Welcome to the first Literature Review on this MH weblog. Today's Review will collate the abstratcs from the latest edition (June 2006) of the biannual Medical Humanities. You can view a PDF of the Table of Contents by clicking here: Download mhJune06.pdf. To view the collated abstracts, please continue beneath the fold.
*NOTE: Medical Humanities, as a BMJ journal, provides free access to all articles published over 12 months ago. The full-text articles from this issue (June 2006) are therefore available for purchase at the Medical Humanities website. Many of the links that appear below do not work properly. However, to proceed to a web page on the journal's web site with active links to the full-text articles, click here.
ORIGINAL ARTICLE |
Dr Bruno Sachs addresses an audience of first year medical students: an extract from the writing of Martin Winckler, French doctor and writer
1 General Practitioner, St Mary’s, Isles of Scilly TR21 0NE, UK
2 27 Rue de la Boussinière, F 72000 Le Mans, France
Correspondence to:
D Jeffries
Top Flat, Rocky Hill, St Mary’s, Isles of Scilly TR21 0NE, UK; djeffries@onetel.com
One of the authors of this paper (DJ) has been impressed by the work of the second author (MW) for some time. On reading one of his works, Les Trois Médecins, DJ was so struck by a particular passage that he attempted a translation. He received not only permission from Winckler to seek publication but also help with the translation. Along with that translation, which forms the body of this article, the passage has been set in context by MW, who also provides some explanation of it. It is DJ’s hope that the article will prove stimulating in its own right, and also lead some readers at least to seek out more of Winckler’s work.
Keywords: medical education; ethics; care; professionalism
[Full Text of Jeffries and Winckler] [Reprint (PDF) Version of Jeffries and Winckler]
ORIGINAL ARTICLE |
"I am living in my own corpse"—the experience of tuberculosis in poems by A B 
imi
-Feren
i2
1 Old Church Slavonic Institute, Zagreb, Croatia
2 Croatian Academy of Sciences and Arts, Department for the History and Philosophy of Sciences, Division for the History of Medicine, Zagreb, Croatia
Correspondence to:
M-A Dürrigl
Old Church Slavonic Institute, Demetrova 11, 10000 Zagreb, Croatia; duerrigl@hfi.hr
This paper focuses on seven poems dealing with various aspects of his experience of tuberculosis and uncovers different shades of poetic self within his verses: the notions of self transforming from a helpless child to a ghostly, transparent creature in the secluded world of a hospital ward, and to decaying flesh and "living in a cadaver" are pinpointed. Poetry as creation is the opposite of physical demise; in poetry 
imi finds escape not from the inevitable end, but from suffering. These poems are not confessions of a sick young man; they are relevant works of art touching readers’ sensitivity and imagination. They may be relevant for medical professionals in enabling them to view disease—in this case tuberculosis—in a wider context and to be open to the many and different ways in which the experience of illness can be expressed.
Keywords: pulmonary tuberculosis; expressionist poetry; literature and medicine; body/mind and soul relationship; attitude to disease; attitude to temporality/dying
[Full Text of Dürrigl and Fatovic-Ferencic] [Reprint (PDF) Version of Dürrigl and Fatovic-Ferencic]
ORIGINAL ARTICLE |
Sickness, healing, and opera: Wagner’s Parsifal
Correspondence to:
K L Dunn
Chaplaincy Office, The Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; Kevin.Dunn@christie-tr.nwest.nhs.uk
Richard Wagner’s opera Parsifal is examined as a study in illness, pain and healing. Wagner’s intention was to communicate directly to the audience the "emotional content" of the suffering of the character Amfortas. This presentation of suffering allows us to take from the opera some general ideas about the nature of illness and healing and their metaphorical representation in art. Further insights can be gained from the genre of classical tragic drama, of which Parsifal is a modern example.
Keywords: opera; drama; tragedy; guilt; sickness; healing
[Full Text of Dunn] [Reprint (PDF) Version of Dunn]
ORIGINAL ARTICLE |
Some perspectives on Chekhov’s short story A Case History
Correspondence to:
Professor J Niemi
Department of Literature and the Arts, University of Tampere, FIN-3301, Finland; juhani.niemi@uta.fi
The Russian writer and physician Anton Chekhov (1860–1904) draws on his clinical experience in many of his stories. One of his later masterpieces entitled A Case History (1898) depicts a physician’s visit to a small industrial community where a wealthy young woman is suffering from diffuse symptoms. The physician, Dr Koryolov, meets the patient and makes a diagnosis. While staying on the estate overnight he also analyses the patient’s relation to her living conditions.
Keywords: Anton Chekhov; Aristotle; doctor-patient communication; literature and medicine; literary interpretation
[Full Text of Niemi] [Reprint (PDF) Version of Niemi]
ORIGINAL ARTICLE |
Creativity, self creation, and the treatment of mental illness
Correspondence to:
Professor Albert Rothenberg MD
Harvard University, Box 1001, Canaan, NY 12029, USA; albert_rothenberg@hms.harvard.edu
This paper examines how an understanding of systematic findings about creative processes involved in art, literature, and science can be applied to the effective treatment of mental illness. These findings and applications are illustrated by particular reference to the work of the poet Sylvia Plath and the treatment of a patient who aspired to become a writer.
Keywords: self creation; creativity; psychotherapy; destructiveness; suicide; Sylvia Plath
[Full Text of Rothenberg] [Reprint (PDF) Version of Rothenberg]
ORIGINAL ARTICLE |
Motherhood versus patienthood: a conflict of identities
Correspondence to:
Janet Rhys Dent
7 Featherston Rd, Sutton Coldfield, B74 3JW, UK; janetrhysdent@hotmail.com
This paper examines a thread that runs through my memoir of illness: the "shock" of becoming a patient and finding that this new identity, "patienthood", conflicts with the specific, culturally defined role of mother that I idealise as "motherhood". I have taken four excerpts from my memoir and discuss them in relation to the way I constructed my intersectional and conflicting identities as mother and patient, both during the initial phase of my illness and in the act of writing about them afterwards. My conclusions echo those of many theorists: while there may be no elusive core self, we are each made up of many identities, many stories, all provisional on factors such as ethnicity, gender, or race, and all in a state of continuous flux in response to changing contexts over time. Furthermore, our identities are often shaped by, and are also shaping, that ethical question: how to lead the "good life". It is all these dimensions that constitute the richness of individual "selfhood".
Keywords: identity; illness; patient; memoir; woman; learning
[Full Text of Dent] [Reprint (PDF) Version of Dent]
ORIGINAL ARTICLE |
Body and self: a phenomenological study on the ageing body and identity
Correspondence to:
Jennifer Bullington
Associate Professor, Ersta & Sköndal University College, PO Box 4619, SE – 116 91 Stockholm, Sweden; Jennifer.Bullington@euc.ersta.se ; Jennifer.Bullington@comhem.se
The aim of the study was to investigate how older people (60+) experience the ageing body and how these experiences affect aged peoples’ sense of identity. Explorative, open ended, interviews were conducted with 13 respondents between the ages of 63 and 82, recruited from a retired peoples’ organisation, Church organisations, and from the working population. The qualitative data was analysed with a phenomenological method, the so called EPP method, the empirical phenomenological psychological method. The results showed that generally the experience of the ageing body has to do with a changed life world, reactions to this change in terms of body and self, and finding ways to feel at home in this changed situation. Results are presented as three typologies, reflecting the different ways in which the respondents described this general experience: existential awakening, making it good enough, and new possibilities. The results give support to the research that points out the importance of activity for the self esteem of the elderly. According to this study, however, the meaning of "activity" can vary and can have different sources of motivation. Respondents in only one typology expressed frustration over limitations of the ageing body. Respondents exhibited entirely different ways of relating to the fact that death was approaching, which raises questions about how the elderly experience this impending horizon. Finally, the gender differences in this small study were quite clear: all the male respondents belonged to the typology "New possibilities", raising questions about gender aspects concerning the meaning of freedom, appearance, activity, and self esteem.
Keywords: ageing body; phenomenology; lived body
[Full Text of Bullington] [Reprint (PDF) Version of Bullington]
ORIGINAL ARTICLE |
Expressing freedom and taking liberties: the paradoxes of aberrant science
Correspondence to:
Dr M Little
Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney NSW 2006, Australia; milesl@med.usyd.edu.au
Complete freedom does not exist, despite people’s preparedness to die for it. Scientific freedom is much defended and yet much misunderstood. Scientists have limits imposed on their freedom by the disciplines and discourse communities in which they place themselves. Freedom within these socially constructed constraints needs to be distinguished from taking liberties with the rules and practices that make up these constraints, and validate the activities of special groups within society. Scientists (and the public) perceive taking liberties with science’s rules and practices as aberrant science, and they often react punitively. Aberrant science can be broadly examined under four headings: wicked science, naughty science, dysfunctional science, and ideologically unacceptable science. When we examine examples of perceived aberrant science, we find that these categories of "misconduct" are connected and often confused. Scientific freedom needs to be redefined with due regard to current understandings of scientists as human beings facing powerful social pressures to deliver results of a particular kind.
Keywords: scientific misconduct; aberrant science; freedom
[Full Text of Little] [Reprint (PDF) Version of Little]
ORIGINAL ARTICLE |
Prenatal diagnosis and selective abortion: a result of the cultural turn?
Correspondence to:
Mr D I Bromage
Centre for Ethics in Medicine, 73 St Michael’s Hill, Bristol, BS2 8BH, UK; danbromage@doctors.org.uk
There is a growing trend in obstetric medicine of prenatal diagnosis and the selective abortion of foetuses that are likely to be born with a disability. Reasons commonly given to explain this trend include the financial implications of screening and testing policies, the disruption to families caused by the birth of a child with a disability, and the potential quality of life of the unborn child. This paper reflects upon another possible reason for this. It is argued that it is, in part, a consequence of our attitudes towards disability and a pursuit of aesthetic perfection. These attitudes arise from a social context that may be explained by considering the effect on the disabled community of the transition from modernity to postmodernity. This shift is demonstrated by inspecting some of the synonymous developments in art history. It is suggested that this "cultural turn" may have both helped and hindered people with disabilities, but the hypothesis requires further testing. This could be best achieved with a qualitative study of what motivates parental decision making in the obstetric unit.
Keywords: postmodern; selective abortion; prenatal diagnosis; culture
[Full Text of Bromage] [Reprint (PDF) Version of Bromage]
ORIGINAL ARTICLE |
Medical ethics as therapy
Correspondence to:
Dr A Zucker
Department of Philosophy, Director, Institute for Applied and Professional Ethics, 202 Ellis Hall, Ohio University, Athens, OH 45701, USA; zuckera@ohio.edu
In this paper, the author examines a style of teaching for a medical ethics course designed for medical students in their clinical years, a style that some believe conflicts with a commitment to analytic philosophy. The author discusses (1) why some find a conflict, (2) why there really is no conflict, and (3) the approach to medical ethics through narratives. The author will also argue that basing medical ethics on the use of narratives has problems and dangers not fully discussed in the literature.
Keywords: therapy; narratives; stories; analytic; clinical
[Full Text of Zucker] [Reprint (PDF) Version of Zucker]
ORIGINAL ARTICLE |
Being the monster: women’s narratives of body and self after treatment for breast cancer
Correspondence to:
L Rosenblatt
Harvard Medical School, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 44 Binney St SW 411, Boston, MA 02115, USA; Laurie_Rosenblatt@dfci.harvard.edu ; larosenbl@yahoo.com
Serious illness and its treatment frequently changes a woman’s sense of herself and her body. Narrative medicine posits that individuals permitted to tell their stories regain control over the plotline of the illness, reclaim the central role as protagonist, and thus diminish the sense of helplessness, marginalisation, and isolation that are inevitable aspects of serious disease. The women presented here speak about losses that occur during treatment for advanced cancer. These losses include: loss of the former body; loss of one or both breasts; loss of hair; loss of fertility, and changes in weight, energy, and sexuality. This paper will not review the medical literature on the psychological aspects of change in appearance secondary to disease and/or treatment. As a way of broadening our understanding of what women attempt to communicate to their care providers about who they are and who they are becoming through the experience of illness, this paper will present brief excerpts from the interviews of four women talking about issues of identity and bodily change, using concepts of feminine identity developed by the French psychoanalytic theorist Hélène Cixous in her essay, The laugh of the Medusa.
Keywords: narrative medicine; breast cancer narratives; feminist theory; Hélène Cixous; cancer and identity
[Full Text of Rosenblatt] [Reprint (PDF) Version of Rosenblatt]
ORIGINAL ARTICLE |
"Stepford doctors": an allegory
Correspondence to:
Gwen M Sayers
Consultant Physician and Honorary Clinical Senior Lecturer (Imperial College School of Medicine), Department of General and Geriatric Medicine, Northwick Park Hospital, Watford Road, Middlesex HA1 3UJ; gwen.sayers@imperial.ac.uk
The Stepford Wives, a novel by Ira Levin, provides the theme for this allegory. The men of Stepford belong to the Men’s Association. Their wives are "perfect", in that they do nothing other than clean, cook, preen, and provide satisfaction without argument for their husbands. They are, furthermore, content with their lot, and believe that their previous interests and freedoms were self indulgent. Levin never informs his readers how the men came to obtain total mastery over their "Stepford wives", although there is the suggestion that the real wives have been replaced by robotic lookalikes.
Keywords: "Stepford wives"; doctor/patient relationship; medical management; freedom; slavery; resources
[Full Text of Sayers] [Reprint (PDF) Version of Sayers]
ORIGINAL ARTICLE |
Evaluating a poetry workshop in medical education
1 Peninsula Medical School, Plymouth, UK
2 Peninsula Medical School, Plymouth, UK
Correspondence to:
Dr Tracey J Collett
Peninsula Medical School, Drake Circus, Plymouth, PL4 8AA, UK; tracey.collett@pms.ac.uk
This study aimed at evaluating how doing poetry could affect students’ understanding of medical practice and at assessing the effectiveness of the evaluation method used. Qualitative research was carried out on the experiences of medical students participating in a poetry workshop, followed by some quantitative analysis. The study was conducted at Peninsula Medical School and St Ives, Cornwall, UK, with three medical students, a poet and a pathologist as participants. Data were collected by interviews, observation and web access. "Doing poetry" with a professional poet was found to assist communication between doctors and patients as it enhanced skills of observation, heightened awareness of the effect of language and fostered deep reflection. Poetry was also found to offer an outlet for medics and patients. The voluntary workshop attracted three participants; however, it might have had an effect on the wider student community because the poetry website received 493 hits in four months. Qualitative methods worked well as a tool for evaluation. "Doing poetry for poetry’s sake" seemed to foster the development of skills related to empathy. The opportunity to do poetry should be made available to medical students as part of a wider arts and humanities programme.
Abbreviations: PMS, Peninsula Medical School
Keywords: poetry; medical humanities; arts and humanities
[Full Text of Collett and McLachlan] [Reprint (PDF) Version of Collett and McLachlan]
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