Medical Humanities current issue

[Editorial] Absent friends in medical humanities

Pattison, S. — 2007-11-30

[Book review] Bioethics and the humanities: attitudes and perceptions

Pattison, S — 2007-11-30

[Original articles] The body as metaphor: digestive bodies and political surgery in Shakespeare's Macbeth

Spicci, M — 2007-11-30

The article aims to reconstruct the perspective of bodily pathology underpinning Shakespeare’s Macbeth. In the play, Scotland’s body politic is frequently depicted as a macro-system suffering from a complexional imbalance of digestive origins. More specifically, Scotland comes over as a huge stomach strangled by a carcinogenic foreign body in need of being "raze[d] out". Since traditional purgative drugs such as "rhubarb" and "cynne" turn out to be totally inefficient to cure the body of Scotland, the resolution to adopt a drastic medical measure becomes more than urgent. The conclusion of the play coincides with the most terrible form of political surgery: Shakespeare’s reiterated use of verbs such as "pluck" and "purge", commonly used in Renaissance herbals and handbooks, suggests that Macbeth’s physical body is suffering from a kind of "blockage", for which herbal treatments are no longer sufficient. Nothing less than a surgical operation is needed to "purge" the corrupt entrails of the State dominated by Macbeth’s tyranny.

[Original articles] Literature and the "good doctor" in Ian McEwan's Saturday

Macnaughton, J — 2007-11-30

There is widespread acceptance in medical humanities circles that reading is good for doctors and that, in medical educational terms, it is particularly good at making better doctors by widening perspective and developing the sensibilities. Recent recommendations on medical education in the UK have allowed medical students to take courses in literature as a component of their degrees, and some have suggested that this option should be compulsory for all doctors. It is possible, however, that in our eagerness to assert the primacy of a literary education for personal development, we can ignore other routes to enlightened, sensitive doctoring. This paper appraises the instrumental role of a literary education for doctors through an analysis of Ian McEwan’s novel Saturday, which deals with the dramatic events in the day in the life of a neurosurgeon.

[Original articles] The intersubjective and the intrasubjective in the patient physician dyad: implications for medical humanities education

Kuper, A. — 2007-11-30

At the heart of medicine is the patient, and the fundamental relationship in medicine is the patient–physician dyad. Smith’s argument for the intersubjective creation of knowledge, which is itself indebted to Bakhtin’s notion of the utterance and of the necessity of "the other" in the development of meaning, enables an exploration of the creation of meaning during the patient–physician encounter. The analysis is enriched by Haraway’s concepts of partial perspectives and of dispersion, which expose the many roles and voices in which the physician and patient may interact. This approach emphasises the use of the medical humanities as a tool to teach medical students about the ambiguities of clinical practice, in which there is often no "right answer" except what is appropriate for the individual patient.

[Original articles] Narratives in specialist palliative medicine

Malthouse, M — 2007-11-30

Where modern medicine has been criticised for having lost sight of the individual on account of its biomedical focus, the profile of narrative in medicine has gained prominence. Within any medical encounter it is possible to identify the existence of several narratives. The aim of this article is to demonstrate this characteristic within the context of specialist palliative care. The emphasis is to see how an awareness of these narratives might improve upon how we attend to the suffering of dying patients. A narrative approach to this work could also help doctors and other healthcare professionals find meaning and understanding in themselves while working in an environment of death and dying. This can expose many challenging personal dimensions that demand reflection, possibly through narrative. The nature of the narratives identified is such that they can weave together and interlink into a greater whole to achieve a much wider set of meanings and shared understandings. However, they can exist in a fragmented state, in which ambiguity, uncertainty and incoherence are sustained. The effect of this should be to encourage us to engage in a more active process of finding meaning, and certainly to recognise that there could be more than one reading or interpretation.

[Original articles] Thinking historically about public health

Bashford, A., Strange, C. — 2007-11-30

This paper argues that analysing past public health policies calls for scholarship that integrates insights not just from medical history but from a broad range of historical fields. Recent studies of historic infectious disease management make this evident: they confirm that prior practices inhere in current perceptions and policies, which, like their antecedents, unfold amidst shifting amalgams of politics, culture, law and economics. Thus, explaining public health policy of the past purely in medical or epidemiological terms ignores evidence that it was rarely, if ever, designed solely on medical grounds at the time.

[Original articles] Metaphors for illness in contemporary media

Hanne, M, Hawken, S J — 2007-11-30

Essayist Susan Sontag alerted us more than 20 years ago to the way in which clusters of metaphors attach themselves to our discussion of certain diseases, and the influence these metaphors exert on public attitudes to the diseases themselves and to those who experience them. This study of feature articles on five diseases—avian flu, cancer, diabetes, heart disease, and HIV/AIDS—published recently in the New York Times reveals distinct patterns of metaphor usage around each. While the metaphors used in relation to the diseases Sontag studied—cancer and HIV/AIDS—have become less emotive and more positively informative, the sensationalist connotations of the metaphor clusters that have formed around two diseases that were not on the agenda for wide public debate in her time—avian flu and diabetes—are hardly congruent with the serious intent of the articles in which they appeared. By contrast, discussion of heart disease involved very limited use of metaphor. The article ends with a call for journalists and medical professionals to become more aware of the impact of the metaphors they use and to collaborate in developing sets of metaphors that are factually informative and enhance communication between doctors and their patients.

[Original articles] Reading between the lines: the experiences of taking part in a community reading project

Hodge, S, Robinson, J, Davis, P — 2007-11-30

Despite the popularity of reading groups, and the increased number of general-practitioner-referred bibliotherapy schemes in the UK, there has been relatively little research on the effects of reading works of literature on the well-being and health of readers. This paper reports the findings of a study set up to explore people’s experiences of taking part in community reading groups run by the Get into Reading Project in Wirral, Merseyside, UK. A qualitative approach was adopted, using three methods. These were participant observation with five reading groups, a key stakeholder interview and, with a sixth group, a single case study that consisted of observation and interviews with group members. The fieldwork conducted with the six groups took place in a variety of settings, including libraries, a residential drug rehabilitation unit and a hostel for homeless men. The research participants were all over 18 years of age, and all were members or facilitators of Get into Reading reading groups. The data were analysed thematically using NVivo qualitative analysis software. The findings show that the groups do not have a specific, targeted, therapeutic function, their primary purpose being more broadly literary, with literature itself trusted both to serve a coalescing social purpose and to offer non-specified but individual therapeutic benefits. Further work should be undertaken to explore the social and therapeutic benefits of reading literature in community settings.

[Education and debate] Teaching medical students professionalism: what role for the medical humanities?

Meakin, R. — 2007-11-30

[Education and debate] Written role models in professionalism education

Coulehan, J — 2007-11-30

After more than a generation of neglect in medical education, professionalism has now been restored to the classroom and clinic. However, the current emphasis on teaching and evaluating professionalism in clinical education risks failure because of the large gap between explicit professional ideals and today’s culture of medical education. For professionalism curricula to be successful, they must be narrative-based, rather than rule-based. This requires substantial increases in appropriate role modeling, opportunities to develop self-awareness, development of narrative competence and investment in community service. Fictional and non-fictional written narratives can play an important supplemental role throughout medical training by introducing additional role model physicians and, more importantly, by promoting discussion and analysis of professional virtue in practice. Using "The Steel Windpipe", "Darkness", "Malingerers" and "The Good Doctor" as examples, the author illustrates the use of short stories to help medical students explore the meaning of professionalism from a narrative perspective.

[Opening the word hoard] Opening the Word Hoard

2007-11-30