eLetters

38 e-Letters

  • response to letter re: The Abdication of King Edward VIII: a study of estrangement between and adult son and elderly mother

    Dear Sir:
    I believe that the author of the letter has misread the aim and content of the article. I nowhere implied that the phenomenon of estrangement was limited to disconnections between older parents and their adult children. However, I chose to focus on that segment because of its unique characteristics, namely, the particular suffering of older estranged parents who, in addition to experiencing the expected adversities of aging, must acknowledge that the window of opportunity for reconciliation with their children is narrowing; nor did I state or suggest that loneliness was universally experienced by older people. The article was inspired by my interest in 20th-century British history and by the many examples of estrangement I have seen over the years in my clinical practice, which is concentrated on older patients. Also, I do agree that the term "elderly" has become freighted and rather pejorative, and I no longer use it in articles or other communication. Language always matters, but perceptions of specific words change markedly over time, and I consider it regrettable that such distractions have become overvalued in academic work. These considerations remain within the narrow province of theoretical gerontologists and reside entirely outside the concerns of frontline practitioners, of which I consider myself one.

  • On intersectionality and pain: a response to Kari Campeau

    As a 5th year medical student of Somali origin with a longstanding interest in the intersection of culture and illness, I particularly enjoyed the Editor’s Choice article entitled ‘Adaptive frameworks of chronic pain: daily remakings of pain and care at a Somali refugee women’s health centre’ by Kari Campeau. I was especially impressed by the way in which Campeau captured how one’s distinct racial and religious character can impact the way chronic pain is understood and responded to by one’s self and by others.

    Particularly disheartening was Campeau’s analysis of how these women often suffer exclusionary sentiment within medical spaces and are consequently less inclined to seek medical treatment for their pain. Understandably, for the women in question, visiting the doctor confers an emotional and communicative labour on top of a pre-existing medical complaint, and ultimately may not be ‘worth it’. The philosopher Miranda Fricker describes a ‘testimonial injustice’, which is a form of epistemic prejudice whereby for marginalised people, there is a diminished level of credibility applied to their word. From Campeau’s research, it appears this type of prejudice may have been at play when her participants had interacted with clinicians.

    As to Campeau’s exploration of the intersection between religion and pain, I would disagree that pain is understood through a wholly fatalistic lens among this cohort. Somalis, who are largely Muslim, believe not only in pre-orda...

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  • Ensuring congruence between medical humanities and medicine

    While this paper gives an eloquent description of discord between a mother and son, it is unfortunate that it attempts to characterize it as relating in particular to later life. There is no evidence in the gerontological literature that this is the case, and discord between adult children and their parent occurs and causes distress across the adult lifespan. In the single paper quoted as a reference, the investigators did not sample discord across the lifespan but only reviewed those dyads where the mother was aged 65-75 (1). This is a common failing of much gerontology, and in particular the literature on loneliness, whereby focusing on later life alone not only misses out on opportunities for considering loneliness across the lifespan but also inappropriately characterizes loneliness as a defining characteristic of later life (2).

    In cultural gerontology (3), just as in the medical humanities, it is important that due critical interrogation is given to congruence between the gerontological sciences and the humanistic inquiry, and indeed to appropriate terminology such as avoidance of the term 'elderly'(4).

    References
    1. Gilligan M, Suitor JJ, Pillemer K. Estrangement between mothers and adult children: The role of norms and values. Journal of Marriage and Family. 2015;77:908-20.
    2. O'Neill D. Loneliness. Lancet. 2011;377:812.
    3. O'Neill D. Geriatric medicine and cultural gerontology. Age Ageing. 2015;44:353-5.
    4....

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  • Alternative Medicine is a Useful Concept

    Pekka Louhiala argues, "there is no alternative medicine" because "it escapes a meaningful definition, and 'alternative medicine' cannot be clearly differentiated from conventional medicine" [1]. I do not consider that his arguments are valid.

    Louhiala does not mention the definitions that have been proposed for "alternative medicine". For example, Eisenberg defined alternative medical therapies as "interventions neither taught widely in medical schools nor generally available in US hospitals" [2]. Cochrane collaboration defined: "Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed" [3]. These definitions are not exhaustive, but they capture what I think is the most essential.

    These definitions consider that the relevant factor for setting up the boundary around alternative medicine is by the lack of social acceptance within mainstream medicine. Thus, alternative medicine consists of i...

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  • A Shift in the MH long needed

    Kristeva and her colleagues argue for a bilateral dialogue between the culture and the scientific Humanities and putatively objective Natural Sciences. As they are strikingly tracing back the Humanities' supplementary character for a dominant biomedical perspective of health and sickness, they establish decisive and inspiring landmarks to realigning the realm of Medical Humanities which needs to be continued. However, it remains unclear which concept of culture is applied and how to equate it to the Humanities as joined opposite of Science. Furthermore, when it comes to criticizing the monopole of evidence-based research in Natural Science, we should consider that it is not this approach that "runs the risk of exalting biology into an ‘essential Being’ and a normative stasis " (p. 3), but as well and in particular the interpretative act of clinicians and medecins which is worth having a deeper look in (as did Zimmermann 2016; Jurecic 2012; Hunter 1991). And, on the opposite, it would be interesting to focus not only on the perspective of the "experts" but as well on the patients' impact on co-creating the array between health and sickness. It would be beneficial to add this experiential dimension of everyday life to the discussion. At last, this well informed polemic offers thorough starting points for further discussion and gives new insights scholars have already been waiting for for so long.

  • Cinema as a tool to increase empathy among medical residents

    In the paper “The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents” Dr. Zazulak and colleagues address the role of an arts-based curriculum as an instrument to increase empathy and stimulate mindfulness and well-being in medical residents (1). I would like to extend the discussion and include cinema as a powerful tool able to not only provide a meaningful educational experience but also improve residents’ empathy and decrease exhaustion.
    Little has been studied and although reported in a few sporadic papers, there is no clear evidence that the use of arts can improve residents’ awareness and sensitivity (2-4). Regardless, there is a current trend of increased theoretical knowledge and objectivity among doctors suffering from a dogmatic approach that lacks empathy and emotion(5). As clearly defined by the authors in an era of increasing burnout among residents, films can not only educate and increase empathy but also serve as a social gathering as well as a way of having fun and relaxing(6). They not only offer an opportunity to face the meaning of being a doctor but also to arouse emotions yet hidden(5, 7). From a personal perspective I can be transported to a reality not clearly seen behind the desk and white coat and other perspectives now appear more tangible; I can see families suffering at home while taking care of their loved ones (Amour), the relation between nurses and paralyzed pati...

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  • Response to Kamath et al 'A syncretic approach can yield dividends'

    Dear Editor,

    We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.

    Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.

    Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (re...

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  • A syncretic approach can yield dividends

    Dear editor,

    We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.

    An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face...

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  • The Therapaeutic Imagination
    susanne stevens

    A book written by Jeremy Holmes, Psychoanalyst,(which I came across on the web) aimed mainly at psychotherapists, 'The Therapeutic Imagination' has used a novel approach to deepen understanding of the two way process involved in understanding self and others, by applying extracts from poetry and novels to explore 'what goes on' from a psychological perspective in a professional relationship- in order to better underst...

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  • The Wonder of Sonder
    susanne stevens

    When children come up with unique words they do not just show a stage of the technical development of language but also their unique understanding of aspects of their lives. Parents or those who look after them often 'get it' whilst nobody else does just because they are tuned in. These words are often kept as unique memories of a child's inner world.

    I would like to offer one of my own. 'Imaginating' which ha...

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