Exploring the Connections between the Medical Sciences and Art (Part 1)

2022/02/17

Masayuki Amagai　Dean, Keio University School of Medicine (Title at that time)

Professor, Department of Dermatology

Yoichi Kitayama　 Guest Professor (Part-time), Faculty of Environment and Information Studies,

Keio University

The Gospellers

Yohko Watanabe　 Professor, Keio University Art Center

Vice Director, Keio Museum Commons

(Names listed in alphabetical order by last name)

Amagai: I was hoping to meet and talk in person, but due to the recent state of emergency, we’ve had to move the discussion online.

This is my fourth year as dean. For some time now, I have wondered if it might be possible to incorporate a little artistic spirit into the world of medical care and education. The ongoing COVID-19 pandemic has heightened this desire, as the campus and hospital have become increasingly sterile. That sets the scene for our conversation today.

Each of us has a different background, and I hope that this talk will lead to ideas that we might never have hit upon alone.

May I ask you to introduce yourselves? I’d like to start with Faculty of Environment and Information Studies Guest Professor Yoichi Kitayama, who is also a member of the Gospellers.

Kitayama: I entered Keio University in 1992, and joined the Gospellers as an undergrad. It took a few years, but I managed to graduate in 1998. Now, in addition to my professional duties as a singer, my friends and I perform regularly as part of an a cappella group in Miyagi Prefecture, which suffered extensive earthquake and tsunami damage in 2011. Since 2012, I have been a faculty member at SFC—Keio University’s Shonan Fujisawa Campus—and while music is my profession, I am also interested in the role that music plays and what it can teach us about society as well as in the relationship between music and education. In fact, I am going to try and take the entrance exam again this May in hopes of entering a graduate program at SFC. My goal is to complete my master's thesis in music by the time I am 50.

Amagai: That's wonderful. For us at the School of Medicine, SFC is a place of exploring the unknown, so could you speak to the atmosphere on campus?

Kitayama: I'm originally from Aomori Prefecture, but I lived in Tokyo when I was a student. It used to take me three hours to get to SFC, so sometimes I would stay on campus overnight to enjoy the atmosphere there instead of going home. I loved computers, so as a college student, I focused all my energy on programming.

When I was going to school, even going to a convenience store was a trek. I think the environment has improved a lot in recent years, but one thing that hasn't changed is that on rainy days, you can still smell the “aroma,” shall we say, of livestock from the nearby farms. I love how green the campus is, too.

My entrance exam consisted of math and essays. Perhaps due in part to the small number of subjects on the entrance exam, I think many SFC students have a particular field that they are exceptionally skilled in. Sometimes the on-campus atmosphere was such that the most interesting or funny person was also the most successful. There was great tolerance for diversity on campus, and people were willing to try new things that seemed interesting.

I joined an a cappella club at Waseda University during my third year, and from then on, singing practice took up all of my time. This made it hard to go to campus, but somehow I still managed to graduate.

When I joined the Gospellers, I was just filling in, so I thought I would just enjoy the music with the Gospellers for a while and then go back to my lab eventually. But as it turned out, I never did go back.

Amagai: So that’s what happened. I’d like to talk more about this later, but next I’d like to turn to Professor Watanabe.

Watanabe: I went to a public high school in Tokyo and majored in art history at Keio. I then went on to graduate school, which I completed in March 1988. After that, I worked at an art museum for about 18 years, and in 2006 I returned to the Keio University Art Center research institute.

While I was still in graduate school, I was hired as a curator at the Tokyo Metropolitan Art Museum, where I continued to work while I wrote my master's thesis. I thought the museum would be understanding of my situation and limit my workload, but that turned out not to be the case. I spent my days writing my thesis in the middle of the night, working on it on the train in the morning, and revising it on the train on my way home after work.

I majored in modern art during university, but since getting a job at the Tokyo Metropolitan Art Museum, I have worked mainly with contemporary art. I really enjoyed my work at the museum when I joined at age 26. It was my dream job. In fact, my father once reminded me that I never used to study in high school and that I was too busy with events like school festivals. He remarked that my job at the museum was exactly the thing I loved doing in high school. It was hard work at times, but there were so many exciting things about the museum that I enjoyed working there. So when Keio University asked me to come back, I might have been hesitant if all I had to do was conduct research and give lectures. But since the Art Center is a research institute where I get to do a wide range of creative work such as organizing events and exhibitions, I jumped at the opportunity.

I’d like to talk about how I met Prof. Amagai through my work at the Art Center and how that led to the inspiration for the discussion we’re having here today.

Watanabe: In 2017, We organized a project called "The Coming and Going of Keio University Shinanomachi Campus" to exhibit the many photographs we took of the buildings on Shinanomachi Campus. One of the initiatives of the Art Center is "Architecture at Keio,” where we take photographs of Keio buildings before they are demolished, some designed by notable architects such as Fumihiko Maki. At Shinanomachi Campus, existing buildings are still being torn down to make way for a new hospital building, and other new buildings are being constructed. At the time of the exhibition, nine of the eleven buildings we had photographed had been demolished and no longer existed.

One day I was walking barefoot around the gallery space looking at photographs on the floor to decide how best to arrange them for the exhibition when Professor Amagai called out to me... It was the first time I'd met him.

We put up very large photos—about 2 meters tall by 1 meter wide—on the outer glass wall of the Institute of Integrated Medical Research building, allowing people walking outside to see them.

The first place we went to shoot for this project was the University Hospital Annex, a building built in the early Showa period. We were able to photograph this building, which was originally used as a hospital ward, just as it was being torn down. Since then, whenever a building is going to be demolished, I am always asked to come and photograph it.

Unlike Keio’s other campuses, Shinanomachi is also home to a hospital. This means we can't take any pictures when patients are present. Buildings are interesting in that once they are empty, they become dead spaces. The timing is extremely difficult to get right because shooting is limited to the moments just before everything in a building gets removed.

Amagai: In “The Coming and Going of Keio University Shinanomachi Campus,” the buildings were illuminated in the frame of the photograph, and the light and shadows came together to make very powerful images. The space where the photos were displayed in the Institute of Integrated Medical Research was exactly what I wanted at Shinanomachi Campus—a space where people could come and go as usual, but when they happened to look around, they encountered a piece of art that made a subtle impression on them.

I think the fact that you created a space that facilitated such daily encounters at Shinanomachi Campus had a huge impact on many people.

I vividly remember when you were spreading out the photos on the floor, and just when I walked by, I was instantly drawn in by your smile and enveloping warmth.

Watanabe: Speaking of my relationship with hospitals, there’s one more thing I’d like to mention. I lost my mother last year. When she passed away, we didn't even know if she had tested positive or negative for COVID-19. I had to wait outside the hospital room when the ventilator was removed. This experience made me even more eager to speak more with you, Professor Amagai, since you are working on the front lines of medicine.

Someone close to me is currently hospitalized with a brain tumor, and I just learned that Professor Kitayama has also suffered from a brain tumor as well. It feels like fate that I am able to speak with you both today.

Amagai: Professor Watanabe mentioned brain tumors, so Professor Kitayama, could you share with us your thoughts, what your experience has taught you, and your expectations for medical professionals?

Kitayama: I didn't have any symptoms so the tumor came as a total surprise. At first, I thought it might be the flu because I felt chilly. When I went in for a CT scan of my upper body, they found a lemon-sized tumor in my brain, and I wondered how I hadn’t noticed it before. Fortunately, it was benign and I had surgery to remove it.

I still have numbness in half of my head, but apparently, this is a mild symptom of trigeminal neuroma. I was told that my pupils had become extremely dilated, so speaking from the experience of someone who was once half-dead, I believe that my life now is an encore performance. Since then, I've been putting everything I have into who I am right now. As for my body, I have stopped pushing myself to work too hard. So even if I do miss an opportunity, I now think that it was simply meant to be. I am able to allocate my energy better, and I feel like I am living with a sense of clarity.

I was once bedridden and couldn’t even walk, but my recovery process was fascinating. In fact, when I walked outside for the first time after leaving the hospital, I fainted after about a kilometer of walking on some uneven ground. I slept on the couch for three or four hours and woke up feeling great, and my legs could move freely. Perhaps my brain had panicked and collapsed, and then it reconstructed itself and came back to life. It was exhilarating to experience something like that with my own body.

I once read a book about a brain scientist who had a stroke and recovered from having lost his memory and the ability to count and thought something similar was happening to me.

I love being able to do things that I couldn’t do before, so I feel that I have been given many such moments like this in my life.

Amagai: As a medical professional, I think it's important to stay healthy and overcome illness. But it's also important to be able to live with an illness rather than constantly struggling to drive it away. I’ve also been hospitalized several times, and listening to what you just said, I am reminded again that it is important for us to learn from our illnesses—not to push ourselves too hard, for example—and to live with our illnesses as we age through our 50s, 60s, and 70s.

Amagai: The current medical system in Japan has both strong and weak aspects.

The current insurance system is based on the assumption that an otherwise healthy person comes into the hospital with a single disease. That means if a patient has more than one disease, the hospital can only charge the government for the costs to treat one disease. However, elderly patients often suffer multiple ailments. Keio University Hospital's philosophy is to provide patient-centered health care, so it's difficult for the hospital to manage treating multiple diseases at once.

The good aspect of Japan's universal insurance system is that it provides equal medical care to all citizens. But we are now living in an era where a single patient may be living with multiple diseases, so I think the question is how the insurance system can respond to this change.

Kitayama: I had no idea that this was a current issue.

Amagai: Some say that hospitals should be turned into corporations to become more efficient, but what would that lead to under the current insurance system? Hospitals might only provide treatments that are profitable. I am concerned about introducing a profit motive into the world of healthcare.

Kitayama: For example, with medical specialization, it’s efficient to rely on a specialist to do something a doctor might be unable to do. But I think there are many instances in society at large where the original reason for this division of labor has been forgotten, which in turn makes things more complicated. Even in the fundamental fields of medicine, things that are happening now are totally different from what was originally envisioned. From my point of view, I wish things could be a little more integrated...

Amagai: This is a slightly different topic, but the current medical system is based on organ-specific medical care, such as cardiovascular medicine for the heart, respiratory medicine for the lungs, and so on. But I believe that in the next 50 years, this system of classifying medical care by organ may not necessarily last.

There are fields where this is already happening. One example is the treatment of cancer in the oncology field. In the past, if a patient was diagnosed with cancer, the patient would be treated by whichever department specialized in the organ that had cancer.

But with chemotherapy, the same drugs may be used to treat different organs. In oncology, we are moving beyond an organ-by-organ approach. The same is true in the world of inflammation. Inflammation in the joints causes rheumatism, inflammation in the intestines causes ulcerative colitis, and inflammation in the skin causes psoriasis, but molecular targeted therapies that stop inflammation are effective across organs, no matter which organ the inflammation is in. So we now know that we don't necessarily need to consider each organ individually when planning treatment, rather we can simply target the molecules that are common to the illness.

The separation of medical care into departments based on organs may have been efficient in the past, but I think it might actually be a hindrance moving forward. Classifications and division of labor may have to evolve with the times. It is difficult to completely transform the existing medical system, but in terms of medical science, I feel that the organ barrier has essentially disappeared and we have reached a new paradigm for classification.

Watanabe: I think it's the same in the art world. Around the 1980s, even in contemporary art, artists were divided into different specialties such as painters, sculptors, and installation artists. Nowadays, contemporary artists work in both oil paints and 3D, so there is no longer any classification of artists by material. Twenty years ago, no one expected that these classifications would disappear.

I think it would be difficult to totally reclassify fields of medicine, where human lives are at stake, but it certainly can happen in art. Genre distinctions are also becoming less important in music, aren’t they? Listening to Professor Amagai, I feel that art and medicine possess a similar kind of dynamism.

Kitayama: The same is true in the world of music, where people move between genres with ease and where different genres are becoming more and more integrated. There are videos on YouTube of one person playing multiple instruments all by him or herself. We live in an age where the number of things we can do is increasing dramatically due to advances in technology and information sharing. I, too, think that the art world is not entirely the same as medicine, but they have similar structures.

Amagai: In the days when we weren’t aware of individual organs, they were lumped together as a single component. After we were able to classify specific organs, we were able to treat each organ individually. This approach has lasted a very long time, but we may have finally come back around to the idea of transcending individual organs. Art and medicine are the same in that they both have long histories that are full of major waves of change, and a human life is but a short part of those histories. So it is very exciting to be able to witness moments when we can deepen our understanding of things we encounter in our time as we shift to the next paradigm and look ahead to the next big ideas.

Continued in Part 2