Measurements, Morality, and the Politics of “Normal” Infant Growth

Although the birth and early life of an infant is similar throughout the world, meanings ascribed to infants differ according to cultural values and beliefs. This essay describes how scholars and healers have come to see the infant as distinct from other types of people, and what implications this distinction carries for how health care is practiced. The first portion of this essay explores how understanding of the infant, particularly the well-accepted notion of “normal” infant growth and development, came to prominence. Drawing from the history of medicine, philosophical thought and colonial practice, this essay demonstrates that the roots of thinking about the infant in terms of his growth are deep and well-defined in North American and European ideologies. The second portion of this essay describes the practical applications and political implications of beliefs about the “normal” infant. In the arena of applied health, policy makers measure infant growth in light of assumptions about the “normal.” A case study of indigenous populations in Irian Jaya, Indonesia, shows that these measurements are highly political. Here government health officials create and manipulate statistics to ensure that indigenous infant health is represented as being below “normal.” The “normal” infant can thus be understood as a subtle and effective construct which, in Irian Jaya, at the least, is used to assimilate indigenous people into the nation-state.     

Religion and medicine: A theoretical overview

Recent scholarly studies in history, sociology, anthropology, religion, and psychosomatic medicine, coupled with clinical experience in the care of patients, call for a reassessment of the interrelationships between religion and medicine. Six major areas of interaction between these forms of human experience are identified and outlined. Investigations into these interlinkages not only offer challenging new opportunities for discovery but also hold promise for the development of new, more effective forms of medical care and healing. This new understanding of the interconnections between medicine and religion has many implications both for health care practitioners and for professionals with specialized training in religious studies.Has studied and taught in the areas of religion, American and Western history, and the history of medicine and medical ethics. He is the author of a number of publications on history, ethics, and the interrelationships between religion and medicine.     

On Being a “Hip” Doctor Today

A brief survey of the history of medicine is described. A gradual disappearance of patients from modern medical practice is noted, and the appearance of symptoms to take their place is evident. Theories of several high-profile medical thinkers who aim to put patients as persons back into modern medical treatment are compared and contrasted. The scope that those theories provide for medical treatment which takes into account more than the sum of a patient's symptoms, or the whole of his or her worldview, including religious belief and practice, is considered. How such leeway invites combining modern allopathic medicine and its emphasis on alleviating symptoms of sickness with alternative and complementary therapies, which raise issues about the relationship between human spirituality and healing and health, is explored.     

Contextualizing psychotherapy as a healing practice: Culture,history, and methods

The histories of modern medicine and psychotherapy are examined to situate psychotherapy in the array of healing practices. Although modern medicine relies on specificity as its central organizing concept, psychotherapy has consistently produced results that are not consistent with a medical model. Moreover, the development of research methodologies used to validate treatments, although useful in the medical context, ignores the experience of the patients as well as the provider of services. It is demonstrated that psychotherapy is a culturally imbedded healing practice and shares similarities with healing practices other than modern medicine. Psychotherapy shares one important feature with modern medicine, however: empirical support for efficacy. Various theories of placebo effects are examined to propose explanations for the effects of psychotherapy. Finally, issues and paradoxes are presented for future consideration.     

Perspectives of Indian Traditional and Allopathic Professionals on Religion/Spirituality and its Role in Medicine: Basis for Developing an Integrative Medicine Program

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75 % of TCAM and 84.6 % of allopathic practitioners) believed that patients’ spiritual focus increases with illness. Up to 58 % of TCAM and allopathic respondents report patients receiving support from their religious communities; 87 % of TCAM and 73 % of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11 % of allopaths, as against 40 % of TCAM, had reportedly received ‘formal’ training in r/s. Both TCAM (81.8 %) and allopathic (63.7 %) professionals agree that spirituality as an academic subject merits inclusion in health education programs (p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India.     

Artificial Intelligence and Medical Humanities

The use of artificial intelligence in healthcare has led to debates about the role of human clinicians in the increasingly technological contexts of medicine. Some researchers have argued that AI will augment the capacities of physicians and increase their availability to provide empathy and other uniquely human forms of care to their patients. The human vulnerabilities experienced in the healthcare context raise the stakes of new technologies such as AI, and the human dimensions of AI in healthcare have particular significance for research in the humanities. This article explains four key areas of concern relating to AI and the role that medical/health humanities research can play in addressing them: definition and regulation of “medical” versus “health” data and apps; social determinants of health; narrative medicine; and technological mediation of care. Issues include data privacy and trust, flawed datasets and algorithmic bias, racial discrimination, and the rhetoric of humanism and disability. Through a discussion of potential humanities contributions to these emerging intersections with AI, this article will suggest future scholarly directions for the field.

     

The Tao of a peaceful mind: the representation of emotional health and healing in traditional Chinese literature

This paper explores the representation of emotional health and healing in traditional Chinese literature, and the holistic relationship between traditional Chinese mental medicine and literature as well as philosophy. The philosophical, moral and aesthetic significance assigned to emotional health and healing not only inspired but also mandated the representation of these subjects in Chinese literature. For many Chinese readers, emotional health is more than a medical concern but is integral to their moral and spiritual wholesomeness, the attainment of which necessarily involves the edifying role of literature. The literary representation of emotional health and healing gave rise to a subculture of emotional health and a medical dilettantism in Chinese society. The mutual inclusivity of the professional and the amateurish is peculiar to traditional Chinese mental medicine. While facilitating popular appreciation of emotional health and helping to validate the legitimacy and efficacy of emotional healing, such a phenomenon also caused a certain degree of charlatanization that undercut the rationality and validity of mental medicine. An investigation into the relationship between traditional Chinese literature and mental medicine provides an interdisciplinary perspective from which to examine the latter's history, theory, and practice, thus shedding a cross-cultural light on modern psychology and psychiatry.     

The Religious and Social Principles of Patients’ Rights in Holy Books (Avesta, Torah, Bible, and Quran) and in Traditional Medicine

Health protection and promotion in healthy people and restoring patients’ health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients’ rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients’ rights. To study the different ideologies of traditional medicine in relation to patients’ rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples’ income. The Old Testament (holy Torah) warned government officials who did not observe patients’ rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics—ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that “health rights” has wider scope than “patients’ rights”. It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.     

I Want to Hold Your Hand: Abstinence Curricula, Bioethics, and the Silencing of Desire

The abstinence approach to sex education remains influential despite its demonstrated ineffectiveness. One bill forbids the “promotion” of “gateway sexual activity,” while requiring outright condemnation of “non-abstinence,” defined so loosely as to plausibly include handholding. Bioethics seldom (if ever) contributes to sex-ed debates, yet exploring the pivotal role of medical discourse reveals the need for bioethical intervention. Sex-ed debates revolve around a theory of human flourishing based on heteronormative temporality, a developmental teleology ensuring the transmission of various supposed social goods through heterosexual marriage (Halberstam, 2005). Heteronormative temporality also constitutes a moralized discourse in which the values of health and presumed certainties of medicine serve to justify conservative religious dictates that otherwise would appear controversial as the basis for public policy. Overall, this analysis explores how moralized medical discourses compound existing injustices, while suggesting bioethics’ potential contributions to moral and political analysis of sex-ed policies.     

Social Constructionist Approach to Suffering and Healing: Juxtaposing Cassell, Gergen and Kleinman

To understand the experiences of suffering (overwhelming somatic pain or illness and its anticipation and other forms of severe distress arising in the socio-moral context) and facilitate healing (developing an enabling meaning and value for one??s experiences when faced with suffering) have been the focus of medicine as a social institution throughout human history. However, the goals of Western biomedicine in the last few centuries shifted from taking care of these experiential concerns of the sufferers to predominantly the diagnosis and treatment of the symptoms of a disease. This article attempts to illustrate how the assumptions of the social constructionist paradigm (with its deconstructionist and reconstructionist facets highlighted in the writings of Kenneth J. Gergen) serve as a suitable metatheoretical framework to understand human experiences of suffering and healing. A critical review of the writings of Eric J. Cassell and Arthur Kleinman on endorsing and researching such experiences resulted in four themes that reaffirmed the utility of this new paradigm. These themes help comprehend that biomedicine??s ontological claims may enhance human suffering, suffering and healing experiences are socio-historically contextualized, such experiences are performances within human interaction and dialogic partnership between the researcher and the participant becomes a meaningful medium to study such experiences.     

Witnessing to Christ Today

The global health situation at the beginning of the third millennium is alarming. 1 While countries in the global North spend huge amounts of money providing high‐tech medicine for their citizens, many people in resource‐limited settings still do not have access to basic health care. These people bear an unjust burden of disease, and tens of thousands die every day of diseases that can be treated and often cured. In this regard, the contribution of Christian churches to health care is sorely needed. Already, churches and faith‐based organizations are important health providers in many countries. This is especially the case with regard to people in remote areas and in resource‐limited settings, and with marginalized groups in these and other places. In addition to the engagement by Christian bodies in health care, in many churches, especially the fast‐growing churches of the global South, spiritual healing is becoming increasingly important. These churches seek to provide healing through prayer, blessing, the laying on of hands, and anointing with oil. However, many inside and outside the churches are not so confident that the churches' engagement in the field of health and healing is essential to their mission. Some argue that the churches should only be involved in health care provision if there are no secular health providers available. Also, whilst others insist on the use of exclusively “spiritual” means to overcome illness, many question whether Christians today should still seek to overcome illness through this approach. Against this background, the World Council of Churches (WCC) and the German Institute for Medical Mission (DIFAEM) wish to contribute to an understanding of the healing mission of the church today. Both organizations are engaged in the field of mission and healing, and have a long history in dealing with questions about the Christian healing ministry. 2 Since its inception, the WCC has regarded issues related to health as part of its core work. Health care and theological questions on health and healing have been on the agenda of WCC programmes on mission, as well as those dealing with justice and diakonia. For many years, the WCC's Christian Medical Commission guided the organization's work on health and healing. DIFAEM has been a partner with the WCC in worldwide discussions on the healing mission of the churches since the mid‐1960s, and a leader in the promotion and implementation of the concept of primary health care. In 2005, the world mission conference in Athens, Greece, considered the theme, “Come Holy Spirit, Heal and Reconcile: Called in Christ to Be Reconciling and Healing Communities,” and strongly reaffirmed the healing mission of the church. In 2007, the WCC and DIFAEM jointly called for a “study group on mission and healing” to follow up the Athens mission conference. This study group was subsequently mandated to work on the Christian understanding of the healing mission of the church, and to promote Christian engagement in the field of health. The members of the group are theologians and medical professionals from four continents and various denominations. 3 The objectives of the group include:

• to clarify the holistic and integrated nature of Christian mission and healing, based on biblical theology;
• to demonstrate ways in which Christian communities can contribute towards health and healing in contemporary contexts.

In this article, the study group offers a summary of the ecumenical discussions on health, healing and wholeness that were documented in WCC publications issued between 1965 and 2005. The main insight of these discussions was that health is not only physical and/or mental well‐being but includes the social and spiritual and other dimensions as well. This is reflected in the definition of health approved by the WCC in 1989: “Health is a dynamic state of well‐being of the individual and society, of physical, mental, spiritual, economic, political, and social well‐being – of being in harmony with each other, with the material environment and with God.” 4 This expanded definition of health leads us to the Christian understanding that healing is not only and not primarily medical. Healing then includes, for instance, addressing the spiritual needs of sick persons as well as working for justice, peace and the integrity of creation. Moreover, the role of congregational and non‐congregational communities and faith‐ based and governmental organizations as well as individual Christians in the field of health and healing becomes obvious. Faith communities/congregations in particular are called to practise healing in various ways. They contribute to healing as social networks, as places of teaching and learning together, and as advocates for justice, peace and the integrity of creation. Healing is practised in liturgical acts and through nurturing and practicing charismatic gifts, through counselling and caring, and through creating safe and open spaces. Faith communities have a role in promoting primary health care, and can become vital partners of the formal health sector. This contribution aims to reaffirm the healing mission of the church, and to encourage churches, plus Christian communities and organizations, to engage in this ministry, and thus take part in God's mission of transforming the world. 5 Beate JAKOB     

WHY BIOETHICS NEEDS THE PHILOSOPHY OF MEDICINE: SOME IMPLICATIONS OF REFLECTION ON CONCEPTS OF HEALTH AND DISEASE

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the “science” of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice.     

A cross‐cultural study of environmental belief structures in USA,Japan, Mexico,and Peru

Throughout history, the way in which people conceive nature/human relationships has dramatically changed, and different cultures also have divergent notions regarding the role humans play in nature. In Western societies a “new environmental paradigm” (NEP) of ecological nature has apparently replaced the old “human exception paradigm” (HEP), which conceives of humans as being superior and apart from nature. Previous research has shown that, in those societies, a marked dichotomy exist between these two apparently contradictory paradigms, meaning that people who accept the NEP reject the HEP. Countries other than Western ones also exhibit a bias towards the ecological paradigm; however, their world‐views are not necessarily dualistic, since they may adhere to the NEP and, simultaneously, believe that human beings are “special.” This study compares world‐views in four different countries. Responses of 1358 undergraduates from USA, Japan, Mexico, and Peru to the HEP and the NEP scale were analysed to see if they confirmed three factors previously found: (1) a vision of separation from nature (HEP), (2) a necessary “balance” between human needs and nature preservation, and (3) the need to impose “limits” on the human impact on nature. This trifactorial structure was tested using confirmatory factor analysis. USA students exhibited two dimensions (HEP‐NEP) and the other samples showed the expected three factors, although they intercorrelated differentially, depending on the national sample. In all samples “balance” and “limits” were positively correlated. In the Peruvian and Japanese samples the HEP and “balance” were negatively correlated while the USA sample produced a negative covariance between HEP and NEP. In the Japanese sample HEP and “limits” were uncorrelated but in Peru these factors covaried negatively, while in the Mexican sample they were positively correlated. The HEP‐NEP two‐factor structure would seem to be limited to Western nations. More countries need to be measured.     

Re-enchanting the body: overcoming the melancholy of anatomy

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control.     

The Clash of Medical Civilizations: Experiencing “Primary Care” in a Neoliberal Culture

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is an element of all tales. Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine.     

略论“协和模式”的形成及其社会影响

北京协和医学院在中国现代医学史上占有重要的历史地位,对于我国医学教育和医疗卫生事业发展起到了不可忽视的推动作用。它在办学实践过程中形成了一套颇具特色的医学教育模式,培养出大批杰出的科研专家、学者和医疗工作者,为中国现代医学发展和医疗卫生制度建设做出了杰出贡献,积累了宝贵经验。     

Innovation Through Tradition: Rediscovering the “Humanist” in the Medical Humanities

Throughout its fifty-year history, the role of the medical humanist and even the name “medical humanities” has remained raw, dynamic and contested. What do we mean when we call ourselves “humanists” and our practice “medical humanities?” To address these questions, we turn to the concept of origin narratives. After explaining the value of these stories, we focus on one particularly rich origin narrative of the medical humanities by telling the story of how a group of educators, ethicists, and scholars struggling to define their relatively new field rediscovered the studia humanitatis, a Renaissance curriculum for learning and teaching. Our origin narrative is composed of two intertwined stories—the history of the studia humanitatis itself and the story of the scholars who rediscovered it. We argue that as an origin narrative the studia humanitatis grounds the medical humanities as both an engaged moral practice and pedagogical project. In the latter part of the paper, we use this origin narrative to show how medical humanists working in translational science can use their understanding of their historical roots to do meaningful work in the world.     

“Hammered down on every side” versus “just being positive”: A critical discursive approach to health inequality

Socio‐economic and health inequality are strongly linked and are increasingly perpetuated by discourses of individual responsibility. However, little research from a critical discursive perspective has addressed how people affected themselves may account for this relationship. This research examined the ways in which people who are in debt, unemployed, or in insecure, minimum‐wage employment construct health and negotiate identities around it. Data from semistructured interviews with 6 participants were analysed and 3 main interpretative repertoires were identified: a medical repertoire of health as a lack of illness; health as adopting the “right” behaviours and attitudes; and health as being heavily influenced by external factors, such as income and life circumstances. The analysis focuses on how participants managed the tension between these latter 2 repertoires by adopting various subject positions around health: that it is “slipping” away from them; that it requires motivation; and that it is unattainable. Underpinning this is a “common‐sense” idea of health as something that is worked towards through culturally approved actions and attitudes.     

The role of attitudes and beliefs in differential health care utilisation among Chinese in Singapore

Abstract

One hundred and twenty-eight Chinese patients at two Western medical practices and two Chinese medical practices in Singapore completed a questionnaire regarding perceptions of illnesses. Health beliefs and attitudes towards different medical practitioners. Results indicate significant differences between those who consult only allopathic physicians (Western doctors) and those who consult both practitioners of traditional Chinese medicine (sinsehs) and Western doctors. Individuals consulting both Western doctors and sinsehs perceived a smaller proportion of “general” illness attributes (those found in both Western and Chinese medicine) to be relevant to specific diseases and showed greater endorsement of Chinese health beliefs than did individuals seeking help only from Western doctors. Also individuals consulting both types of practitioners expressed less satisfaction with the doctor's treatment than did those consulting only Western doctors and also rated sinsehs as more concerned with patient well-being and as listening more to their patients.     

The Worldviews of Healing Traditions in the East and West: Implications for Psychology of Religion

This article will compare the worldviews of psychotherapy traditions in Eastern and Western culture, particularly the therapeutic factors and principles indigenous to the Chinese culture. The author will first define the meaning of culture and psychotherapy from a postmodern anthropological approach. By referring to history and literature in the study of cultural psychology, a comparison will be made between the value systems lying behind therapeutic methods used in the East and West. This includes the worldviews on the body and mind, the self, mental health, relationship, community, healing, and spirituality. Lastly, a famous Chinese legend will be used as an example to illustrate how worldview differences between the East and West determine the goals and process of psychotherapy. It is hoped that psychology of religion would be sensitive to the underlying worldviews across different cultures, without imposing its definition of “mental health” and method of “healing,” as different religions embody different cultural traditions as well. It is argued that whether spirituality or religion is helpful to the wellbeing of local people, it should be defined by the local persons and expressed in their mother tongue. Hence a psychology of religion for Chinese people should respect its customs of healing and particular set of worldviews.