Showing papers in "Literature and Medicine in 2006"
TL;DR: The aim in this essay is to explore the variety of textual representations deployed in case reports and to suggest that the plurality of past forms licenses renewed experimentation in the writing of clinical case reports today.
Abstract: The clinical case report is a literary tool that enables clinicians to depict and think medically about a sick person's situation. Composed for the most part as chronologies set out as observations, case reports are marked by various forms of literalism contrasted with more expressive forms of writing. In this way, they adopt literary framings and dramatic devices to help to convey the patient's overall situation and the physician's reaction to it. Encoding the clinically essential for the purposes of record, demonstration, and communication, the shape and emphases of case reports today build on, and contribute to, a long train of developments in medical theory, practice, and case description. My aim in this essay is not to suggest a single unbroken continuity between past and present case reports, but rather to explore the variety of textual representations deployed in their composition and to suggest that the plurality of past forms licenses renewed experimentation in the writing of clinical case reports today.
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TL;DR: It is suggested that the literary model of close reading might helpfully illuminate interpretive anxiety as a problem facing both physician and patient and three ways that medicine might think about challenges to its hermeneutic security are considered.
Abstract: This essay considers hypochondria not as a psychiatric diagnosis but as a hermeneutic position: a consequence of attending to the uncertainty of being an embodied human; an anxious skepticism; a resistance to reassurance based on an arguably too-close reading of body and self. Medicine commonly rejects such interpretation in order to reduce the potential proliferation of meaning to those signs it can interpret in diagnostically and therapeutically useful ways. I suggest that the literary model of close reading might helpfully illuminate interpretive anxiety as a problem facing both physician and patient, and I consider three ways that medicine might think about challenges to its hermeneutic security: pathologizing the uncertainty and "hating the hypochondriac" patient; attempting to override uncertainty with additional information; and, finally, imaginatively inhabiting the patient's anxiety and working within it, through the recognition that medicine itself is a hermeneutic and potentially hypochondriac enterprise.
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TL;DR: This essay assumes the possibility of establishing a fruitful mutual relationship between narratology and autobiographical illness narratives, and focuses on several ways in which the latter illuminate, and sometimes problematize, central notions in narratological and narrative theory.
Abstract: This essay assumes the possibility of establishing a fruitful mutual relationship between narratology and autobiographical illness narratives. Within this relationship, it focuses on several ways in which the latter illuminate, and sometimes problematize, central notions in narratology and narrative theory. The main issues explored are 1) the complex interaction between the collapse of the body and that of the narrative, and its implications for the interplay between order and contingency; 2) the resistance of a disintegrating body to both verbalization and narration, as well as its paradoxical articulation in language and narrative; 3) the potential undermining of the author-reader "contract" by a blunt narration of disturbing physical details; and 4) the ethical and psychological risks involved in texts where flesh-and-blood readers are also (fictional?) characters, and the pain, misunderstandings, and erasures such implicated readers may experience in the reception.
23 citations
TL;DR: This essay uses the stories contained in these accounts to study individuals' perspectives on the emotional experience of becoming a physician and demonstrates how physicians in training must often struggle alone to understand and incorporate their physical and emotional vulnerability into their sense of themselves as physicians.
Abstract: Between 1965 and 2005, over forty books about medical education were published. This essay uses the stories contained in these accounts to study individuals' perspectives on the emotional experience of becoming a physician. In particular, it examines the ways in which experiences has registered themselves on—and in—the very bodies of these men and women. It examines the authors' uses of metaphor, sensory imagery, and physical descriptions in ways that underscore their own feelings of uncertainty and vulnerability. Finally, it demonstrates how physicians in training must often struggle alone to understand and incorporate their physical and emotional vulnerability into their sense of themselves as physicians.
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TL;DR: More representations of ovarian cancer in public and popular culture, as well as images that appeal to a wider range of sensory experience, may help the problem of late-stage diagnosis by producing greater practical awareness of the ovaries and ovarian disease.
Abstract: Ovarian cancer is the deadliest of all gynecological cancers. Diagnosis is often late-stage when the disease has spread and is harder to manage. Primarily non-visual and sometimes ambiguous early symptoms are exacerbated by the rarity and metaphoric/metonymic character of representations of the ovaries or ovarian disease in television, film, and literature. More representations of ovarian cancer in public and popular culture, as well as images that appeal to a wider range of sensory experience, may help the problem of late-stage diagnosis by producing greater practical awareness of the ovaries and ovarian disease.
21 citations
TL;DR: It is argued that nineteenth-century clinical case histories were porous forms created by diverse and probably irresolvable pressures, and competing functions as both dramatic narratives and assemblies of clinical data—or, to use metaphors common during that period, the world of the theatre and of the granary.
Abstract: Nineteenth-century medical stories are commonly interpreted within one of two frameworks. The first derives from the work of Michel Foucault, especially his early book The Birth of the Clinic: An Archaeology of Medical Perception, now over forty years old. Foucault describes nineteenth-century medicine as the triumph of an objectifying rationalism that accompanied dramatic professional and institutional transformations. Doctors became certified experts who subject patients to a dispassionate, objectifying "gaze"; individual patients became types or exemplary "cases"; normalcy, rather then well-being, became the goal of treatment; and diagnosis was increasingly offered by probabilistic, taxonomic, or formulaic assessment rather than by personal inquiry. In short, nineteenth-century clinics installed structures of power and attitude that resembled other Victorian institutions, such as prisons, governmental agencies, workhouses, and so on. The outcome, Foucault argues, was an epochal shift in the understanding of medical language, professional attitudes, and regimes of treatment that continues today. The second framework derives from the clinical neurologist Oliver Sacks, author of Awakenings, The Man Who Mistook His Wife for a Hat, and An Anthropologist on Mars. In these books, Sacks provides dense and sympathetic case histories of grave neurological dysfunction. For him, the language of medicine in the nineteenth century reveals something rather different from that revealed to Foucault, something lacking in modern technocratic medical reportage. In
TL;DR: This essay examines the changing conventions in anatomical illustration over the course of the nineteenth century, focusing on the difficulties of representing the dead human face.
Abstract: From the sixteenth to the early nineteenth century, the dominant tradition of anatomical illustration was strangely dynamic and expressive, featuring scenes such as skeletons striding through pastoral landscapes, deeply dissected corpses smirking seductively, or cadavers participating in their own dissections By the end of the nineteenth century, anatomical illustrators embraced a more straightforward project: representing the physical body, shorn of agency, individuality, and personhood This essay examines the changing conventions in anatomical illustration over the course of the nineteenth century, focusing on the difficulties of representing the dead human face The face is decidedly both visual—an expressive object to be seen—and textual—shaped by a history, a series of experiences arranged by consciousness as narrative This doubleness not only makes the face a difficult site for modern anatomical illustration but also gives the face its ethical charge
TL;DR: This essay examines mesmerism as a form of holistic healing for Fuller, tracing her journey from a woman encumbered by intense pain to a woman who celebrated her magnetic female body and the spiritual liberation it afforded.
Abstract: In Woman in the Nineteenth Century (1845), the American feminist Margaret Fuller promoted the "magnetic" element of the woman as a source of liberation and empowerment. During the time that she was composing this work, animal magnetism, or mesmerism, was a popular form of medical treatment in America and Europe. Fuller suffered chronic pain from intense headaches and spinal curvature, and her letters and essays indicate that she found relief in magnetic treatments at a time when women were thought to be particularly susceptible to the mesmeric trance. Fuller's experiences with mesmerism not only provided a remedy for her physical ailments but also contributed to her theory of feminism. This essay examines mesmerism as a form of holistic healing for Fuller, tracing her journey from a woman encumbered by intense pain to a woman who celebrated her magnetic female body and the spiritual liberation it afforded.
TL;DR: This essay explores how the inherent characteristics of narrative film can provide fresh and sometimes surprising access to viewers' affective lives as dissociative barriers are temporarily relinquished.
Abstract: Taking a cue from Arthur Frank's model of reading, this essay proposes a "thinking with" mode of engagement with narrative film, with the implicit aim of developing a pragmatic application for film viewing in narrative medicine. Few approaches to film take the feelings that attend or that are provoked by film seriously, despite the fact that emotions elicited while watching film feel very real to us. These are emotions with depth, emotions we have felt before, and are inexorably attached to specifics within the narratives of our own lives. This essay explores how the inherent characteristics of narrative film can provide fresh and sometimes surprising access to viewers' affective lives as dissociative barriers are temporarily relinquished. Viewers' attention to inner processing of their viewing experience may be usefully employed to gain greater access to processes of valuation and what Cathy Caruth terms "unclaimed experience," if we take time and attend, and if we develop techniques and skills for doing so.
TL;DR: Drawing upon queer theory, this paper examines the heterosexual assumptions that underlie bioethics case narratives, finding that these case narratives reproduce rather than challenge the hetero-narrative pattern of the authors' culture's stories.
Abstract: Drawing upon queer theory, this paper examines the heterosexual assumptions that underlie bioethics case narratives. These case narratives identify few individuals as having same-sex desires; it is only when homosexuals become dangerous to the straight community that they are "displayed" in bioethics cases. The perspective of same-sex desire as dangerous can be seen not only in the explicit content of these narratives but also in the sexual orientation that is implied of the reader of bioethics. In the end, bioethics case narratives reproduce rather than challenge the hetero-narrative pattern of our culture's stories.
TL;DR: This essay will use narrative cinema—Charlie Kaufman's unusual 1999 film Being John Malkovich—as well as the disciplines of oral history and trauma studies, to expand the frame around medicine's understanding of truth in illness stories.
Abstract: In the context of evidence-based science, where all truth has become knowable though rigorous experimentation and interpretation, the ambiguity and complexity of patient stories render them too often at the margins of medical practice. Stories that are not corroborated by "scientific evidence" are "false" and their tellers deemed "bad historians." In the increasingly technical world of medicine, this logic is in danger of becoming extended to almost all patient stories. Efforts in medical education to honor stories of illness must grapple with the profession's vexed expectations of veracity in patient narratives. This essay will address the issues of truth, representation, and story in medicine with the goal of complicating medicine's understanding of patient narratives. This essay will use narrative cinema—Charlie Kaufman's unusual 1999 film Being John Malkovich—as well as the disciplines of oral history and trauma studies, to expand the frame around medicine's understanding of truth in illness stories.
TL;DR: It is suggested that the Great Moments series of commercial paintings produced by Parke, Davis and Company between 1948 and 1964 offer important lessons for thinking about the historically embedded beliefs painted into the many pharmaceutical advertisements that confront present-day doctors, patients, and other consumers.
Abstract: This essay sheds light on present-day pharmaceutical advertisements by looking back to an important early chapter in pharmaceutical company–sponsored promotion: the Great Moments in Medicine and Great Moments in Pharmacy series of commercial paintings produced by Parke, Davis and Company between 1948 and 1964. Beginning in the early 1950s, Parke-Davis delivered reproductions of the Great Moments series to physicians and pharmacies throughout the United States and Canada and funded monthly pull-out facsimiles in key national magazines. The images also appeared in calendars, popular magazines, and "educational" brochures. By the mid-1960s, articles in both the popular and the medical press lauded the Great Moments images for "changing the face of the American doctor's office," while describing the painter, Robert Thom, as the "Norman Rockwell" of medicine. Our analysis uses source material including popular articles about the Great Moments series, existing scholarship, previously unexamined artist's notes, and, ultimately, the images themselves, to explain why these seemingly kitschy depictions attained such widespread acclaim. We show how Great Moments tapped into a 1950s medical climate when doctors were considered powerfully independent practitioners, pharmaceutical companies begged doctors' good graces, and HMOs and health plans were nowhere to be seen. The article concludes by suggesting that the images offer important lessons for thinking about the historically embedded beliefs painted into the many pharmaceutical advertisements that confront present-day doctors, patients, and other consumers.
TL;DR: It is concluded that healing narrative enhances the capacity to embrace radical change and to balance memory, imagination, and the here and now.
Abstract: The intersection of narrative and medicine has long been a compelling place for research, practice, and theory. Current conceptions of this relationship focus, as Rita Charon puts it, "on the fully envisioned plight of each patient, of each caregiver, of each institution of health care, and of the whole society that suffers and that tries to heal." Because narrative has become so important to the medical humanities, looking at narrative critically may help practitioners see ways in which narrative can both engender and deflect healing. An analysis of trauma narrative using the language and conceptual framework of homeostasis and entropy reveals that not all narratives engendered by traumatic experience are healthy or life-giving. Using Harriett Doerr's Stones for Ibarra as an extended representation of trauma and narrative healing, this essay concludes that healing narrative enhances the capacity to embrace radical change and to balance memory, imagination, and the here and now. Healing narrative does not produce freedom from pain but the freedom to mourn loss and live beyond it.
TL;DR: This essay examines James's late story "The Bench of Desolation" to appreciate the narrative strategies adopted in its telling and uses the textual recognition that occurs in this story as a model for the mutual recognition possible in the clinical setting.
Abstract: Henry James's understanding of the perilous consequences of telling of the situation of another seem salient to the clinical enterprise. This essay examines James's late story "The Bench of Desolation" to appreciate the narrative strategies adopted in its telling. The narrator of this story gradually nears the suffering protagonist and shifts from mockery to seeming compassion in the presentation of his plight. By effacing himself, or making himself transparent, the narrator exposes the characters directly to the reader, bringing the reader into intimate contact with the characters. These observations have evident clinical resonance. Other works James read or wrote at the time he wrote this story help us to understand what might have been on his mind during the creation of this work. The textual recognition that occurs in this story is given as a model for the mutual recognition possible in the clinical setting.
TL;DR: The concept of "thinking without thinking" is again gaining recognition in terms that echo the nineteenth-century insistence on "unconscious cerebration" as a positive and pragmatic problem-solving mode as mentioned in this paper.
Abstract: Victorian mental science led both scientists and nonscientists to consider whether between reason and emotion, thinking and feeling there exists a third type of thought, "thinking without thinking," that can serve as an epistemological alternative to reasoned thought. Drawing on physiological theories of mental reflex action, mid-nineteenth-century scientists made the startling claim that the mind performs some of its most complicated, innovative, and creative work mechanically. In probing the realities, possibilities, and dangers of nondeliberate thought, Victorian novelists turned to the emphasis on "experience" in medical practice as a possible model for integrating tacit knowledge into a theory of learning and action. Today, bolstered by work in cognitive science on the central role of nondeliberate thought in complex as well as everyday decisions, the concept of "thinking without thinking" is again gaining recognition in terms that echo the nineteenth-century insistence on "unconscious cerebration" as a positive and pragmatic problem-solving mode.
TL;DR: By probing the traditions and past performance of the journal he now edits, Dr. Horton indeed seems to be performing his own “experiments” in conceptualizing the responsibilities of text—and of journals—today.
Abstract: We have chosen to reproduce as closely as possible the oral rhetoric and “experience” of the following text, for its power derives from its generic nature as manifesto and examination of conscience. We have listed all works cited in the bibliography, but we have neither tampered with the tempo, the grammar, or the stream-of-consciousness texture of the piece nor inserted endnotes into the lecture manuscript. By probing the traditions and past performance of the journal he now edits, Dr. Horton indeed seems to us to be performing his own “experiments” in conceptualizing the responsibilities of text—and of journals—today. As a follow-up of interest, we see that the Lancet has announced a Call for Stories in preparation for a December 2007 special issue of fiction on any aspect of medical science or health. Please see http://ees.elsevier.com/thelancet for information on submission. —the Editors-in-Chief