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From hermeneutics to heteroglossia: ‘The Patient’s View’ revisited
  1. Benjamin Chin-Yee1,
  2. Pablo Diaz2,3,
  3. Pier Bryden2,
  4. Sophie Soklaridis2,3,
  5. Ayelet Kuper1,4
  1. 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  3. 3Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  4. 4Department of Medicine, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Benjamin Chin-Yee, Department of Medicine, University of Toronto, Toronto, ON M5B 1W8, Canada; benjamin.chinyee{at}mail.utoronto.ca

Abstract

This article explores conceptual and methodological challenges surrounding the recovery of patients’ voices in the history of medicine. We examine the debate that followed Roy Porter’s seminal article, ‘The Patient’s View: Doing Medical History from Below’ (1985). Porter argued that patients should be given a central role in medical history, aiming to restore to patients a voice and agency that is often lost in ‘physician-centered’ historical narratives. His work carried significant influence but also sparked an ongoing debate about the possibility of conducting ‘patient-centered’ history of medicine. The growth of the medical humanities has afforded renewed attention to patient narratives, supporting the need to recognise patients’ voices in contemporary healthcare and medical education. However, several barriers complicate and problematise the expansion of a patient-centred epistemology across historical periods. Postmodern critics have expressed scepticism that ‘the patient’s view’ can be recovered from history, with some claiming that ‘the patient’ is a construct of the ‘medical gaze’ whose subjectivity cannot be reconstituted outside of sociohistorical discourses of knowledge and power. Psychiatry in the mid-20th century presents a particular challenge for patient-centred history. We discuss the influence of postmodern theorists, especially Michel Foucault, whose work is seen as undermining the possibility of a patient-centred epistemology. We argue against Foucault’s erasure of the patient, and instead explore alternate constructivist epistemologies, focusing on the hermeneutics of Hans-Georg Gadamer and dialogism of Mikhail Bakhtin, to help address historiographical challenges in recovering ‘the patient’s view’. To illustrate the value of Gadamerian and Bakhtinian approaches, we apply them to a case study from the Verdun Protestant Hospital (Québec, Canada) from 1941 to 1956, which sheds light on the introduction of the first antipsychotic, chlorpromazine, into clinical practice. We highlight how Gadamer’s hermeneutics and Bakhtin’s dialogism together offer insights into patient perspectives during this liminal period in the history of psychiatry.

  • patient narratives
  • history
  • psychiatry
  • philosophy of medicine/health care
  • medical humanities
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Footnotes

  • Twitter @Pablo Diaz

  • Contributors BC-Y, PD and AK contributed to the conception and design of this study. BC-Y, PD and AK conducted the data analysis and prepared the initial draft of the manuscript with input from PB and SS. All authors approved the final draft of the manuscript.

  • Funding Funding support was provided by the Hewton and Griffin Archival Research Award, Centre for Addiction and Mental Health, and the Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. There were no funds or time allocated for patient and public involvement so we were unable to directly involve patients in this study at its current stage.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Douglas Mental Health University Institute Research Ethics Board (IUSMD-16-52). All archival materials used in this study were anonymised, and identifying patient information was changed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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