Creative Writing as a Medical Instrument

Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination.     

Cognitive-behavioral therapy and decision science

In recent decades cognitive-behavioral therapy (CBT) and decision science (DS) have emerged within the field of psychological science. Though these are two vastly different areas of study, they are similar in that they address human information processing, cognition, behavior, and the link between them. In this article, we provide brief summaries of CBT and decision science, discuss their similarities and differences, and discuss how future research can identify ways in which these fields can inform each other. Several CBT techniques that might be of use to the efforts of the decision science field to prevent cognitive biases are suggested. Research that integrates these two fields may lead to the improvement of both.     

We are one: Grief,weeping, and other deep emotions in response to nature as a path toward wholeness

Abstract

Using his own experience of grief in nature as a starting point, the researcher conducted an intuitive inquiry (Anderson, 2004) into experiences of grief, weeping, and other deep emotions in response to the natural world. Written stories of 40 people, told in the style of embodied writing (Anderson, 2001), were gathered and studied. The primary interpretation framed by the researcher was that experiences of grief, weeping, and other deep emotions in response to nature represent moments in a process of psycho‐spiritual transformation capable of healing the splits between mind and body, and between humanity and nature, that are prevalent in contemporary industrial and post‐industrial societies. Additional interpretations, focusing on the role of the body and embodiment, grief and weeping, and nature and spirituality, are offered. Interpretations are fleshed out with excerpts from participants’ stories.     

Rapid Aimed Limb Movements: Differential Effects of Practice on Component Submovements

Three experiments are reported in which subjects practiced rapid aimed limb movements (arm pointing and wrist rotation) toward a visible target region. Subjects were required to minimize their movement durations while still landing in the target. The movement trajectories were examined to assess the effects of practice on separate component submovements of the limb movements. The results revealed that practice improved primarily temporal, not spatial, aspects of performance. Practice reduced the overall movement durations, but had different effects on the individual submovements: Practice allowed subjects to reduce the amount of time spent performing final corrective submovements, but actually increased slightly the time needed to produce the initial ballistic submovement. The results suggest that practice in the present task primarily enhanced the ability to use feedback information, but there was also some evidence of changes in the ballistic, preprogrammed portion of the movements. The results demonstrate that analysis of submovements can reveal important details of the underlying motor control processes.     

Moments of Spontaneity and Surprise: The Nonlinear Road to Something More

Moments of spontaneity and surprise create opportunities for change to occur through perturbations in the analyst-analysand system. These moments of authentic person-to-person contact violate anticipated patterns of intersubjective engagement. Mutative potential arises from the coconstruction of new relational configurations and the resultant modifications in the procedural memory system of both members of the analytic dyad. Three moments of spontaneity and surprise from the analysis of a man with a rigid character structure are presented and discussed.     

MBTI and historical data

The Myers-Briggs Type Indicator presents a model of personality which may be useful for understanding historical personalities, but empirical verification is necessary.     

Emergence,Story, and the Challenge of Positive Scenarios

This article is divided into three parts. The first part describes the paradox of positive scenarios: they are much harder to write than negative scenarios. The second part describes the logic of emergent systems whose properties are neither reducible to nor predictable from the properties of their component parts. The third part shows how the concept of emergence can be used to lend plausibility to those optimistic scenarios that might otherwise be rejected as mere wishful thinking.     

Protection of children's rights to self-determination in research

Federal guidelines require that informed consent be obtained from participants when they are enrolled in a research study. When conducting research with children, the guidelines utilize the term permission to describe parents' agreement to enroll their children in a study. The basic components of consent and permission are well described and identical, with the exception of the person for whom the decision to participate is being made (i.e., oneself as opposed to one's child). Beyond permission, when enrolling minor participants in research, affirmative agreement to participate in research or assent must be obtained from the child participants themselves. The concept of children's assent to research, however, is poorly defined, resulting in inconsistency in its pursuit and consequently, in its utility. The interface between cognitive development, emotional, and social development must be examined as its pertains to this special situation of decision making. For this process to meaningfully protect minors, the assent process must be clarified, decisions regarding parental veto power must be more convincingly justified, and researchers must be better educated and held accountable for the valid execution of this process. Strategies for implementing the assent process more effectively are presented.     

New lessons from knockout mice: The role of serotonin during development and its possible contribution to the origins of neuropsychiatric disorders

Serotonin (5-HT) modulates numerous processes in the central nervous system that are relevant to neuropsychiatric function and dysfunction. It exerts significant effects on anxiety, mood, impulsivity, sleep, ingestive behavior, reward systems, and psychosis. Serotonergic dysfunction has been implicated in several psychiatric conditions but efforts to more clearly understand the mechanisms of this influence have been hampered by the complexity of this system at the receptor level. There are at least 14 distinct receptors that mediate the effects of 5-HT as well as several enzymes that control its synthesis and metabolism. Pharmacologic agents that target specific receptors have provided clues regarding the function of these receptors in the human brain. 5-HT is also an important modulator of neural development and several groups have employed a genetic strategy relevant to behavior. Several inactivation mutations of specific 5-HT receptors have been generated producing interesting behavioral phenotypes related to anxiety, depression, drug abuse, psychosis, and cognition. In many cases, knockout mice have been used to confirm what has already been suspected based on pharmacologic studies. In other instances, mutations have demonstrated new functions of serotonergic genes in development and behavior.