On the Moral Imagination

An evocative phrase within the medical humanities lexicon (I know, I know, I'm way behind in this series . . . ) is the "moral imagination," which we've briefly discussed.  The idea, roughly, is that a healer's ability to imagine what it might be like to experience the illness phenomena the patient narrates is itself of moral significance.  The healer who has a better developed imaginative faculty, IMO, is that much more likely to heal the patient, as opposed to merely treat the disease.  David Henderson Slater has an excellent post underscoring the importance of the moral imagination for the physician over at the Literature, Arts, and Medicine Blog.

Excerpts:

When we see a patient in clinic, or in the operating theatre, or on the ward, we see only a tiny part of their lives. We tend to see what they want to present to us. The clinic and the ward are not real life, or only a tiny part of it. If I really want to know what life is like for my patient I have to spend hours at it - perhaps also visiting them at home (something I often do) or in the Nursing Home. That way I get a feel for the things that get forgotten in clinic- such as the long hours of inactivity, or the financial poverty of the family, and an appreciation of what is important to them - for example the religious artefacts on the walls, the family pets, the old cars littering their garden, the half finished Do-it-Yourself projects.

While narrative studies are not my area of focus within the medical humanities (I gravitate to ethics, policy, and the history of medicine & public health), there is no doubt in my mind that narrative is important academically because it is so important phenomenologically.  What I mean by that is, in Slater's articulation, the idea is that the visits between doctor and patient are merely one tiny slice of the larger stream of narratives that comprise the patient's life.  To actually understand what it might be like to experience the illness(es) that the patient is living and/or dying with, attention simply has to be given to the larger context in which the patient is living out his or her life.  As Slater notes,

But sometimes we can’t access the patient in this direct way, and sometimes we don’t notice things. Our minds and our eyes need to be trained to spot things; so does our imagination. As trainee doctors we get extensive training in physical examination. I believe we also need to train our imagination, to learn to think what life is like for others, to experience things vicariously.

Indeed.  The suggestion here is not that the healer must go out and examine how the patient lives his or her life -- although that is probably a very good idea, and seems to me to characterize some of what medical anthropologists "do" and why it might be important -- but rather that the imagination is a faculty, and can be honed and refined like any other.  And the more developed this faculty is, the more effective, IMO, the healer is likely to be.

In any case, go read the whole post, which includes some perspectives from an Oxford medical student on disability and film.

Comments

[Patrick S. O'Donnell]

I wonder if this imaginative ability or capacity might be more accurately described as empathy, which is a relatively new term in English (see the helpful entry on 'empathy' by Karsten Stueber in the SEP: http://plato.stanford.edu/entries/empathy/#Rel, and cf. Michael Slote's The Ethics of Care and Empathy, 2007).

[Dov Henis]

Why Pavlov Is Smiling In 2008

The GGRPVR Chain:
Genes, God, Religion, Placebo, Virtual Reality.

A. Imagination Medicine

http://www.sciencenews.org/view/feature/id/39046/title/Imagination_Medicine
Brain imaging reveals the substance of placebos. Expectation alone triggers the same neural circuits and chemicals as real drugs.

"It all boils down to expectation. If you expect pain to diminish, the brain releases natural painkillers. If you expect pain to get worse, the brain shuts off the processes that provide pain relief. Somehow, anticipation trips the same neural wires as actual treatment does.

Scientists are using imaging techniques to probe brains on placebos and watch the placebo effect in real time. Such studies show, for example, that the pleasure chemical dopamine and the brain’s natural painkillers, opioids, work oppositely depending on whether people expect pain to get better or worse. Other research shows that placebos can reduce anxiety."

B. Placebos: some background info

http://www.cerebromente.org.br/n09/mente/pavlov_i.htm
http://www.cerebromente.org.br/n09/mente/placebo1_i.htm
http://thjuland.tripod.com/placebos.html

The concept of a placebo comes from medieval times, when professional mourners were paid to stay by the bedside of. deceased person, reciting a psalm beginning "Placebo Domino..." or "I shall please the Lord." "Placebo" gradually became the word used for the paid mourner, whose grief was, in fact, false.

C. Life's Manifest

http://www.the-scientist.com/community/posts/list/112.page#578

Genes are the primal, first stratum, Earth's organism.

D. Of Science and Religion

http://www.physforum.com/index.php?showtopic=18243&st=0&#entry267674

E. So why is Pavlov smiling in 2008?

Pavlov demonstrated effecting placebo phenomena in multicelled organisms by manipulation of their drives-reactions. Now placebo phenomena are demonstrated in the multicelled organism's genes and genomes, in our primal first stratum and 2nd stratum base organisms...a very good reason to smile.

Now an interesting chain is exposed to our view, the GGRPVR Chain, the Genes-God-Religion-Placebo-Virtual Reality chain, a most intriguing cultural evolution chain, extending from the genes genesis to nowadays...

Dov Henis

(A DH Comment From The 22nd Century)
http://blog.360.yahoo.com/blog-P81pQcU1dLBbHgtjQjxG_Q--?cq=1