Showing papers in "Medical Humanities in 2017"

Health-related shame: an affective determinant of health?

Abstract: Despite shame being recognised as a powerful force in the clinical encounter, it is underacknowledged, under-researched and undertheorised in the contexts of health and medicine. In this paper we make two claims. The first is that emotional or affective states, in particular shame, can have a significant impact on health, illness and health-related behaviours. We outline four possible processes through which this might occur: (1) acute shame avoidance behaviour; (2) chronic shame health-related behaviours; (3) stigma and social status threat and (4) biological mechanisms. Second, we postulate that shame9s influence is so insidious, pervasive and pernicious, and so critical to clinical and political discourse around health, that it is imperative that its vital role in health, health-related behaviours and illness be recognised and assimilated into medical, social and political consciousness and practice. In essence, we argue that its impact is sufficiently powerful for it to be considered an affective determinant of health, and provide three justifications for this. We conclude with a proposal for a research agenda that aims to extend the state of knowledge of health-related shame.

The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents

Abstract: Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice (Art of Seeing) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents.

Can narrative medicine education contribute to the delivery of compassionate care? A review of the literature

Abstract: Narrative Medicine has emerged as a discipline from within the medical humanities1 and takes inspiration from philosophy, literature, poetry, art and social sciences theories. In particular, it is underpinned by philosophical approaches such as phenomenology, postmodernism and narratology, proposing that clinicians must attend to the lived experience of their patients and apply the science to the person.2 Meanwhile, the link between medicine and literature is evident in the growing volume of texts written about professionals', or lay people's experiences of illness and disease.3–8 In exploring this link further, Charon9 has contributed greatly to consolidate the theory of Narrative Medicine. She defines it as ‘medicine practiced with the narrative competencies to recognise, absorb, interpret and be moved by the stories of illness’.9 She suggests that, in exploring texts and reading them closely, one finds the tools of language such as metaphor, plot, character and temporality. She suggests that learning such skills enables clinicians to recognise that same language when it appears in clinical interaction practice. This ‘narrative competence’ can be fostered through education initiatives that particularly explore literature, creative and reflective writing, storytelling and poetry.9 As Lewis2 explains, the question is about what kind of healthcare we want to deliver. Those who practise Narrative Medicine suggest that the adoption of this approach may help marry the art and science, thus improving quality in delivering a more person-centred type of care.2 ,10 With its emphasis on the patient experience, Narrative Medicine complements the current dominance of productivity, efficiency and evidence-based care. Similarly, Narrative Medicine contributes to attempts to go beyond the positivist dominance in healthcare that threatens quality of care, as science alone cannot help us to understand the unpredictability and frailty of people.11–13 To secure support for Narrative Medicine education, there …

Pain, objectivity and history: understanding pain stigma.

Abstract: The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the 'subjectivity' of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present.

A dirty little secret: stigma, shame and hepatitis C in the health setting

Abstract: While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.

On shame and voice-hearing

Abstract: Hearing voices in the absence of another speaker—what psychiatry terms an auditory verbal hallucination—is often associated with a wide range of negative emotions. Mainstream clinical research addressing the emotional dimensions of voice-hearing has tended to treat these as self-evident, undifferentiated and so effectively interchangeable. But what happens when a richer, more nuanced understanding of specific emotions is brought to bear on the analysis of distressing voices? This article draws findings from the ‘What is it like to hear voices’ study conducted as part of the interdisciplinary Hearing the Voice project into conversation with philosopher Dan Zahavi's Self and Other: Exploring Subjectivity, Empathy and Shame to consider how a focus on shame can open up new questions about the experience of hearing voices. A higher-order emotion of social cognition, shame directs our attention to aspects of voice-hearing which are understudied and elusive, particularly as they concern the status of voices as other and the constitution and conceptualisation of the self.

The ghost of pandemics past: revisiting two centuries of influenza in Sweden

Abstract: Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the ‘configuration’ of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of ‘pandemic’ influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures—households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life.

Shame and the vulnerable self in medical contexts: the compassionate solution.

Abstract: Shame is a powerful experience that plays a vital role in a whole range of aspects of the clinical encounter. Shame experiences can have an impact on our psychological and physiological state and on how we experience ourselves, others and our relationships. The medical encounter is an obvious arena for shame because we are presenting (aspects of) our bodies and minds that can be seen as unattractive and undesirable, diseased, decayed and injured with the various excretions that typically might invite disgust. In contrast, experiences of compassion of acceptance, validation and kindness and can increase approach, openness and preparedness to engage with painful difficult scenarios. While shame is an experience that separates, segregates, marginalises and disengages people, caring and compassion facilitate integration, (re)connection and support. Given the potential opposite impacts of these different types of social experience, this paper will outline their evolutionary origins and compare and contrast them with particular reference to the medical context.

‘There was no great ceremony’: patient narratives and the diagnostic encounter in the context of Parkinson's

Abstract: This paper draws on stories of diagnosis that emerged from a broader narrative study exploring the lived experience of Parkinson's (n.37). Despite the life-changing nature of their diagnosis, participants' narratives highlighted considerable shortcomings in the way in which their diagnostic encounter was handled, echoing the findings of previous research in which it has been noted that 'the human significance' of diagnosis was passed over. Building on the literature, this paper provides empirical material that reveals the sensitivities involved at the moment of diagnosis. By examining both the structure and content of participants' narratives, this article discusses the diagnostic encounter in relation to three key concepts that connected many participants' stories: a 'bareness' or lack of 'ceremony', a sense of emotional and physical 'abandonment' and the impact on a person's illness story when faced with a 'hierarchy' of illness. This paper aims to raise awareness of contemporary issues related to the diagnosis of Parkinson's, and invites reflection on how diagnosis might be undertaken in a way that truly acknowledges its human significance.

The medical reshaping of disabled bodies as a response to stigma and a route to normality

Abstract: Disabled people are said to experience stigma because their embodied presence in the world does not fit with how others interact and use their bodies to be social participants. In response they can turn to medical procedures, such as surgery or physiotherapy, in order to reshape their bodies to more closely approximate norms of social interaction and embodiment. This paper explores how medicine plays a role in attempts to be recognised by others as normal and acceptable by minimising disability. It will do so via a focus on disabled young people, in order to explore how their emerging identities and aspirations for the future influence how they think about their bodies, what normality means and their participation in multiple activities that work on their bodies. The paper draws from an Economic and Social Research Council (ESRC) project that used a range of qualitative research methods with a group of disabled young people. The project explored ways in which participants actively worked on their bodies to be more normal and examined the disciplinary and agency dynamics involved in this work.

I cut therefore I am? Avoiding labels in the context of self-injury

Abstract: Non-suicidal self-injury (NSSI) represents a critical global health concern. While our understanding of NSSI has evolved dramatically over past two decades,1 the language used to refer to those who self-injure has not. Terms such as self-injurer and self-harmer continue to be used throughout the empirical literature2 and likely in clinical settings. From a humanistic standpoint, these referents may perpetuate unhelpful discourses and exacerbate the stigma that …

Shame, stigma, HIV: philosophical reflections.

Abstract: It is a distinctive feature of HIV that its pathology cannot be adequately grasped separate from a number of psychosocial factors, and stigma is widely seen as the most prominent. We argue that it is equally important to have an adequate understanding of shame, as the emotional response to stigma. We have identified five ways shame might negatively impact upon attempts to combat and treat HIV, which emerge from the stigma HIV carries and STI-stigma in general. In this paper, we draw out four insights from philosophical work on emotions and shame which we propose will improve understanding of shame and stigma. We conclude by briefly discussing how these insights might shed light on the negative role shame can play for a person living with HIV engaging with, or being retained in, care. We conclude by proposing further study.

Who cares? The lost legacy of Archie Cochrane

Abstract: Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's book Effectiveness and Efficiency from 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, is not part of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences in Effectiveness and Efficiency From these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner.

‘She sits all day in the attitude depicted in the photo’: photography and the psychiatric patient in the late nineteenth century

Abstract: The links between mental state and art in all its various forms and media have long been of interest to historians, critics, artists, patients and doctors. Photographs of patients constitute an extensive but largely unexplored archive that can be used to recover patient experience in the late nineteenth and early twentieth century. The camera and the photograph became tools to communicate information about mental ill health between doctors, their patients and their colleagues. They were published in textbooks and journals, exhibited, exchanged and pasted into medical case books alongside case notes. But they were also used by patients to communicate their own experiences, identity and sense of self. This article uses published and case book photographs from c. 1885–1910 to examine the networks of communication between different stakeholders and discourses.

Heritage and Stigma. Co-producing and communicating the histories of mental health and learning disability

Abstract: University engagement with mental health services has traditionally been informed by the vocational and pedagogical links between the two sectors However, a growth in the interest in public history and in the history of mental healthcare has offered new opportunities for those in the humanities to engage new audiences and to challenge perceptions about care in the past The introduction of the ‘impact agenda’ and related funding streams has further encouraged academics to contribute to historical debates, and to those concerning current services One such example of this is the Arts and Humanities Research Council funded Heritage and Stigma project at the University of Huddersfield, which was conceived to support mental health and learning disability charities in the exploration and dissemination of their own histories Using this project as a case study, this paper will draw on primary source material to reflect on the opportunities and challenges of working in partnership with such groups In particular, it will consider the need to address issues of stigma and exclusion in tandem with a critical understanding of the moves to ‘community care’ instigated by landmark legislation in the form of the 1959 Mental Health Act Overall, it provides evidence of an inclusive, coproductive model of design and highlights the positive contribution to communicating mental health made by those based in the humanities

A comparative study of cognitive behavioural therapy and shared reading for chronic pain.

Abstract: The case for psychosocial interventions in relation to chronic pain, one of the most common health issues in contemporary healthcare, is well-established as a means of managing the emotional and psychological difficulties experienced by sufferers. Using mixed methods, this study compared a standard therapy for chronic pain, cognitive behavioural therapy (CBT), with a specific literature-based intervention, shared reading (SR) developed by national charity, The Reader. A 5-week CBT group and a 22-week SR group for patients with chronic pain ran in parallel, with CBT group members joining the SR group after the completion of CBT. In addition to self-report measures of positive and negative affect before and after each experience of the intervention, the 10 participants kept twice-daily (12-hourly) pain and emotion diaries. Qualitative data were gathered via literary-linguistic analysis of audio/video-recordings and transcriptions of the CBT and SR sessions and video-assisted individual qualitative interviews with participants. Qualitative evidence indicates SR's potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2 days following SR. Both findings lay the basis for future research involving a larger sample size.

Shame, stigma and medicine.

Abstract: > “As a young physician in the mid-80s, caring for people who had contracted HIV, I lost two of my patients to suicide at a time when the virus was doing very little harm to them. I have always thought of them as having been killed by a metaphor, by the burden of secrecy and shame associated with the disease”. > Abraham Verghese1 When, in the late 1980s, the psychiatrist Donald Nathanson organised a symposium on the nature of shame, it turned out to be the first such event to deal with the subject in the history of psychiatry or psychoanalysis on either side of the Atlantic. It seems strange that such a ubiquitous emotion had excited so little academic interest to that point, but as Nathanson points out—shame makes us so uncomfortable that we will go to great lengths to avoid it.2 Yet, despite our efforts to ignore it, shame remains universal—there can be few of us who have not been seared by shame at some stage of our life. In fact, some philosophers argue that shame is inescapable in human experience, a fundamental part of child development that textures personal, social and political aspects of adolescent and adult life.3 4 As Tanner states (when responding to an accusation of impudence) in Shaw’s Man and Superman : > “Yet even I cannot wholly conquer shame. We live in an atmosphere of shame. We are ashamed of everything that is real about us; ashamed of ourselves, of our relatives, of our incomes, of our accents, of our opinions, of our experience, just as we are ashamed of our naked skins”.5 The prevalence of shame in the medical clinic was identified by the physician Aaron Lazare around the same time as Nathanson’s symposium. Lazare proposed that patients were at a …

Suicide voices: testimonies of trauma in the French workplace

Abstract: Workplace suicide has become an urgent social concern internationally with rising numbers of employees choosing to kill themselves in the face of extreme pressures at work. Yet, research on this phenomenon is hampered by fragmentary statistical data and the sheer contentiousness of this issue. This paper presents the preliminary findings of a research project on workplace suicides in France, where there has been a ‘suicide epidemic’ across a wide range of companies. I draw on an analysis of suicide letters linked to 23 suicide cases across three French companies during the period 2005–2015. My methodological approach is informed by the work of suicide sociologist, Jack D Douglas, who emphasised the importance of narrative, testimony and voice to our understanding of the causes of suicide. Douglas argued that an analysis of the ‘social meanings’ of suicide should start with a consideration of the motivations attributed to self-killing by suicidal individuals themselves and those close to them. Why does work or conditions of work push some individuals to take their own lives? What can the ‘suicide voices’ articulated in recent testimonies tell us about the causes of workplace suicide? In this paper, I treat suicide letters as a unique mode of testimony that can reveal some of the profound effects of workplace transformations on subjective, intimate and lived experiences of work. By examining French suicide testimonies, my aim is to deepen our understanding of the nature and causes of suicide in today9s globalised workplaces.

Narrative empathy and illness memoirs: Arthur Frank's At the Will of the Body and Kathlyn Conway's Ordinary Life

Abstract: This article analyses the concept of narrative empathy in illness memoirs. These texts negotiate the narrative identity of an autobiographer as he or she recounts the disruptive experience of illness, an experience in which physical and emotional traces dramatically and definitively shape our sense of self. While narrative emotions are certainly deployed in these autobiographies in order to connect with the readers and promote social change, this empathic connection is not so much aimed at arousing compassion but rather more positive emotions on the experience of illness. I will explore the emotional representations of cancer in Arthur Frank's At the Will of the Body (1991) and Kathlyn Conway's Ordinary Life: A Memoir of Illness (1997), focusing on the identity strategies these authors use in order to become affirmative models of disability and illness, showing the damaging effects not of disease or impairment but, rather, of the cultural mythologies that interpret those conditions in reductive or disparaging ways.

‘Deal with It. Name It’: the diagnostic moment in film

Abstract: The moment a serious diagnosis is announced creates an important crisis for a patient, as it shifts their sense of self and of their future potential. This essay discusses the creative representation and use of this diagnostic moment in film narratives. Using Still Alice , A Late Quartet , Wit and Cleo from 5 to 7 as examples, we describe how each of these uses the diagnostic moment in relation to narrative construction and characterisation in recognisable ways. We associate the diagnostic moment with certain narrative and visual devices that are frequently implemented in films as means for character development, and for managing the audience9s empathy. This is the case whether or not the diagnosis is contested or accepted, and whether the diagnostic moment is the frame for the narrative, or a closing device. By analysing its representation in film, we emphasise the cultural significance of diagnosis as a life-transforming event.

Murder by the book: using crime fiction as a bibliotherapeutic resource

Abstract: Crime is a popular genre of fiction, widely read but sometimes seen as ‘throwaway’. Disregarding this type of fiction because it is seen as low quality does not take into account its value to readers. Reading has been established as a means of improving mental health and well-being—often known as bibliotherapy. This often focuses on fiction considered to have literary merit rather than genre fiction like crime. However, in framing therapeutic reading in this way, the impact of texts considered to have low cultural value such as crime has been concealed. Examining readers’ responses as a starting point identifies some reasons why crime fiction fulfils a need. Readers in an empirical study spoke about the strong narrative as a distraction, the predictability as a comfort and the safe distance from events as a reassurance that left them feeling that reading crime fiction was a refuge from the world. In exploring readers’ responses in relation to the academic literature, the paper argues that there is a need to think differently about how readers engage with texts and how they experience reading as therapeutic, with a role for fiction like crime.

'He would by no means risque his Reputation': patient and doctor shame in Daniel Turner's De Morbis Cutaneis (1714) and Syphilis (1717).

Abstract: This article offers a historical corollary to the examination of shame in medical practice by considering the negotiation of shame in the treatment of a stigmatised disease at a time in which surgeons themselves occupied a highly ambivalent social position. It will focus on case studies provided by Daniel Turner (1667–1741), prominent surgeon and later member of the College of Physicians, in his textbooks De Morbis Cutaneis. A Treatise of Diseases Incident to the Skin (1714) and Syphilis. A Practical Dissertation on the Venereal Disease (1717). Turner demonstrates an awareness of the precarious position of both the surgeon and the syphilitic, and devotes significant portions of his text to advising the trainee surgeon on how to manage patients' reticence over disclosure of symptoms, expectations for cure and impudence towards medical authority. In turn, the trainee must manage his own reputation as a moral and medical authority who can treat all distempers, yet without condoning or facilitating the shameful behaviours associated with a sexual disease. Furthermore, shaming plays a key role in enabling Turner to fashion an ideal patient whose successful cure will both respond to and build the surgeon's medical authority and that of the medical field in general.

A fuller picture: evaluating an art therapy programme in a multidisciplinary mental health service

Abstract: Art therapy has a long history in mental healthcare, but requires an enhanced evidence base in order to better identify its precise role in contemporary services. This paper describes an evaluation of an art therapy programme in an acute adult psychiatry admission unit in Ireland. A mixed method research design was used. Quantitative data were collected through a survey of 35 staff members and 11 service users. Qualitative data included free text comments collected in the survey and individual feedback from service users. Both methods aimed to assess the role of art therapy as part of a multidisciplinary mental health service. Thematic content analysis was employed to analyse qualitative data. Staff demonstrated overwhelming support for art therapy as one element within multidisciplinary services available to patients in the acute psychiatry setting, Qualitative feedback associated art therapy with improvements in quality of life and individual support, and emphasised its role as a non-verbal intervention, especially useful for those who find talking therapy difficult. Creative self-expression is valued by staff and service users as part of the recovery process. Recommendations arising from the research include continuing the art therapy service, expanding it to include patients under rehabilitation, provision of information and education sessions to staff, and further research to identify other potential long-term effects. The low response of staff and small sample in this study, however, must be noted as limitations to these findings.

Bioethics and imagination: towards a narrative bioethics committed to social action and justice

Abstract: Recently, the involvement of various authors coming from the social sciences and the arts has reinforced the humanistic component of bioethics. Their contributions vary from very theoretical perspectives to rather practical ones. In this paper, Martha Nussbaum's books, The Fragility of Goodness (1986), Love's Knowledge (1990), Cultivating Humanity (1997) and Creating Capabilities (2011) are analysed from the vantage point of narrative bioethics. It is argued that Nussbaum's notions of 'Narrative', 'Imagination' and 'Cultivation' open up the possibility of developing an action-oriented form of narrative bioethics, that is, a bioethics committed to social action and justice.

A crisis of meaning: can 'schizophrenia' survive in the 21st century?

Abstract: Both within clinical and wider societal discourses, the term 'schizophrenia' has achieved considerable potency as a signifier, privileging particular conceptual frames for understanding and responding to mental distress However, its status has been subject to instability, as it has lacked indisputable biological correlates that would anchor its place within the canon of medical diagnosis Informed by a semiotic perspective, this paper focuses on its recent history: how 'schizophrenia' has been claimed, appropriated and contested-and how this connects with its earlier history of signification It also explores how the dominance of this signifier has influenced the ways in which people with the diagnosis may find themselves constructed in their interactions with professionals, family and wider society, and hence how they may come to see themselves It is argued that, from a point in the 1990s when 'schizophrenia' had achieved an almost iconic status, the term is now subject to greater instability, with concerns and challenges being raised from both within and outside psychiatry On the one hand, this uncertainty has triggered a 'calls to arms' from those within the psychiatric establishment who see diagnoses such as 'schizophrenia' as crucial to their professional identity and status On the other hand, this has created spaces for new conversations and alliances between elements within neurology, psychiatry, social work and other professions, and between these and service users Some of these conversations are casting doubt on the validity and utility of 'schizophrenia' as a construct, and are beginning to posit alternative regimes of signification

Opposed to the being of Henrietta: bioslavery, pop culture and the third life of HeLa cells.

Abstract: Operating at the intersection of thanatopolitics and African-American cultural studies, this essay argues that the commercial sale of HeLa-themed art and other bioproducts perpetuates the bioslavery of HeLa cells, a circumstance created by legal and medical discourses tracing back to US racial slavery. Racial slavery normalised economic, social and legal inequities that the nation continues to struggle with and, the article posits, laid foundation for the dynamics that currently exist between Henrietta Lacks' genealogical family, the HeLa cell line, and the medical-pharmaceutical establishment. The author turns to fashion ethics discourse and trademark law as potential sites for reparations.

Introduction: historical contexts to communicating mental health.

Abstract: Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue Our introduction provides some framework for the history of communicating mental health over the past 300 years We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology However, while the modes of communication have developed, the issues involved remain essentially the same Most practitioners have sought to understand and to innovate, though not always with positive results Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear

From Face/Off to the face race: the case of Isabelle Dinoire and the future of the face transplant.

Abstract: Isabelle Dinoire, the world's first face transplant recipient has died, 11 years after the procedure that brought her unwanted fame and media attention. While medical debates centre mainly on ethical and medical concerns like immunosuppressant use, the psychological hazards of face transplants are still being overlooked. Using medical and media reports and examining the gendering of clinical and patient narratives, this article argues we need to look again at face transplants and their motivation for individuals as well as society.

A deep ethics for mental difference and disability: the ‘case’ of Vincent van Gogh

Abstract: Despite a growing prevalence of mental illness diagnoses and treatments, there remains remarkable interpretive diversity regarding the meaning of these diagnoses and their implication for mental healthcare. Humanities scholarship devoted to language, power and ethical cares of the self provides invaluable tools for navigating interpretive diversity in this domain. This scholarship suggests that ethical questions of informed consent regarding mental difference and disability go much deeper than the usual standards. Ethical questions of informed consent go back to the very language choices people use to narrate and navigate the mental difference or disability. Making these ethical choices between different ways of understanding psychic difference is fundamentally about making narrative and lifestyle choices. This article considers these issues in the context of the many interpretations of Vincent van Gogh9s life and their ongoing relevance for contemporary approaches to mental difference and disability.

When doctors are patients: a narrative study of help-seeking behaviour among addicted physicians

Abstract: In recent decades studies based on questionnaires and interviews have concluded that when doctors become ill they face significant barriers to seeking help. Several reasons have been proposed, primarily the notion that doctors' work environment predisposes them to an inappropriate help-seeking behaviour. In this article, the idea of the ill physician as a paradox in a medical drama is examined. Through a text-interpretive and comparative approach to historical illness narratives written by doctors suffering from one specific diagnosis, namely opioid addiction, the complex set of considerations guiding their behaviour as patients are to some extent revealed. The article concludes that, in the identity transition necessary to become a patient, doctors are held back by their professional status and that every step to assist them needs to take shape based on an awareness of the underlying principles of the medical drama. Written illness narratives by doctors, such as those highlighted in this article, might serve as a tool to increase such awareness.