Medical Humanities current issue

Picasso, professionalism and plastic surgery: why privileging the patient's perspective is a moral imperative

Kirklin, D. — Mon, 30 Nov 2009 10:48:26 PST

Public confessions of a sinner: a healthy take on obesity?

Scholz, S. — Mon, 30 Nov 2009 10:48:26 PST

Therapeutic acts of witness: why writing poetry and prose has never been just for patients

Roscoe, L. A — Mon, 30 Nov 2009 10:48:26 PST

Existential boredom: the experience of living on haemodialysis therapy

Moran, A, Scott, P A, Darbyshire, P — Mon, 30 Nov 2009 10:48:26 PST

Empathy is an essential component of professional nursing practice. In order to empathise appropriately with patients, it is crucial that nurses appreciate, understand and respond to their patients’ experience of illness. This study sought to explore the experiences of 16 people with end stage renal disease on haemodialysis therapy in Ireland. A hermeneutical phenomenological methodology was employed incorporating qualitative interviews. The data were analysed using qualitative interpretive analysis. The experience of waiting was significant for the participants in the study. The experience of waiting was constituted by two themes labelled killing time and wasting time. It is suggested that the participants’ experience of waiting is reminiscent of Heidegger’s existential account of boredom. Moreover, the existential perspective of boredom contained within the participants’ accounts is also depicted by Beckett in his play Waiting for Godot. Consequently, the literature of both existential writers is incorporated to provide a more in-depth description of the participants’ experience of waiting. It is hoped that the insights provided in this paper will enable practitioners to gain a new awareness and understanding of patients’ experiences of end stage renal disease and haemodialysis therapy. This would subsequently enable these professionals to empathise more effectively with their patients’ situation and respond more appropriately to their care needs.

Confessions of the flesh and biopedagogies: discursive constructions of obesity on Nip/Tuck

Rail, G, Lafrance, M — Mon, 30 Nov 2009 10:48:26 PST

Informed by the work of Michel Foucault, the authors discuss the Nip/Tuck episode entitled "Momma Boone" and how it discursively constructs "obesity". They show how this popular media text can be understood as a crystallisation of the dominant discourse surrounding fat bodies. In the process, how the episode can be seen as a "biopedagogy" that instructs its viewers in how to think and feel about the fat body is examined. Foucault’s formulation of the confessional is seen to be useful to theorise the ways in which biopedagogy leads subjects to believe and ultimately take part in processes leading to salvation. It is argued that in this Nip/Tuck episode, biopedagogy functions in and through Momma Boone’s "confessions of the flesh", that is, confessions aimed at revealing her obese body so that it can be rescued, rehabilitated and saved. Momma Boone’s salvation is shown to require three stages: first, the "confession" of obesity; second, the conversion to the "truth" of the "dominant obesity discourse"; and third, the codification of a "new life" for the obese subject. In the end, it is argued that since it is represented as abject, monstrous and out of control, Momma Boone’s body is made to inspire fear and panic in so far as it provides constructed "evidence" regarding the consequences of the obese subject’s failure to convert to the truth of obesity discourse.

A time like all others

Gardner, C — Mon, 30 Nov 2009 10:48:26 PST

Finding a voice: revisiting the history of therapeutic writing

Peterkin, A D, Prettyman, A A — Mon, 30 Nov 2009 10:48:26 PST

We review the history of therapeutic writing, focusing on the role of narrative competence and the use of writing therapy for stress, trauma and coping with chronic illness. After providing a historical overview of the evidence for writing’s positive effects on health and the hypothesised mechanisms underlying this effect, we ask whether narrative competence can explain and improve writing’s benefit. Narrative competence is defined across two dimensions: (1) Emplotment, or the ability to construct and comprehend goal-oriented connections among temporally situated events; and (2) Meaning, or the ability to understand and communicate contextual interpretations of ambiguous story structures. We suggest that the ability to construct well-organised and meaningful narratives is an important skill for successfully coping with life stressors and trauma, enabling individuals to create coherent stories from fractured memories and to facilitate cognitive processing of traumatic events. Given the positive effect of narrative competence on psycho-physical health, there is a need to broaden medical use of narrative competence therapies beyond the current interventions aimed at fostering empathy among healthcare providers, to include therapies for the patients themselves. Toward this end, we briefly explore one clinical model currently offered by Dr Allan Peterkin and colleagues at Mount Sinai Hospital providing group Narrative Competence Psychotherapy (NCP) for individuals living with HIV.

Glancing light: three prose poems

Brueggemann, J G — Mon, 30 Nov 2009 10:48:26 PST

Picasso's bodies: representations of modern society?

Borsay, A — Mon, 30 Nov 2009 10:48:26 PST

During the course of a long artistic career, the work of Pablo Picasso (1881–1973) passed through a number of stages. This article concentrates on his representation of the human body prior to the First World War. Three paintings are used to illustrate the transition from social realism to the Blue period and Cubism: Science and Charity (1897); Tragedy (1903); and Seated Nude (1909/10). They are interpreted through the lens of Arthur C Danto's concept of the "art world", which subsequent theorists have elaborated to capture the historical context as well as the aesthetic form and biographical detail that preoccupied traditional critics. Therefore, the analysis not only embraces colour, perspective and significant events in Picasso's life but also early 20th century politics and ideology, science and medicine. In this way, the synergies that exist between cultural artefacts and the body are demonstrated, and the interdisciplinary understanding of health and healthcare that medical humanities promote is endorsed.

Performing the good death: the medieval Ars moriendi and contemporary doctors

Thornton, K, Phillips, C B — Mon, 30 Nov 2009 10:48:26 PST

Death is inevitable, but dying well is not. Despite the role of medical professionals as overseers of dying in contemporary society, there is comparatively little discourse among doctors about the constituents of a good death. In the 15th century, by contrast, the Ars moriendi portrayed normative medieval ideas about good and bad deaths. At a time when dying could be viewed as a performed battle against damnation, the Ars moriendi codified a set of moral precepts that governed the expression of autonomy, relations between the dying and the living and orientation towards God. In these images, dying well is a moral activity that results from active decisions by the dying person to turn from earthly preoccupations to contemplation of, and submission to, the divine. It is likely in contemporary society that there is a range of understandings of the "good death". While attitudes to personal autonomy may differ, reflectiveness and dying at home in the presence of family (expressed in the Ars moriendi), remain part of many modern notions of the good death. We argue that medical institutions continue to construct death as a performed battle against physical debility, even when patients may have different views of their preferred deaths. The dialectic approach of the Ars moriendi may offer a way for contemporary doctors to reflect critically on the potential dissonance between their own approach to death and the variety of culturally valorised "good deaths".

Jane Austen and Addison's disease: an unconvincing diagnosis

White, K G — Mon, 30 Nov 2009 10:48:26 PST

Jane Austen’s letters describe a two-year deterioration into bed-ridden exhaustion, with unusual colouring, bilious attacks and rheumatic pains.

In 1964, Zachary Cope postulated tubercular Addison’s to explain her symptoms and her relatively pain-free illness. Literary scholars later countered this posthumous diagnosis on grounds that are not well substantiated, while medical authors supported his conclusion.

Important symptoms reported by contemporary Addison’s patients—mental confusion, generalised pain and suffering, weight loss and anorexia—are absent from Jane Austen’s letters. Thus, by listening to the patient’s perspective, we can conclude it is unlikely that Addison’s disease caused Jane Austen’s demise.

Disseminated bovine tuberculosis would offer a coherent explanation for her symptoms, so that Cope’s original suggestion of infective tuberculosis as the cause of her illness may have been correct.

What training do artists need to work in healthcare settings?

Moss, H, O'Neill, D — Mon, 30 Nov 2009 10:48:26 PST

Given the increased attention paid to the development of arts in healthcare settings, the need for a formalised training framework to enable artists to work comfortably and safely in healthcare settings has become pressing. This paper sets out a review of literature and best practice regarding the training of professional artists wishing to work in healthcare settings. The authors’ research confirms the gap in the arts sector with regard to such training. Very little formal training is currently available internationally for artists wishing to work in healthcare settings outside of the arts therapies professions. There is a need for the health sector to formalise a currently ad hoc approach to employing artists in healthcare settings. There are a number of best-practice models of arts and health practice from which we can learn but relatively scant literature on course development. The arts therapies are relatively expert in the domain of using the arts in healthcare and while there are different aims and intentions to this work, it is important that any establishment of arts and health training recognises the contribution and expertise of arts therapists in the healthcare arena. A culture of mutual learning between the arts therapies and the arts and health specialists is recommended.

Opera and madness: Britten's Peter Grimes--a case study

Dura-Vila, G, Bentley, D — Mon, 30 Nov 2009 10:48:26 PST

In this paper, Britten’s opera Peter Grimes (1945) is used as an illustrative case study through which to examine the depiction of psychiatric disorders in opera. It is argued that Peter Grimes is a powerful example of how opera, in the hands of a great composer, can become an invaluable tool for examining subjective human experience. After a brief discussion of opera as a vehicle to express emotions, various operas are drawn upon to provide a historical perspective and to demonstrate the long interconnection existing between opera and madness. An in-depth analysis of Peter Grimes, its background and central character, is then provided, in order to demonstrate how opera can elicit empathy for individuals affected by mental health problems.

Hospital time

Rowe, M — Mon, 30 Nov 2009 10:48:26 PST

Challenges to UK community pharmacy: a bio-photographic study of workspace in relation to professional pharmacy practice

Rapport, F L, Doel, M A, Jerzembek, G S — Mon, 30 Nov 2009 10:48:26 PST

This paper presents a novel, qualitative, bio-photographic study with intertextual analysis highlighting the relationship between community pharmacy workspace and practice. Sixteen pharmacists working across pharmacy types such as independent shops, large and small pharmacy chains and multiple pharmacies such as those in supermarkets participated in data capture and feedback consultation. Findings disclosed workspaces unfit for purpose and a workforce ill at ease with their new professional identity, involving increasingly complex tasks in health provision and retail. There was conflict between delegating to others and taking personal responsibility, and there were pressures from a demanding public within the context of a target-driven, litigious society. The study highlights that innovative, mixed methods in this context reveal nuanced, rich data.

An immigrant's story

Nenner, F — Mon, 30 Nov 2009 10:48:26 PST

Using art and literature as educational resources in palliative care

Lawton, S, McKie, A — Mon, 30 Nov 2009 10:48:27 PST

This case study outlines a staff seminar programme that used art and literature as vehicles to explore personal and professional dimensions of palliative care. Participating staff found the learning experience interesting and insightful.

Using paintings to explore the medical humanities in a Nepalese medical school

Shankar, P R, Piryani, R M — Mon, 30 Nov 2009 10:48:27 PST

Direct red: a surgeon's story

Craft, N — Mon, 30 Nov 2009 10:48:27 PST

Cutting for Stone

Faunce, T A — Mon, 30 Nov 2009 10:48:27 PST

Blue pills: a positive love story

Williams, I — Mon, 30 Nov 2009 10:48:27 PST

The body and the arts

Dakin, P K — Mon, 30 Nov 2009 10:48:27 PST

The growth of British sex education films: negotiating what we shouldn't know

Crowther, B — Mon, 30 Nov 2009 10:48:27 PST

Nurse Edith Cavell

Wall, R, Rafferty, A M — Mon, 30 Nov 2009 10:48:27 PST