Hektoen International

A Journal of Medical Humanities

Medicine’s “Naming of the Parts”: Less instrumentalism and more aesthetics?

Alan Bleakley
Plymouth, United Kingdom

The English poet Henry Reed first published “Naming of the Parts” in 1942. English schoolchildren of my generation, born soon after WWII, learned this poem by heart. But we were too young to know, and perhaps our English teachers failed to notice, that the poem is full of sexual innuendo. Ostensibly, the five-stanza poem is about the standard issue Enfield rifle and its component parts:

And this you can see is the bolt. The purpose of this
Is to open the breech, as you see. We can slide it rapidly
Backwards and forwards: we call this
Easing the spring.

As each part of the rifle is named, so it is compared with features of nature in the springtime—a pun on “Easing the spring”:

And rapidly backwards and forwards
The early bees are assaulting and fumbling the flowers:
They call it easing the Spring.

The poem is an anti-war manifesto as it celebrates the pastoral idyll away from the battlefield or the training ground. But the sexual double meaning is in plain sight. Why does this matter? The poet’s genius is in turning outwardly plain information (the purpose of the bolt is to open the breech) into meaning, through metaphor and allusion—again, as innuendo (easing the spring/Spring).

Here is another sex story. Seahorses, surely amongst the most graceful of animals, enjoy a unique mating process where it is the male who becomes pregnant and gives birth. This comes after an extraordinary courtship dance where the female transfers her eggs to the brood pouch of the male. It is here that the male both fertilizes the eggs and incubates them until they hatch, then gives birth to fragile, miniature seahorses. Here is the downside of the story: emboldened by the second-term US President Trump administration’s support of widespread book banning across America for titles describing, for example, same-sex relationships or initial sex education for children, one right-wing group in Tennessee attempted to ban a book on seahorses where it contained images of the animals mating.1 One can only guess what horror these people must have experienced in discovering that it is the male seahorse who gives birth. Henry Reed’s poem and frolicking seahorses cannot be reduced to purely technical or instrumental events. They necessarily invite ethical, gender-political, and transcendental (affording meaning such as awe and wonder) readings; but, above all, they summon aesthetic readings as appreciation of beauty and form.

Early-year medical students formally study neither poetry nor the sex life of seahorses, but are immersed in learning biomedical knowledge that informs future clinical practice. Such pedagogy is prone to reduction to technical information through an instrumental values lens as education is reduced to training.2 Here, to draw on the poet T.S. Eliot’s3 distinction, knowledge is reduced to “information,” rather than expanding to embrace “meaning.” We are all too familiar with this in the information age, where attention span is brief and sound bites are circulated. In this climate, curriculum (the overall course of study that has a strong informal component and shapes an identity) is reduced to functional units, as syllabi. As for the outcomes of learning, capabilities (how learning may flower in the future) are trumped by here-and-now exhibitions of competences, or “good enough” performances. Where thinking (the cognitive domain of rational judgment) and doing (the sensorimotor domain of practices) are seen to be central to learning, the affective domain of emotions (often characterized as irrational) and the intuitive domain (such as use of the imagination and abductive reasoning) are sidelined. In short, learning is typically skewed—by design—towards the reductive instrumental, thereby again sidestepping the critical values of the ethical, aesthetic, political, and transcendental.

The Swiss zoologist Adolf Portmann (1897–1982) was a shining example of a natural scientist who favored form (the morphological) over function.4 Portmann’s rallying cry was “nothing useful”—referring, for example, to the superfluous singing of birds beyond the instrumental purposes of marking a territory or attracting a mate, as singing for its own sake (including improvisation). Television natural history programs are dominated by neo-Darwinian tropes. Here, self-presenting animals are stereotypically described as engaging in either territorial or mating behaviors, where their outward expressive forms—for example as colorations, movements, and calls—are reduced to functions serving evolutionary survival. Portmann saw function as important, but secondary to and embedded in form as the primary semiotic medium that he termed “expressive properties” of animals. Medical students globally are introduced to anatomy typically through cadaver dissection rather than study of expressive properties as surface and living anatomy, turning a potentially aesthetic learning experience into an instrumental anesthetizing.

Portmann says of stereotypical functional views of animal patterning: “Coloration is seen as signalling … or it is observed as camouflage apparel” rather than appearing for its own sake as self-expression.5 What is our “natural” response to a peacock’s tail? Surely it is one of appreciation and wonder, placing form before function. And what do we make of the spectacular array and display of deep-sea animals showing coloration and patterning from the subtle to the sublime and baroque? Show an array of pictures of such animals to ordinary folk and their response is aesthetic—again, wonder and appreciation. However, articles written by marine zoologists on such deep-sea creatures explain all colorations (or lack of expression in transparent bodies) in terms of “camouflage apparel.” As Portmann says: “The functional interpretation has become more and more inclusive and … has come to dominate the entire view of living form.”5 Form follows function, rather than the obverse. Neither is Portmann seduced by the translation of morphological characteristics into informational schemes such as classifications or taxonomies (“a systematic survey of all the known animal species”).4 Rather, he is concerned with animals in terms of morphology, as “the special nature of their visible appearance.”4 Such “self representation within the realm of appearance”6 extends to the animal’s relationship to its environment, including its own species and other animals.

The often spectacular murmurations of starlings are typically described by ornithologists as a survival strategy, offering protection from predators who find it difficult to pick off an individual bird from a rapidly moving flock. But, drawing on Portmann’s mantra of form before function, or appreciation before explanation (the aesthetic impulse), what does the naïve eye see but a wonderful aesthetic event? To this we can add expressions of play among young animals that outstrip functional purposes such as social bonding or learning dexterity. Chris Woolston, noting that the dominant theory “is that play helps animals learn important skills” points to a counterargument, where:

… experiments haven’t borne this out. A 2020 study of Asian small-clawed otters living in zoos and wildlife centers found that the most dedicated rock jugglers weren’t any better than their non-juggling friends at solving food puzzles that tested their dexterity, like extracting treats jammed inside a tennis ball or under a screw-top lid.

… kittens that grow up surrounded by cat toys aren’t especially successful hunters as adults, and playful juvenile meerkats aren’t any better as adults at managing territorial disputes.7

In contrast, for humans, play has long been seen by psychoanalysts as functional rehearsal for cooperative social exchange, where hard-line authoritarians have been seen to have been deprived of, or unable to successfully engage in, play as children.8 But Woolston concludes that: “Play is fun, and fun is good”7 or Portmann’s “nothing useful.”

Yet functional thinking drives us to imagine that what is “fun” is also superficial, even superfluous, rather than essential. But what is essential to learning is beyond instrumental necessity. Again, life urges deep engagement with ethical, aesthetic, political, and transcendental values. In a standard medical education, the first two years are typically centered on learning pure and applied biosciences: anatomy, physiology, biochemistry, pathology, microbiology, and pharmacology. There is a danger that this complex is taught as instrumental and formulaic, or purely fact- and information-based, as these subjects extend to areas such as clinical reasoning and clinical applications. A further danger here is that linear models dominate over complex thinking. The latter sees bodies as Portmann did, as expressive actors situated in an ever-changing umwelt or immediate environment that affords bodies certain possibilities, and closes down other options. He learned this from the work of the German biologist Jakob Johann von Uexküll (1864–1944).9 Now, we describe such body-relations within an umwelt as the interfunctioning of dynamic, open, complex, adaptive systems with a number of more-or-less stable attractors. Thus, for example, life expectancy risk from a range of respiratory disorders is embedded in a complex set of environmental affordances such as dampness in housing and high air pollution.

While science, to many of those who study it (my academic background was originally in zoology), is patently an art or has evident aesthetic contours, to others science is coldly objective and reductionist. Thus, for example, seeking objective fact in science is typically through controlled experiment—either testing extant hypotheses generated by a theory through gathering evidence (deductive reasoning), or making specific observations under controlled conditions and deriving a theory from those observations (inductive reasoning).

But there is also the art of abduction, first introduced by the philosopher Charles Sanders Peirce as “best available” possibility, or “best guess” from observation.10 Such thinking is backed up by aphorisms such as “when you hear hoofbeats, don’t imagine zebras.” In other words, stick with the most likely explanation. However, this may be wrong. The finer art of diagnostic observation requires educated sense and sensibility, seeing the person’s aesthetic self-display in the wild. For example, a child may be diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) when they have a Functional Vision Disorder (FVD), diagnosed through a functional vision examination carried out by a qualified teacher of the visually impaired. “Functional” misdirects here, because this distinction between ADHD and FVD can be fine, and both conditions may be expressed in the one child. Such testing can be framed as instrumental, but this misses the primary importance of the aesthetic eye. We need medicine to embrace aesthetic form, and medical education to champion aesthetic values beyond the purely functional, following in the footsteps of Adolf Portmann.

References

  1. Ovenden R. “There is no political power without power over the archive.” The Observer, July 13, 2025; p. 10.
  2. Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, Power and Location. Dordrecht, Springer.
  3. Eliot TS. The Rock. London: Faber & Faber, 1934.
  4. Portmann A. Animal Forms and Patterns: A Study of the Appearance of Animals. London: Faber and Faber Ltd., 1952: p.12.
  5. Portmann A. What Living Form Means to Us. Spring: Archetypal Psychology, Jungian Thought. 1982, 27-38, p. 29.
  6. Portmann A. The Orientation and World-Relation of Animals. Spring: Archetypal Psychology, Jungian Thought, 1986: 1-15, p. 2.
  7. Woolston C. The puzzle of play. Knowable magazine, March 30, 2021. Available from: https://knowablemagazine.org/content/article/mind/2021/why-animals-play
  8. Winnicott DW. Playing and Reality. New York, NY: Basic Books, 1971.
  9. von Uexküll, JJ. A Foray into the Worlds of Animals and Humans: With a Theory of Meaning. Minneapolis, MI: University of Minnesota Press, 2010.
  10. Fann KT. Peirce’s Theory of Abduction. Singapore: Partridge Publishing, 2020.

ALAN BLEAKLEY is Emeritus Professor of Medical Education and Medical Humanities at Peninsula School of Medicine, University of Plymouth, UK. He is Past President of the Association for Medical Humanities and author of over 20 books on medical humanities in medical education. He has an international reputation as a scholar and is a widely published poet. 

Summer 2025

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