good mechanics about diseases, and that they can look up anything about diseases and how to treat them. But that doesn’t involve reading things that aren’t only related to the patient you’re addressing at that moment, and that doesn’t involve pleasure reading.

My point is that we no longer live, if we ever did, in the same neighborhood as our patients. We are in not just an ivory tower, but it’s got a moat around it, and they have to come to us. So I ask every resident, “How did the patient get here today?” And you know, after the first 20 or 30 eyerolls they realize it’s relevant. Or, “Who’s at home?” Many residents initially say, “That’s too personal.” This is family medicine that I’m talking about, and they’re saying to me that just asking who’s at home is too personal, or asking about the father when a newborn is brought in by the mother or grandmother or great-grandmother for a well-child visit is too personal.

You couldn’t get any further from my father’s education at Downstate in the 1930’s (when it was Long Island College of Medicine). He would walk two to three blocks to make house calls or even deliver babies. I may be romanticizing, but I think we’ve moved so far away from them, the patients, that now it’s all about us.

When I was a new faculty member at Baylor I didn’t know anything about Houston, so I started exploring the city. I began in January. By July, I proposed doing a community field trip for the incoming interns and new faculty. I chartered a school bus and took them to a Black radio station, an art museum, the city desk of one of the two daily newspapers, the county health department, the city council, the jail, and the criminal court. I did this for 12 years. I’d change the itinerary a little bit, and the only requirement was that they would write a reflective statement. When the residents were getting their exit interview from residency after three years, the community field trip – – that one day that they had as interns – – was one of the highest rated activities.

I think it’s so important to recognize with humility that we don’t know very much about our patients anymore. I’ll give you one quick example. I was attending in an ICU at Baylor and one of the residents was rattling off endless laboratory results. The patient was intubated, so we couldn’t talk to him. Finally, I just said, “Who is this patient? You’ve told me every laboratory result known to mankind, but you’ve never said a word about who he is.” Tomorrow morning, tell me who he is.” And I walked away, I was so angry.

And the next morning the resident excitedly said, “You wouldn’t believe who this guy is. He’s the architect who designed this hospital!” I mean, he was absolutely incredulous. And it wasn’t anything great that I’d said, other than to stop presenting people as numbers. Stop talking about people as “diabetics.” Just say, “the patient with diabetes.” It doesn’t take that much of a leap to talk about people with a disease, rather than who they are as a disease. And again, I’m not the first to suggest this, but it’s also astounding that we can’t dissuade residents from presenting people by race and gender. Warren Holleman, Marsha Holleman, and Bill Monroe wrote a terrific essay, a critique of how we present and discuss patients, in Literature and Medicine in 1992 called, “Is there a person in this case?”

JC: With regard to the bus trips and the field trips, in 1968 when I was a second year medical student at the University of Pittsburgh, we had a community and preventive medicine course in which weekly or biweekly we would go to nursing homes, to neighborhoods, like the so-called Hill District, which was the African American neighborhood in in Pittsburgh, and so on. What I’m trying to say here is that many of these ideas we’re coming up with and saying this would be something new, were practiced in the past, but have been lost. The other thing has to do with interviewing patients. I wrote an article in the early 1980s in the Annals of Internal Medicine called “Who is the Poor Historian?” And I pointed out that that when you’re interviewing a patient, which of you is the historian? Well, obviously, it’s the doctor who is collecting the data and who is trying to assemble and interpret it as a historian does. So again, this was 30 years ago.

Alan: This is so amazing. We should collect all these. One of my favorites is “well- developed, well-nourished and in no acute distress,” which should only ever be used to describe an infant in the neonatal ICU. Instead, imagine calling a woman “well-developed, well-nourished…” And you see this on every chart. This is what the dopey electronic medical records populate.

We are so beyond reclaiming the medical record. I did a grand rounds a few years ago about scribes. For the past decade, I’ve been privileged to have had an incredible experience with medical scribes. These are mostly pre-med students at the University of Alabama who have been one better than the next. One of them wasn’t even going to go into medicine but I urged her to apply, and she did. It’s a terrific way to help mold their thinking about medicine. I don’t like the idea of shadowing, which is passive, whereas being a medical scribe is a commitment, and it’s not easy. I’ve watched these students closely, and it has been a great joy. I confess that I initially opposed having a scribe, because I thought it was going to violate the patient-physician relationship and confidentiality. But it’s a wonderful experience that I wish we would be able to expand.

It’s absolutely astounding how we’ve become so absorbed in populating medical records with minutiae that very few people read. In auditing records of residents, I look past the templates. I want to read their narrative. I want to see that this was generated by a human being.

JC: My sense is that, as a result of my own experience, what we have done in teaching the human aspects of medicine and providing role models and images of what that could be, is that we have influenced a percentage of young medical students and residents who have been malleable in a way and made them better doctors. And that percentage, I don’t claim that it’s large, but I think it’s a real contribution.

We’ve talked a lot about the difficulties and the disparities and in a sense of atrocities, really, of modern medicine, but I’d like to leave this conversation with a positive note. So I guess I’d like to ask you, Alan, what kind of positive note can we end on from your experience?

Alan: You know, every day I must count my blessings. I give thanks for the opportunity to experience the moments that I get with patients, with residents, with colleagues. I’m

a critic, but I’m also probably the biggest fan of what we do in family medicine. When it was founded as a specialty in 1969, there was a kind of a nostalgia for, and resurrection of, the old general practitioner. So I’m really living at least in some way like my dad lived and appreciating these experiences with people. I don’t think medicine is anything other than that. I admire radiologists, especially those that want to see a picture of the patients that they’re reading the films on. I admire every sub-, sub-, sub- specialist there is, because, gosh, it’s good to know that if you need them, they’ll be there. But what a privilege it is to be able to see people from all generations at any given moment. I never know from one day to the next who I’m going to see, and on a single day about two years ago I actually saw patients of four generations in the same family: great grandmother, grandmother, mother and daughter. So I think that I’m a commercial for family medicine, but I’m not a commercial for making medicine into a disease-oriented, as opposed to a people-oriented, field. I think we can’t get to the diseases until we know who people are.

JC: I agree. I’m not sure we can return to the past or to the more holistic view that we recognize in your father and some of the doctors that I encountered when I was young. But I think we need to keep working and seize any opportunity that presents itself to get our message through. I’d like to thank you for this discussion. We could continue for several hours on these topics, and that would be very interesting, but in the interest of time, we have to conclude now. So thank you.

Alan: And I want to thank you and Lucy for thinking of me in this context. I also would be remiss in not thanking my wife, Doris. We’re going to be celebrating our 49th anniversary (in September 2024) with a few days in the Adirondack Mountains. Also, my three sons, Leon, David, and Sam, my late father and mother, Eric Solberg (my colleague and co-author in DOC for over 25 years), and the many mentors I’ve had: English professor Chick Chickering at Amherst College; cardiologist and poet John Stone at Emory University School of Medicine; Howard Rusk, the pioneering rehabilitation medicine physician in New York; Sam Nixon, a president of the American Academy of Family Physicians; and Bob Rakel, who was the chairman who took a chance on me after I was fired as editor of the New York State Journal of Medicine, even though I hadn’t worked in a hospital or clinic for several years.

I’ve been incredibly fortunate to have all these individuals in my life. There was also Kurt Deuschle, chair of community medicine at Mount Sinai School of Medicine. When I was fired as editor, I called him, looking for a few words of sympathy and encouragement. Instead, Kurt sternly replied, “It’s your own damn fault.” I was crestfallen and speechless. But then he explained, “You got too far away from patients.”

I’ve never forgotten that advice.

Alan Blum, MD, is a family physician and professor of Family Medicine at the College of Community Health Sciences, which also functions as the Tuscaloosa Regional Campus of the University of Alabama School of Medicine. He is the first holder of the Gerald Leon Wallace Endowed Chair in Family Medicine at The University of Alabama College of Community Health Sciences. One of the foremost authorities on tobacco problems, Blum is the director of The University of Alabama Center for the Study of Tobacco and Society, which he established in 1999.

Links
1964 Surgeon General’s Report
University of Alabama Center for the Study of Tobacco and Society
Irwin Redlener’s Bio on Wikipedia
Alan’s stories and sketches of patients 
Alan’s website about an artist who was a patient for over 50 years at the state mental hospital in Tuscaloosa

Intro photos from Covering Cancer? exhibition at Center for the Study of Tobacco and Society

One of the most successful patient-artists was Auguste Forestier, hospitalized at Saint-Alban at the age of 27 after placing pebbles on a train track and causing a train to derail.  After his discharge from treatment, Forestier remained at Saint-Alban for the rest of his life, where he worked in the kitchen. He began to create toys for the children of hospital employees using discarded materials, even butcher’s bones.  In this exhibition we see not only a boat created by Forestier from scraps of wood but also a print of Tosquelles proudly holding up one of Forestier’s boats.  

The work of Saint-Alban artists came to the attention of French artist Jean Dubuffet, who, after reading the 1922 book Art of the Insane, had founded the Art Brut (also known as Outsider Art) movement.  Dubuffet’s attempts to collect it were at first greeted with skepticism by Tosquelles.  However, the success of Forestier (eventually he even came to the attention of Picasso) was such that the profits from his work were used to help fund the hospital.   

At its previous venues in Europe (the show originated in Barcelona) a larger number of pieces from Saint-Alban were displayed.  At its US venue, the show has been augmented with work from American asylums, which prove to be a highlight of the exhibition.  Even without a Tosquelles to inspire them, these patients created beautiful and fascinating art.  

We see, for example, a coat made by Myrllen, a schizophrenic patient from Tennessee.  The patient had reportedly worsened in response to such few treatments as were available at the time.  In desperation, she was given discarded rags and threads.  What she produced gives us a window into her condition, with strange words and figures whose meaning was known only to her.  Ironically, after making several such pieces the patient lost her creative impulse and stopped sewing once put on Thorazine, the first antipsychotic medication.   

Another piece, a watercolor entitled “An Antarctic Scenery,” is one of the earliest known American asylum paintings (c. 1816).  The patient-artist, Richard Nisbett, in his paranoid imagination has chosen to depict “a fleet of murtherous Pirates” invading Antarctica. Nisbett was a patient at Pennsylvania Hospital in Philadelphia under the treatment of none other than Benjamin Rush, often considered to be the father of American psychiatry.  

Although the exhibition closes in August, a book (which will be for sale at the Museum and online) is expected to be released in November 2024.  The link to a virtual conversation with the show’s curators is given here:  https://www.youtube.com/watch?v=s9j3fMn0xJA (1 hour 19 minutes).

Francesc Tosquelles is frequently mentioned in The Rebel’s Clinic, by Adam Shatz,  a recent biography of the psychiatrist, Frantz Fanon.

A Tosquelles Glossary from the Barcelona exhibition is also a helpful tool: https://www.cccb.org/en/exhibitions/guide/francesc-tosquelles/237849 

Illustrations: 

Auguste Forestier (1887–1958, France) Untitled (Boat), 1935–1949, Wood, fabric, metal, leather, nail, 29 1/2 x 45 1/4 x 9 1/2 in. Centre Pompidou, Paris, Musée national d’art moderne/Centre de création industrielle, ART BRUT/Gift of Bruno Decharme in 2021, AM 2022-43. 

Romain Vigouroux (active mid-20th century, France), Francesc Tosquelles on the Roof of a Building at the Saint-Alban Psychiatric Hospital, Holding a Sculpture by Auguste Forestier, 1947, Gelatin silver print, 7 x 4 7/8 in Collection Family Ou-Rabah Tosquelles. 

Richard Nisbett (1753 England-1823, United States) An Antarctic Scenery, 1816, watercolor.  Collection of The Library Company of Philadelphia.  

American Folk Art Museum  
Lincoln Square, New York, NY 10023
Folkartmuseum.org

Dr Ravi: Good afternoon and thank you for agreeing to be interviewed.  To begin, can you tell us something about yourself?

Dr Unni: I was Pulikkal Subran and Vilasini’s second son born in 1969. At that time Chettichal, the remote village in Thrissur district, Kerala, India where I was born, was a ‘pure’ village in the real sense, with all the features and richness of a remote countryside untouched by modernization.

Maybe I was destined to be alone while growing up. I grew up as an introvert. Spoke little; brooded always. Plants and flowers, bees and butterflies, birds and branches of sandalwood, dreams, and I – all grew up together. The silence was our language. Intimacy was our grammar. 

In 1986 I enrolled in the Government Medical College, Thrissur. Seven years after this (in 1993) was the most important phase of my evolution. I learned the simple truth that while friends are the greatest teachers of life and love, they are also, by the very nature of close friendship, able to “invade” your emotional and psychological space, to manipulate your thoughts, actions, and even perceptions of the world, sometimes even negatively.   At this time my tastes in the arts began to change; light music gave way to classical compositions and watercolors to oils and acrylics. Themes evolved from landscapes to surrealism, to abstraction and postmodernism.

Dr Ravi: What got you interested in the arts?

Dr Unni: Frankly, it was a natural activity for me, just like eating and playing, right from the earliest days I remember. I used to draw and paint from childhood days, continued it always. With more ‘education’, always informal, from my artist-teachers, the style changed, subject matter changed, and the materials changed. The most important change was the medium. My primary medium changed to photography from the late 1990s. I do paint even now, and make sculptures from found objects and granite, and create on-site installations. What keeps me attached to photography is its innate quality of making memories permanent, and its quality of refining my vision of the world.

Dr Ravi: You were a keen painter during your undergraduate medical days. Do you still pursue painting?

Dr Unni: Yes, I do. But I seldom exhibit. It remains mostly a private engagement. After opting for photography as my primary medium, I have been combining photographic printmaking with painterly practices like over-painting and over-drawing on photographs creating works of art that stay at liminal spaces, smoothening the distinction between painting and photography.

Dr Ravi: When and how did you get interested in photography?

Dr Unni: I got interested in photography around 1995, and I bought my first SLR camera a few years later; photography has occupied the major share of my expressive activities since then. At that time, it was my connection with nature and its beauty that attracted me to photography. I was always amazed by the transience of natural phenomena like light, the moon, and the monsoon. What attracted me was the fleeting moments in the natural world that had no permanence. I hoped to preserve those moments through photography. Later I understood that the transient moments must be transient to possess their innate elegance. This understanding took me to more of conceptual art photography wherein I had to tax heavily my imagination, execution, and labor-intensive processes in both analog and digital photography. Through this practice, I was trying to make my thoughts and memories into palpable objects that can last and stimulate me (and others) to make more meaningful art.

Dr Ravi: What were some key moments in your journey as a photographer?

Dr Unni: For a true photographic artist, every moment is a key moment, the only question being how sensitive he or she is in recognizing the true significance of the moment. As for my evolution as an artist, one significant point in time was my meeting with Mr. Vijayakumar Menon, an art historian and teacher, a relationship that lasted for decades until his passing a year ago. Some other people who influenced me as an artist were Mr. T.N.A. Perumal, a nature photographer and naturalist, and Mr. Theo Berends of the Netherlands, a fine art photographer. The single most important influence in my evolution was, and continues to be, my association and friendship with platinum photographer and photo-historian Mr. Herbert Ascherman Jr, of Cleveland, Ohio, USA. He mentored me in the nuances of black & white photography and analog photographic processes in his Cleveland studio. 

If you mean to ask about my achievements, I have had solo exhibitions in the Cleveland Museum of Natural History in the USA, the Film and Industry Museum in Germany, and a few group shows in Australia, the Middle East, and the UK, in addition to several venues in India. I received the title ‘Associate of the Royal Photographic Society’ from London in 2007 and a Senior Fellowship from the Ministry of Culture, Government of India, in 2013. Along with some of my friends, I founded PhotoMuse – the Museum of Photography in Kerala, southern India, in 2014, the first of its kind in the country. What I consider the greatest achievement is my contribution to mentoring a new generation of photographers in Kerala and beyond, imparting to them the same edge of a new vision that I owed to my mentors, through various academic activities of PhotoMuse over a decade.   

Websites by Dr. Unni Krishnan Pulikkal

www.unnipulikkal.art 

www.photomuse.in

Dr Ravi: How did the idea of the photography museum (PhotoMuse) come to you?

Dr Unni: My interest in the arts and its history has taken me to many museums around the world. Most of my journeys, especially those I did in the company of my mentor Herbert Ascherman Jr., always focus on art and photography museums. This allowed me to understand how important museums are to preserve our cultural legacy, to spread awareness about the cultural and humanistic significance of art, and to appreciate how significant it is to instill goodness in the human mind through art, music, literature and other cultural practices. This becomes especially important in a world filled with falsehood, negativism, antagonism, and violence. It was this realization that fuelled thoughts of setting up a museum of photography – the PhotoMuse – that can over time become a repository of photographic legacy and become a universally accessible tool to impart cultural education and spread awareness about the environment.

Dr Ravi: Can you share some interesting facts about the museum and its inauguration?

Dr Unni: The ‘museum’ was, interestingly, begun in a 50 square foot space (yes, you read it right – fifty square feet!) under the stairs of the Sneha hospital, with one staff, one computer and a small rack, in 2014. Soon, we shifted to a rented building and later moved to two other rented places over 10 years. In 2023 we purchased land, redesigned the existing building into a contemporary museum, and shifted to this new place in early 2024. The museum now holds more than 15000 objects of photographic history and is growing! It now has a board of trustees, and around 500 active subscribed members. Mr. Herbert Ascherman Jr. who underwrote the museum and is an advisor to the museum flew in on very short notice from the USA to India to inaugurate the museum on 10th March 2024. 

Dr Ravi: You have blended the modern and the ancient in your house. Can you share something on how you constructed the house? And how you maintain it?

Dr Unni: My house is basically built in a traditional South Indian design. It was made with locally available natural materials like laterite and wood, mostly reused wood sourced from other ancient houses. The only space that you could probably call modern is my studio where I have photographic equipment, and the paraphernalia for printmaking. It also doubles up as an acoustically designed space for music and movies. 

Dr Ravi: How do you balance your medical practice with your photography and artistic interests?

Dr Unni: Even though my formal training was in modern allopathic medicine, not art, I am living now as a part-time medical practitioner. I practice medicine half of the day, and art during the other half. It goes in a highly synchronous way because the basic undercurrent in both streams is humanism. Medicine heals mostly physical illnesses; art promotes mental wellness. The feel-good moments of art practice help me balance the stressful hours of medical practice. The goodness of art nourishes my mind, and cultivates a more humanistic culture within, helping me recognize patients as ‘human beings with a problem’ rather than ‘cases with beautiful findings’. 

Dr Ravi: You have an open-air art gallery at the entrance to your hospital. Can you mention more about this gallery?

Dr Unni: Yes, the Open Art Gallery in a hospital is something rare in India, I think. It is a project by PhotoMuse Museum and sponsored by the hospital.  It was established in memory of Vijayakumar Menon, an advisor of the museum right from its inception. The gallery holds photographic and art exhibitions around the year, accessible 24 hours a day to the patients, bystanders, and the public at large. In addition to this, the hospital exhibits various works of visual art on its walls. Together, these works of art create a soothing ambiance that calms and eases ailing minds.

Dr Ravi: What are your future plans for the museum?

Dr Unni: We are trying our best to broaden its activities, enlarge its already good collection, widen its reach to different strata of society, and, if possible, rebuild the museum with more space and amenities.

Dr Ravi: How do you think arts should be incorporated into the medical curriculum in Kerala?

Dr Unni: Fascinating and relevant question! Medical professionals need to be exposed to more cultural spaces of the country to broaden their humanitarian outlook and increase their understanding of how people engage with that cultural space. This exposure to the humanities will strengthen medical professionals’ ability to make sensible diagnoses based on peoples’ socio-cultural backgrounds and deliver treatment with humanism at heart and hand.

Dr Ravi: Any other points from your side?

Dr Unni: As part of broadening my cultural activities, I have stepped into another new art project. In addition to the PhotoMuse Museum which holds my photographic collections, I am curating another art museum at Kodakara in Kerala. The Art Museum of Love, which opened for public viewing on June 10th, 2024, holds and exhibits most of my art collection. It is based on the theme of LOVE, and consists of pieces which I have collected over the last 25 years, including paintings, sculptures, photographs, fabrics, and more. I hope this museum will help more people understand the value of the emotion we call love with a vast spectrum of intertwined emotional threads, including friendship, parental love, romantic love, and sexuality.

Happiness to you!
Unni

Dr. P. Ravi Shankar was a classmate of Dr Unnikrishnan at the Government Medical College, Thrissur, Kerala and lived in the same residence hall with him. He has long been fascinated by Dr Unni’s work and visited him at his home in December 2023. 

Webphoto: Jodhpur Royal family, c.1910, Albumen Print, 300×260 mm, Unknown Photographer, PhotoMuse Collection

A Tale of Two Museums  

Ravi Shankar Mar 4, 2025

Unni, a talented artist and photographer, founded two unique museums in Kodakara, Kerala, celebrating love and photography.