Reading Cultural Studies of Medicine

This article introduces cultural studies of medicine to medical humanities readers. Rather than offer extended definitions of cultural studies of medicine or provide a detailed history of the domain, I have organized this introduction around a close reading and review of three recently published texts in the field. These three texts, dealing respectively with “cyborg” technology, AIDS, and the medical “management” of sexual identity problems, represent excellent examples of the opportunities and possibilities of applying cultural studies approaches to medical topics. After working through these texts (and the semiotic “theories” which animate them), I devote my conclusion to a broader consideration of the role of cultural studies of medicine for both medical practice and medical humanities scholarship.     

Pedagogy and the Art of Death: Reparative Readings of Death and Dying in Margaret Edson’s <Emphasis Type="Italic">Wit</Emphasis>

Wit explores modes of reading representations of death and dying, both through the play’s sustained engagement with Donne’s Holy Sonnets and through Vivian’s self-reflexive approach to her illness and death. I argue that the play dramatizes reparative readings, a term coined by Eve Kosofsky Sedgwick to describe an alternative to the paranoid reading practices that have come to dominate literary criticism. By analyzing the play’s reparative readings of death and dying (as well as its representation of the shortcomings of paranoid readings), I show how Wit provides lessons about knowledge-making and reading practices in the field of health humanities.     

The Effects of Text Difficulty on Second Graders' Fluency Development

In this study, two groups of second graders participated in Fluency-Oriented Reading Instruction (FORI) but their repeated reading experiences used different kinds of texts. One group—the Literature group—read texts from the district's literature-based, basal reading program. The second group—the Content group—read from a set of science and social studies texts that were written to have few rare, multisyllabic, single-appearing words. Control-group students read from the district's literature-based program. Both intervention groups made greater gains in reading rate than Control group students and Content students made greater gains in reading rate than Literature students. Content and Literature groups outperformed Control students on the comprehension measure but did not perform significantly differently from one another. The gains made by the Content classrooms were made in approximately half the amount of time allocated to reading instruction as by Literature classrooms.     

Bernard Shaw and the doctors: The art and science of medicine inThe Doctor's Dilemma

What did Bernard Shaw really think about doctors? Although any reader with a sketchy understanding of Shaw's work is inclined to think that he condened the entire profession, a careful reading of his most well-known play featuring medical practitioners reveals a mixed attitude. InThe Doctor's Dilemma, one finds a position that may be representative of Shaw's attitude. In this play, he places the entire Edwardian medical establishment—consultants and general practitioners — on stage, and he focuses the attention of this diverse group on the problem of a patient. In doing so, Shaw is able to separate the play's characters into representatives of (1) the newscientific medicine and (2) the venerableart of medicine. He satirizes the arrogance of the former, and he presents the humane attitude of the latter in a favorable light.     

How to do things with (recorded) words

The aim of this paper is to evaluate which context determines the illocutionary force of written or recorded utterances—those involved in written texts, films and images, conceived as recordings that can be seen or heard in different occasions. More precisely, my paper deals with the “metaphysical” or constitutive role of context—as opposed to its epistemic or evidential role: my goal is to determine which context is semantically relevant in order to fix the illocutionary force of a speech act, as distinct from the information the addressee uses to ascertain the semantically relevant context. In particular I will try to assess two different perspectives on this problem, a Conventionalist Perspective and an Intentionalist Perspective. Drawing on the literature on indexicals in written texts and recorded messages, I will argue in favor of the Intentionalist Perspective: the relevant context is the one intended by the speaker. Bringing intentions into the picture, however, requires qualification; in particular, I will distinguish my Weak Intentionalist proposal from a Strong Intentionalist one. I will show that the Weak Intentionalist Perspective is flexible enough to deal with cases of delayed communication, but not so unrestricted as to yield counter-intuitive consequences.     

Corrupting Conversations with the Marquis de Sade: On Education,Gender, and Sexuality

In this essay, the author joins a conversation started by Martin (Reclaiming the conversation: the ideal of the educated woman. Yale University Press, New Haven, 1985) regarding gender and education seeking to extend the conversation to address sexuality. To do so, the author brings a reading of the Marquis de Sade to challenge the emphasis on reproduction in education as it relates to gendered and sexual norms. The author, following Martin’s approach in Reclaiming the Conversation, reads one particular text of Sade’s—Philosophy in the Bedroom—to argue for queer possibilities that Sade brings to the conversation around gender and sexuality within twenty-first century education. The Marquis de Sade may viscerally seem an inappropriate choice to return to and use to join the conversation, but his novelic imagination incites complications in the conversation. Following in the footsteps of Martin’s re-reading of historic philosophical texts the author offers not only another layer of thinking about “female education,” but also opens up space for engaging gender and sexuality in the history and philosophy of education. As issues around gender and sexed bodies become ever more present and contested in educational discourses, does Sade continue the conversation in ways that corrupt the reproductive aims of education?     

Being the Shadow: Witnessing Schizophrenia

This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of psychiatric power. As I will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis.     

Where's the impairment: An examination of factors that impact sustained attention following a stressor

This contribution examines the emotional engagement of men and women when reading narrative texts, aiming to see under which textual conditions men and women turn out to be different from or similar to each other in what they think and feel during reception. As part of an experimental mixed-methods study, male and female readers are asked to read either experience-type texts (focusing on inner experiences of characters) or action-type texts (focusing on actions as part of a suspenseful plot) and report their engagement on questionnaire scales and in written protocols. Results show that men and women differ in their engagement when reading action texts and in their emotional affinity to plots. They are highly similar when reading the experience texts, however, and in their affinity to characters. This study underlines that the emotional responses of males and females during reading are highly dependent on (con)textual cues.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Medicine as Enlightenment cure: Benedetto Frizzi, physician to eighteenth-century Italian Jewish society

This article examines modern Jewish doctors and the Enlightenment in action through its analysis of Dr. Benedetto Frizzi (1756–1844) as an Enlightenment Jewish physician and public intellectual in Habsburg northern Italy. Frizzi sought to spread the new Enlightenment gospel of polizia medica—public health policy or social medicine—that he learned from its pioneering exponent, Dr. Johann Peter Frank, his teacher at the University of Pavia. Frizzi dispensed Enlightenment medicine for the benefit of the state and society in general, as well as Jewish society and culture in particular, for he saw himself as both public health crusader and doctor-priest ministering to his own people. His commitments to Enlightenment science and rationalism led him to criticize Jewish social practices harshly even as he creatively reinterpreted classic Jewish texts; accordingly, Frizzi was regarded in some quarters as subversive, while in others as an apologetic defender of Jews and Judaism. Situating Frizzi within the traditions of Jewish as well as European Enlightenment physicians, this article raises broader questions about religion and secularism in the modern discourse of medicalized Judaism.     

Dissoziation und Kreativität—Entrückungen im Alltag

Our everyday life is characterized by changing conditions of awareness up to ecstasy. Ecstasy is a special form of dissociation, which must be differentiated from the pathological-clinical forms of dissociation. Its psychic mechanisms are illustrated by the example of ecstasy during the process of reading. On the basic of the myths of Dionysos and Orpheus as well as in biographies of artists, the ability to reach the state of ecstasy is described as one of the presuppositions for creativity, which must be supplemented by the ability of working through. Reverie and interpretation are the corresponding creative abilities in the psychoanalytical process. Our psychic vitality and creativity results from permanent switches between these different spheres, which must be identifiable as being distinct. The disappearing fonction du réel (Janet)—because of the increasing virtualisation of our everyday life—should be discussed with respect to creativity.     

Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education

Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students’ essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors’ status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine.

     

Ego development in perspective: Structural stage,functional phase,and cultural age-period models

Ego development is emerging as one of the more important areas of research in developmental psychology. This paper presents a structural stage approach to ego development and distinguishes it from two other models of ego development, which are termed functional phases and cultural ages. Two subtypes are also delineated within the structural stage approach—a monodomain and a multisubdomain—and the latter is argued for. These concepts are then illustrated through an analysis of four prominent ego development theories—those of Robert Selman, Robert Kegan, Jane Loevinger, and Erik Erikson. The important similarities and critical differences of the theories are clarified, which enables the authors to present a summary integration.     

Distance Learning: Empathy and Culture in Junot Diaz’s “Wildwood”

This essay discusses critical approaches to culture, difference, and empathy in health care education through a reading of Junot Diaz’s “Wildwood” chapter from the 2007 novel The Brief Wondrous Life of Oscar Wao. I begin with an analysis of the way that Diaz’s narrative invites readers to imagine and explore the experiences of others with subtlety and complexity. My reading of “Wildwood” illuminates its double-edged injunction to try to imagine another’s perspective while recognizing the limits to—or even the impossibility of—that exercise. I draw on post-colonial theory and feminist science studies to illuminate a text that is created and interpreted in a post-colonial context—the Dominican diaspora in the United States. The essay offers a model of historical and critical analysis that health care educators can use to frame the concept of empathy in the classroom and the clinic.     

Analyzing the accuracy of probability judgments for multiple events: An extension of the covariance decomposition

The probability score (PS) can be used to measure the overall accuracy of probability judgments for a single event, e.g., “Rain falls,” or “This patient has cancer.” It has been shown previously how a “covariance decomposition” of the mean of PS over many occasions indexes several distinct aspects of judgment performance (J. F. Yates, Organizational Behavior and Human Performance, 30, 132–156 (1982)). There are many situations in which probability judgments are reported for sample space partitions containing more than one event and its complement, e.g., medical situations in which a patient might suffer from Disease X, Disease Y, or Disease Z, or testing situations in which the correct answer to an item might be any one of alternatives (a) through (e). The probability score for multiple events (PSM) serves as a measure of the overall accuracy of probability judgments for the events in partitions of any size. The present article describes and interprets an extension of the covariance decomposition to the mean of PSM. The decomposition is illustrated with data from two contexts, medicine and education.     

“Getting the Knowledge Right”: Patient Communication,Agency, and Knowledge

In 2013, in accordance with a provision in the Patient Protection and Affordable Care Act (2010), the U.S. government began fining hospitals with “excessive” patient readmission rates. Those working to respond to this issue have identified discharge communication with patients as a critical component. In response to this exigency and to contribute to the conversation in the medical humanities about the field’s purview and orientation, this article analyzes studies of and texts about communication in health and medicine, ultimately arguing that the on-going circulation of compliance rhetoric and assumptions has limited efforts to improve patient communication. The article, furthermore, considers that humanist ideals of agentic action, the patient-centered care movement’s emphasis on the patient, and biomedicine’s tendency to treat evidence-based knowledge as fixed and given may have combined to support a rationale for using patient adherence to treatment guidelines as metrics in measurement studies designed to identify effective communication strategies. Finally, the article proposes that those working in the medical humanities consider the value of interdisciplinary posthumanist scholarship—specifically, its treatment of agency and knowledge as emergent, distributed, and contingent—and its potential to transform or extend in productive ways the conversation about what constitutes effective communication with patients.     

Vernacularizing Jñāndev: Hagiography and the Process of Vernacularization

The process of vernacularization involves more than literary language, but also invokes social ethics and an investment in the idioms of everyday life. Vernacularization can reach beyond texts to enact its force upon biographies as well, altering the ethics and quotidian memory of sacred figures. The paper examines how texts and biographical memory identified with the medieval Marathi “saint” (sant) Jñāndev (about thirteenth century) underwent a process of vernacularization that altered the social ethics of texts associated with Jñāndev and with the public memory of the saint himself. In particular, issues of caste and gender as subjects of the process of vernacularization are discussed, and especially in the context of producing bhakti publics—social spheres of devotion—that merge with the Vārkarī religious tradition in Maharashtra.     

Art’s False “Ease”: Form,Meaning and a Problematic Pedagogy

This paper argues that in foregoing the questions that emerge from the dialectical relationship between form and meaning, an intrinsic fallacy mistakes the relationship between the arts and education for a simplistic mechanism of signification—a false “ease”—where empty forms are supposedly given meaning by ethical and aesthetic givens as if the pedagogy of art were analogous to an empty room that was (or still needs to be) inhabited. Art’s false “ease” presents a tautology that presumes the relationship between the arts and learning on assumptions that force a false equivalence between (a) the perception of implicit causes that constitute a number of externalised artistic attributes (such as creative, critical, and intuitive forms of thinking and making) by which the arts are instrumentalised, and (b) a number of desired effects that are seen as being equal to the relative value that an arts subject (or discipline) commands in a perceived relationship with the world in terms of its use and therefore function. To counter this distortion this paper makes a case for a pedagogical aesthetics that would unlearn—and thereby exit—the educationalist tautology of art’s false ease. While politically this would mean that the arts are recognized in their ability to think and act outside the traditional notion of schooling as a walled polis, philosophically this represents a challenge to move arts education away from the “spatial” concepts by which dialectical narratives, such as those of form and content, have been hitherto assumed as constructivist signifiers.