Medical Humanities recent issues

Ancient answers to modern maladies: the art of actively seeking out the patient's voice

Kirklin, D. — Fri, 29 May 2009 10:01:19 PDT

Medical humanities: demarcations, dilemmas and delights

Shafer, A. — Fri, 29 May 2009 10:01:19 PDT

Hearing Australian Aboriginal voices on neglect and sustainability

Faunce, T. — Fri, 29 May 2009 10:01:19 PDT

Borderlands: professional life lived precariously but happily in anthropology and medicine

Kleinman, A. — Fri, 29 May 2009 10:01:19 PDT

The death of Hector: pity in Homer, empathy in medical education

Marshall, R, Bleakley, A — Fri, 29 May 2009 10:01:20 PDT

Empathy is thought a desirable quality in doctors as a key component of communication skills and professionalism. It is therefore thought desirable to teach it to medical students. Yet empathy is a quality whose essence is difficult to capture but easy to enact. We problematise empathy in an era where empathy has been literalised and instrumentalised, including its measurement. Even if we could agree a universally acceptable definition of empathy, engendering it in the student requires a more subtle approach than seems the case currently.

We therefore examine this modern concept and compare it with others such as pity and compassion, using the medium of Homer’s Iliad. Two famous scenes from the Iliad elicit pity in the characters and the audience. Pity and compassion are, however, given a complexity within the narrative that often seems lacking in modern ways of conceptualising and teaching empathy.

Correction

Fri, 29 May 2009 10:01:20 PDT

Language, games and the role of interpreters in psychiatric diagnosis: a Wittgensteinian thought experiment

Thomas, P, Shah, A, Thornton, T — Fri, 29 May 2009 10:01:20 PDT

British society is becoming increasingly culturally and linguistically diverse. This poses a major challenge to mental health services charged with the responsibility to work in ways that respect cultural and linguistic difference. In this paper we investigate the problems of interpretation in the diagnosis of depression using a thought experiment to demonstrate important features of language-games, an idea introduced by Ludwig Wittgenstein in his late work, Philosophical investigations. The thought experiment draws attention to the importance of culture and contexts in understanding the meaning of particular utterances. This has implications not only for how we understand the role of interpreters in clinical settings, and who might best be suited to function in such a role, but more generally it draws attention to the importance of involving members of black minority ethnic (BME) communities in working alongside mainstream mental health services. We conclude that the involvement of BME community development workers inside, alongside and outside statutory services can potentially improve the quality of care for people from BME communities who use these services.

Storying the street: transition narratives of homeless youth

Ottaway, N, King, K, Erickson, P G — Fri, 29 May 2009 10:01:20 PDT

Toronto Youth Street Stories is an innovative, web-based storytelling project that was conducted with homeless youths in Toronto. As a collaborative knowledge dissemination initiative, the project engaged youthful participants, authors, community mentors, youth service agencies and university-based researchers. Over 50 youths were encouraged to express their personal perspectives through author-led, creative writing workshops, resulting in youth-created stories, poems and pictures about a wide array of feelings and experiences. Across the dozens of pieces of writing, there is evidence of a chronology of street life, or an "arc of experience", that ranges from living with abuse and despair, leaving home, living on the street, experiencing a crisis or turning point, accessing services and gradually moving away from street life toward self-sustaining independence and security. This arc of experience includes the stories of youth who have transitioned away from the street as well as those still facing homelessness. This paper describes this arc of experience and illustrates it with the subjective material generated by the youths’ stories about their lives on the streets of Toronto. We conclude that this project provided an important, creative outlet for the youths, and increased understanding of the challenges, stigma and resilience of homeless youth.

Narrating the Holocaust: in pursuit of poetic representations of health

Rapport, F, Sparkes, A C — Fri, 29 May 2009 10:01:20 PDT

This paper considers the scope of poetic representation for exploring notions of health and wellbeing in the testimony of Holocaust survivors. The paper is based on the representation, through poetic form, of testimony derived from multiple in-depth interviews with a Holocaust survivor, Anka, in south-east Wales. This paper concentrates on two of those interviews, the first a life story and the second an interview focusing on health, illness and wellbeing. Two poetic representations, one derived from each interview, provide examples of the principal investigator’s response to the oral testimony, and the authors explore how these forms can present authentic and rigorous data distillates without detracting from the emotive, contextualised and powerful messages of the original text. The poetic representations offer an analysis of the survivor’s life experiences, especially in Auschwitz concentration camp, and her personal perspective on her health and wellbeing. The authors discuss the value of poetic representation as a methodological approach, consider the poetic form for working with survivor stories and suggest how others might judge these pieces, to highlight the strengths and weaknesses of these alternative forms of data representation. They also consider the role of the researcher and Anka in creating the final product and the effect of Anka’s voice on the researchers’ work.

Troubling dimensions of heart transplantation

Shildrick, M, McKeever, P, Abbey, S, Poole, J, Ross, H — Fri, 29 May 2009 10:01:20 PDT

Heart transplantation is now the accepted therapy for end-stage heart failure that is resistant to medical treatment. Families of deceased donors routinely are urged to view the heart as a "gift of life" that will enable the donor to live on by extending and sustaining the life of a stranger. In contrast, heart recipients are encouraged to view the organ mechanistically—as a new pump that was rendered a spare, reusable part when a generous stranger died. Psychosocial and psychoanalytic research, anecdotal evidence and first-person accounts indicate that after transplant, many recipients experience unexpected changes or distress that cannot be understood adequately using biomedical explanatory models alone. In this paper it is argued that phenomenological philosophy offers a promising way to frame an ongoing empirical study that asks recipients to reflect on what it is like to incorporate the heart of another person. Merleau-Ponty and others have posited that any change to the body inevitably transforms the self. Hence, it is argued in this paper that replacing failing hearts with functioning hearts from deceased persons must be considered much more than a complex technical procedure. Acknowledging the disturbances to embodiment and personal identity associated with transplantation may explain adverse outcomes that heretofore have been inexplicable. Ultimately, a phenomenological understanding could lead to improvements in the consent process, preoperative teaching and follow-up care.

An ethical and social examination of dementia as depicted in Japanese film

Asai, A, Sato, Y, Fukuyama, M — Fri, 29 May 2009 10:01:20 PDT

The ageing population means that dementia is a serious social problem in Japan. Attitudes toward ageing in Japan are increasingly negative, and views of life and death among older people vary. Numerous ethical problems exist in the medical treatment of dementia. Amidst such conditions, it is important and beneficial to examine films that depict demented patients and to consider the issues raised by these films. Through film we see many aspects of a country and its times: culture and ideology, morality and religion, medical treatments, views on life and death, social conditions and what issues are viewed as problems. The best films both entertain audiences and provide viewers with opportunities to think about social problems. In the past 30 years, 10 films about dementia had been made in Japan and two of these—The Twilight Years (Kôkotsu no hito) and Memories of Tomorrow (Ashita no kioku) are the main focus of this paper. In our analysis we consider three points: how the patients are informed of their disease, the characters’ wishes for death, and terminal medical care.

George Eliot's Middlemarch: a contribution to medical professionalism

Rosin, A — Fri, 29 May 2009 10:01:20 PDT

The qualities of medical professionalism have been questioned in the last few years. George Eliot’s 19^th century novel Middlemarch illustrates some of the truths that should underlie the physician-patient relationship, and depicts prophetically some of the developments that were to occur in reality in the medicine of the 20^th and 21^st century. Her insight into the problems facing a medical researcher and the fictional conflicts between vocation and marriage are real issues of medical professionalism even today.

Using Indigenous Australian drama to break cultural barriers in healthcare relationships

Matharu, K — Fri, 29 May 2009 10:01:20 PDT

Since colonisation, the marginalisation of Indigenous Australians has adversely affected their language, culture and health. Mainstream society has failed to address social differences and establish culturally-appropriate health programmes for these groups. This paper extracts important humanistic themes within the context of health from four Indigenous Australian plays written during a period of social unrest in response to past oppression: (1) The dreamers, by Jack David; (2) Murras, by Eva Johnson; (3) Coordah, by Richard Walley; and (4) The keepers, by Bob Maza. These plays will be analysed to (a) illuminate human suffering from an indigenous perspective, based upon social and cultural planes of analysis; (b) understand the socio-cultural basis of poor health; and (c) instruct healthcare professionals that health is a social construct that can be interpreted as the product of select plays that are not solely based upon an illness narrative.

Developing narrative competence in medical students

Younie, L — Fri, 29 May 2009 10:01:20 PDT

Salt bridges: fluid interactions between artists and scientists in the lab, Department of New Biochemistry, Oxford

Wallace, M — Fri, 29 May 2009 10:01:20 PDT

A balcony in Nepal: glimpses of a Himalayan village

Ravi Shankar, P — Fri, 29 May 2009 10:01:20 PDT

The making of Mr Gray's anatomy: bodies, books, fortune, fame

Ferguson, A — Fri, 29 May 2009 10:01:20 PDT

Grey's Anatomy: scalpels, sex and stereotypes

Hallam, J. — Fri, 29 May 2009 10:01:20 PDT

The English Surgeon

Greenhalgh, T — Fri, 29 May 2009 10:01:20 PDT

Doctors as Nietzschean supermen?

Parker, C — Fri, 29 May 2009 10:01:20 PDT

Doctors as Nietzschean supermen? Author's reply

Papadimos, T J — Fri, 29 May 2009 10:01:20 PDT