Rejecting Medical Humanism: Medical Humanities and the Metaphysics of Medicine

The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day.     

The (In)flexible self: Psychopathology,mindfulness, and neuroscience

Clinical and neuroscientific evidence indicates that transdiagnostic processes contribute to the generation and maintenance of psychopathological symptoms and disorders. Rigidity (inflexibility) appears a core feature of most transdiagnostic pathological processes. Decreasing rigidity may prove important to restore and maintain mental health. One of the primary domains in which rigidity and flexibility plays a role concerns the self. We adopt the pattern theory of self (PTS) for a working definition of self. This incorporates the pluralist view on self as constituted by multiple aspects or processes, understood to constitute a self-pattern, i.e. processes organized in non-linear dynamical relations across a number of time scales. The use of mindfulness meditation in the format of Mindfulness Based Interventions (MBIs) has been developed over four decades in Clinical Psychology. MBIs are promising as evidence-based treatments, shown to be equivalent to gold-standard treatments and superior to specific active controls in several randomized controlled trials. Notably, MBIs have been shown to target transdiagnostic symptoms. Given the hypothesized central role of rigid, habitual self-patterns in psychopathology, PTS offers a useful frame to understand how mindfulness may be beneficial in decreasing inflexibility. We discuss the evidence that mindfulness can alter the psychological and behavioral expression of individual aspects of the self-pattern, as well as favour change in the self-pattern as a whole gestalt.We discuss neuroscientific research on how the phenomenology of the self (pattern) is reflected in associated cortical networks and meditation-related alterations in cortical networks. Creating a synergy between these two aspects can increase understanding of psychopathological processes and improve diagnostic and therapeutic options.     

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.

     

When east meets west: reflections on the use of Buddhist mindfulness practice in mindfulness-based interventions

The Western mental health profession has included Buddhist practices in its clinical applications, and Buddhisms’ contribution to mindfulness-based interventions (MBIs) could be considered as one of its main inputs. However, MBIs appear to depart in some key ways from their Buddhist origins whereby it may reduce its psychotherapeutic value and affect the accurate dissemination of the Buddhas’ teachings. This paper reflects on some of these departures, by firstly discussing the term mindfulness, which, as used in the MBIs, has a more restrictive meaning than that meant by the Buddha. Secondly, this paper discusses the usefulness of MBI therapists being knowledgeable in a range of meditation techniques, rather than in only a few. And thirdly, this paper discusses the usefulness of MBI therapists having a personal mindfulness practice of ones’ own, and concludes by suggesting that an explicit acknowledgement of the Buddha in the formation of the MBIs be considered.     

Affirming the Existential within Medicine: Medical Humanities, Governance, and Imaginative Understanding

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as "arts-in-health"): first, an intellectual enquiry into the nature of clinical medicine; second, an important dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting "humane health care" as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative "targets," new forms of management tyranny.     

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.

     

My <Emphasis Type="Italic">Ishvara</Emphasis> is Dead: Spiritual Care on the Fringes

Human suffering speaks differently to different lived contexts. In this paper, I have taken a metaphoric representation of suffering, Ishvara, from the lived context of a Hindu immigrant woman to show that suffering is experienced and expressed within one’s lived context. Further, a dominant narrative from her world is presented to show that the same lived context can be a resource for spiritual care that could reconstruct her world that has fallen apart with a suffering experience. Having argued that suffering is experienced and expressed within one’s lived context, and that lived context could be a resource, in this paper I present that spiritual care is an intervention into the predicaments of human suffering and its mandate is to facilitate certain direction and a meaningful order through which experiences and expectations are rejoined. Finally, I observe that spiritual care is an engagement between the lived context where suffering is experienced and the spiritual experience and orientation of the caregiver.     

Perceived Spirituality,Mindfulness and Quality of Life in Psychiatric Patients

There is some evidence of the relationship between spirituality and quality of life, but there are few bibliographic references on these constructs for patients suffering from mental illness; thus, this study was aimed at revealing the possible role of spiritual outlooks as a protective factor in these individuals. The sample consisted of 96 Portuguese psychiatric patients, selected from a psychiatric hospital and assessed based on parameters for quality of life, spirituality and mindfulness. The data support some theories about the nature of the spirituality. Spiritual beliefs are poorly correlated with the quality of life index, and there is a moderate association between these beliefs and some aspects of mindfulness. It is suggested that a spiritual outlook of psychiatric patients should be taken into account in psychological interventions.     

Bridging Science and Religion: How Health‐Care Workers as Storytellers Construct Spiritual Meanings

Contrary to the notion that medical science has supplanted religious understandings of human suffering, recent research suggests that health‐care workers like nurses can still portray their confrontations with illness and death in spiritual terms through storytelling. However, scholars have yet to systematically analyze the rhetorical devices used to construct spiritual meanings. Drawing on a symbolic interactionist perspective, we theorize that front‐line health professionals can deploy various rhetorical devices to infuse their workplace interactions with a spiritual significance. We also propose novel fuzzy set analysis techniques for determining which configurations of devices are most important in developing spiritual meanings. This approach was illustrated by examining 173 stories elicited from nurses at a nonsectarian, teaching hospital about encounters at work that significantly impacted their understanding of spirituality. Consistent with our expectations, the way in which nurses tell stories about their experiences not only shapes whether they attach spiritual significance to them, but whether they perceive spirituality and medicine to be compatible. We discuss the implications of our findings for future research on lived religion, conflicting identities, and institutional boundaries.     

Bearing Response-Ability: Theater, Ethics and Medical Education

This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that of ethical responsibility, which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson's widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential, or potential to engender new forms of inter-human relationality.     

RESILIENCE,AGENCY, AND EVERYDAY LOJONG IN THE TIBETAN DIASPORA

ABSTRACT

Despite exposure to political violence, many Tibetans in the diaspora avoid framing past experience in terms of trauma. Instead, they deploy shared cultural understandings often infused with Buddhist doctrine, to reframe loss, violence and displacement. Drawing on 14 months of ethnographic research in Dharamsala, India conducted in the Tibetan language, this article investigates how Tibetans utilise everyday cultural wisdom framed by lojong (mind-training) teachings to cope with adversity. Here, compassion practices serve to orient members of the diaspora towards recovery even, and perhaps, especially, when they are struggling. In this article, I argue that this cultural form of resilience is better conceived of as a practice of agency than a mental health practice, despite a global interest in adapting meditation and mindfulness for use in clinical settings. This study also challenges theory on structural violence and social suffering, which tends to overemphasise victimhood, bypassing the ordinary (and extraordinary) ways that people find agency.     

Social and Gendered Readings of Illness Narratives

This essay recognizes that the interactions that define medical care are problematic and that narrative is invoked to overcome these strains. Being grounded in science, medicine, too, might be influenced by a particular world-view that arose in the natural philosophy of the Scientific Revolution. If narrative responds to this sort of medicine, it may retain traces of this mindset. A feminist approach responds to this viewpoint and may used beneficially to analyze both the story of medicine and the stories within medicine. Tensions discussed from this perspective are those between sickness and health and those between patient and provider; also questioned are suitable form(s) of narrative and whose narratives are valued. Suggestions for broadening narrative to address these issues include letting the body speak for itself, overcoming the power differential in the patient/provider interaction and using standpoints to foster a more equal and just medical system.     

A rose by any other name

In this article I describe a mental health programme that has clear, though unstated, adumbrations of the spiritual practice of mindfulness. The programme has been successful in the southern USA, an area noted for its religious and political conservatism. I provide a background of the historical, political, cultural and religious situation affecting spiritual education in the USA with which such programmes contend. Research methodologies include historical research, text analysis and personal interviews.     

Toward an Aesthetic Medicine: Developing a Core Medical Humanities Undergraduate Curriculum

The medical humanities are often implemented in the undergraduate medicine curriculum through injection of discrete option courses as compensation for an overdose of science. The medical humanities may be reformulated as process and perspective, rather than content, where the curriculum is viewed as an aesthetic text and learning as aesthetic and ethical identity formation. This article suggests that a "humanities" perspective may be inherent to the life sciences required for study of medicine. The medical humanities emerge as a revelation of value inherent to an aesthetic medicine taught and learned imaginatively.     

Health and Healing: Spiritual, Pharmaceutical, and Mechanical Medicine

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or “allopathic” (disease as “other” or “outsider”) practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such “world medicine” as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice.     

THEOLOGY AND SCIENCE OF MENTAL HEALTH AND WELL‐BEING

The approach to mental health and well‐being taken here illustrates the complementary perspectives approach and assumes that there are useful and intersecting contributions from science (including medicine) and from religion and spirituality. What counts as poor mental well‐being depends on the interaction of relatively objective criteria with culturally contingent value judgments. I then discuss theological perspectives on depression, including a consideration of sources of hope and tolerance of dysphoria, and argue that depression can be part of a spiritual journey. I then look at the relationship between psychosis and religion, including the work of Isabel Clarke, arguing that a spiritual approach to psychosis can complement a medical approach. Finally, I present a pastoral case study illustrating the interface between neurological and spiritual aspects of the sense of presence. A religious perspective can challenge and complement current assumptions about mental health in a potentially fruitful way.     

微创体系中人文思想的探索

医学人文学是发展现代医学的一项重要内容.从微创医学体系中的人文思想、探索微创人文思想的意义、实现微创医学过程中的微创人文思想三个方面对建立在现代医学模式基础上的微创医学体系发展中的有关人文思想进行了系统的探索,以揭示微创医学体系中人文思想的意义和价值,同时强调其在医疗实践中的实际应用.     

From method to hermeneutics: which epistemological framework for narrative medicine?

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice.     

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.