Showing papers in "The Journal of Medical Humanities in 2008"
TL;DR: It is suggested that hermeneutic phenomenology is uniquely suited to challenge the core assumptions of medicalization by expanding psychiatry’s narrow conception of the self as an enclosed, biological individual and recognizing the ways in which their experience of things—including mental illness—is shaped by the socio-historical situation in which the authors grow.
Abstract: With the increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) there has been a growing tendency in the mental health professions to interpret everyday emotional suffering and behavior as a medical condition that can be treated with a particular drug. In this paper, I suggest that hermeneutic phenomenology is uniquely suited to challenge the core assumptions of medicalization by expanding psychiatry’s narrow conception of the self as an enclosed, biological individual and recognizing the ways in which our experience of things—including mental illness—is shaped by the socio-historical situation in which we grow. Informed by hermeneutic phenomenology, psychiatry’s first priority is to suspend the prejudices that come with being a medical doctor in order to hear what the patient is saying. To this end, psychiatry can begin to understand the patient not as a static, material body with a clearly defined brain dysfunction but as an unfolding, situated existence already involved in an irreducibly complex social world, an involvement that allows the patient to experience, feel, and make sense of their emotional suffering.
58 citations
TL;DR: This essay explores how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing perpetuates a dualism of humanity that would have humanism as the counterpoint to the biopsychosociologisms of the authors' day.
Abstract: The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day.
42 citations
37 citations
TL;DR: It is argued that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM).
Abstract: We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada’s seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted – or is even desirable – given that Canadian medical humanities programs are largely shaped by individual educators’ interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities – which defy easy metrical appraisal – are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches.
34 citations
TL;DR: This essay uses Foucault’s discussion of biopower to describe the ways in which brain-based self-help literature enables self-constitution in a biosocial age where health is a central means of communicating personal worth, social value and political order.
Abstract: Brain imaging is a persuasive visual rhetoric by which neuroscience is articulated as relevant to the construction and maintenance of desirable selves. In this essay, I describe how “brain-based self-help” literature disseminates neuroscientific vocabularies to public audiences. In this genre, brain images are an authoritative visual resource for translating neuroscience into a comprehensive program for living. I use Foucault’s discussion of biopower to describe the ways in which brain-based self-help literature enables self-constitution in a biosocial age where health is a central means of communicating personal worth, social value and political order. The implications of this continuous self-fashioning are not limited to the personal realm but have important political consequences.
32 citations
TL;DR: This essay draws on two emerging fields—the study of comics or graphic fiction, and disability studies—to demonstrate how graphic fictions articulate the embodied, ethical, and sociopolitical experiences of impairment and disability.
Abstract: This essay draws on two emerging fields—the study of comics or graphic fiction, and disability studies—to demonstrate how graphic fictions articulate the embodied, ethical, and sociopolitical experiences of impairment and disability. Examining David B’s Epileptic and Paul Karasik and Judy Karasik’s The Ride Together, I argue that these graphic novels unsettle conventional notions of normalcy and disability. In so doing, they also challenge our assumed dimensions and possibilities of the comics genre and medium, demonstrating the great potential comics hold for disability studies.
32 citations
TL;DR: It is shown that the recovery model represents an approach to caring for the self that is congruent with critical themes inherent in some forms of contemporary philosophy, particularly that of Michel Foucault and Jurgen Habermas.
Abstract: The recovery model, as applied in mental health, is significant because it intends to foster a critical retrieval by the subject of herself as a self-determining agent of change. This paper will show that the recovery model represents an approach to caring for the self that is congruent with critical themes inherent in some forms of contemporary philosophy, particularly that of Michel Foucault and Jurgen Habermas. The paper will also consider the contribution that Habermas’ discourse ethics could make towards the non-coercive, dialogical resolution of differences between clients and professionals.
30 citations
TL;DR: This essay argues that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance.
Abstract: Evidence-based medicine’s (EBM) quantitative methodologies reflect medical science’s long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM’s attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients’ experience. This problem is evident in the case of bibliotherapy (patient reading as treatment modality), a practice widespread despite its reliance on anecdotal evidence. While EBM purports to replace such flawed practice with reliable evidence-based methods, this essay argues that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance.
29 citations
TL;DR: This special issue critically examines the role of the medical humanities in medical education and their potential to serve, inadvertently or otherwise, as a tool of governance.
Abstract: The medical humanities have been presented as a panacea for medical reductionism; a means for ‘humanizing’ medicine. However, there is a lack of consensus about the appropriate contributing disciplines and how curricula should be taught and assessed. This special issue critically examines the role of the medical humanities in medical education and their potential to serve, inadvertently or otherwise, as a tool of governance. The contributors, who include medical educators and medical practitioners, employ a range of perspectives for analysing the pertinent issues.
28 citations
TL;DR: This essay examines public discourses surrounding President Clinton’s attempt to restore African Americans’ trust by apologizing for the TSE, and illustrates the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public.
Abstract: The Tuskegee Syphilis Experiment (TSE) has shaped African Americans' views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton's attempt to restore African Americans' trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies.
26 citations
TL;DR: By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation, and should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny.
Abstract: This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as “arts-in-health”): first, an intellectual enquiry into the nature of clinical medicine; second, an important dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting “humane health care” as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny.
TL;DR: It is argued that the core of an interdisciplinary field of medicine and humanities, or medical humanities, is an interpretive enterprise that is not readily open to quantitative assessment.
Abstract: Accepting as a given that the humanities disciplines are not product or “results” driven, this paper argues that the core of an interdisciplinary field of medicine and humanities, or medical humanities, is an interpretive enterprise that is not readily open to quantitative assessment. A more humanistically oriented medical practice can derive, however, from the process that produces new insights and works toward the development of a new, mutually shared, and humanizing language.
TL;DR: This paper will consider how the illness experience marks a transformation of embodied subjectivity that, in turn, triggers transformations of other kinds.
Abstract: Within the fields of social medicine and the medical humanities, chronic illness is acknowledged not just as an individually but as a socially transformative experience. The proliferation of published ‘illness narratives’ in recent years attests to the socially compelling nature of this particular story of transformation. Indeed, illness narratives have, in the past decade or so, become a rich source of interest in sociological and medical anthropological work for their capacity to map the material transformation of person to patient, of an assumed to a newly fluid model of subjectivity. Their significance is particularly visible in the cultural context of the west, where more people live both to be diagnosed with chronic illnesses (such as cancer) and to survive them. With a focus on two recently published Australian works, Eating the Underworld: A Memoir in Three Voices (2001), by the psychologist Doris Brett, and Tiger’s Eye: A Memoir (2001), by the historian Inga Clendinnen, this paper will consider how the illness experience marks a transformation of embodied subjectivity that, in turn, triggers transformations of other kinds. These works have quite different intents, but they provide models for exploring how physical and individual transformation through illness becomes the occasion for reconsidering the body of history, and of the resonances of history in social memory.
TL;DR: It is shown that the ethic of care captures the moral situation of live kidney donations in a more coherent and comprehensive way, and offers guidance for practitioners that is more attentive to the actual moral transactions among donors and recipients.
Abstract: In this paper, we seek to re-conceptualize the ethical framework through which ethicists and medical professionals view the practice of live kidney donations. The ethics of organ donation has been understood primarily within the framework of individual rights and impartiality, but we show that the ethic of care captures the moral situation of live kidney donations in a more coherent and comprehensive way, and offers guidance for practitioners that is more attentive to the actual moral transactions among donors and recipients. A final section offers guidelines for the practice of live kidney transplants that emerge from an ethic of care.
TL;DR: Several contemporary accounts of psychopathy by Robert Hare and Paul Babiak are examined, it is argued that their accounts ought to be thought of as a “mythos,” for they betray a telling uncertainty about where “fact” ends and “fantasy” begins.
Abstract: Medical accounts of the absence of conscience are intriguing for the way they seem disposed to drift away from the ideal of scientific objectivity and towards fictional representations of the subject. I examine here several contemporary accounts of psychopathy by Robert Hare and Paul Babiak. I first note how they locate the truth about their subject in fiction, then go on to contend that their accounts ought to be thought of as a “mythos,” for they betray a telling uncertainty about where “fact” ends and “fantasy” begins, as well as the means of distinguishing mental health from mental illness in regard to some social roles.
TL;DR: How individuals who speak more than one language have in the past and can in the present serve as mediators within the health care system is described and the need for closer attention to such resources stressed.
Abstract: The movement of peoples across linguistic boundaries means the existence of individuals who speak, to a greater or lesser extent, more than one language. How such individuals have in the past and can in the present serve as mediators within the health care system is described and the need for closer attention to such resources stressed.
TL;DR: Jonathan Moreno argues that a pragmatic approach is the best approach for bioethicists and health care practitioners to use when confronted with difficult ethical problems.
Abstract: Jonathan Moreno argues that a pragmatic approach is the best approach for bioethicists and health care practitioners to use when confronted with difficult ethical problems. There is no one formula to which to appeal in determining which course of action is right or wrong when making decisions about hastening or prolonging life, for example. Instead the best decision that can be expected under the circumstances emerges as the result of a slow process of consensus building, negotiation, and compromise. Decision makers’ interpretive and reflective skills need to be strengthened to achieve this type of ethical decision.
TL;DR: The social history of medical freedom and liberty in North America during the late nineteenth and early twentieth centuries is explored.
Abstract: Education, medicine and psychotherapeutics offer exemplary sites through which liberty and its dreams are realized. This article explores the social history of medical freedom and liberty in North America during the late nineteenth and early twentieth centuries. The National League for Medical Freedom (NLMF) and the American Medical Liberty League (AMLL) offered fierce resistance to allopathic power. Allopatic liberties and rights to medical practice in asylums, clinics, courts, hospitals, prisons and schools were never certain. The politics of these liberties and rights represents a fascinating story that neither intellectual nor social historians have fully appreciated.
TL;DR: The author argues that the humanities are both marginalised and required and that the arts can provide a means to redefine values within medical practice.
Abstract: Working as a clinician within the National Health Service (NHS) in England is described along with the difficulty of identifying a role for the humanities within the organisational framework. The author argues that the humanities are both marginalised and required and that the humanities can provide a means to redefine values within medical practice.
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TL;DR: This is a personal account of life in the United Kingdom National Health Service by a pathologist who has worked there for 25 years, finding a doctor’s working life is now less autonomous, less centred on the patient and less fun.
Abstract: This is a personal account of life in the United Kingdom National Health Service by a pathologist who has worked there for 25 years. The principles of clinical governance are embraced by the medical profession, but their application is often insensitive, governmental and bureaucratic. A doctor’s working life is now less autonomous, less centred on the patient and less fun. Medical humanities are a balm for the sore spots but not, I think, used consciously so by management, likely suffering from the same bureaucratic governmentality that sees value in nothing–unless it can be measured.