Showing 111 - 120 of 382 annotations tagged with the keyword "Narrative as Method"

The Crazy Man

Porter, Pamela

Last Updated: Mar-15-2008
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel for Young Adults

Summary:

Twelve year -old Emaline is riding with her father as he discs their fields, when she sees her beloved dog Prince running dangerously close to the blades. In trying to stop him, she falls off the tractor and her leg is sliced almost completely through. In anger, her father shoots Prince and leaves home. She is rushed to hospital where a series of operations and treatments save her limb, although it is permanently shortened and she walks with a limp.

The fields need seeding. In desperation Emmy’s mother appeals to the local “mental hospital,” and Angus, the crazy man, arrives to help. Emmy is warned to stay clear of him, and neighbours gawk, but she begins to notice his special qualities. He quietly sows the fields with blue flax and yellow mustard rather than the unsellable wheat. He helps fit her with a built up shoe, and he is steadfast though frightened when falsely accused of theft. Yet some neighbours, like Harry Record, cannot adapt to Angus and believe that the family is taking risks. Just as Angus is the object of ridicule, Emmy is mercilessly teased for her deformity by Record’s son, Joey.

One night in a snowstorm both Joey and Angus disappear. Angus has been driven out of town and dumped by Harry Record, but he finds Joey lost in the storm and brings him home. Record refuses to accept his guilt and pleads not guilty. As the book ends Angus is more accepted, but a trial is looming, in which Emmy and Joey will have to give evidence against his father.

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Summary:

Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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Annotated by:
Kennedy, Meegan

Primary Category: Literature / Nonfiction

Genre: Criticism

Summary:

This book could perhaps have been called "Pathology and Identity in the Medical Case History and the British Novel." Tougaw here examines the mutual fascination of both nineteenth-century medicine and the British novel with pathology: that both "novels and case histories require a suffering body at narrative's center" (8), and that both "put into circulation a model of identity whereby the subject is always caught in a double bind... between health and pathology" (9). He examines developments in the medical case history, as a narrative, and argues that both this and the novel permitted an escape from "the nineteenth-century zeal for classification" (2). He reads the doctor-patient relationship as analogous to the reader-novel relationship, and argues that both genres must balance competing modes of approach: diagnosis and sympathy.

The book focuses on "controversial or marginalized maladies" (18), with each chapter acting as, itself, a case study. The first chapter, however, sets up Tougaw's critical terms of diagnostic and sympathetic reading, alternatives that help readers negotiate their discomfort with controversial conditions. The second chapter examines how the rhetoric of disability helps provide cover for "scientific scrutiny" (19) in cases of breast cancer, which bring to the foreground concerns over the limits and gendering of privacy and the body. Chapter Three builds on Peter Logan's work on the nervous narrator, examining Jane Austen's use of indirect discourse to finesse questions of hypochondria, compulsive storytelling, and early-nineteenth-century medical knowledge.

The fourth chapter focuses on the mid-century debate over mesmerism and anesthesia, reading cases alongside relevant novels by Wilkie Collins, Sheridan Le Fanu, Robert Louis Stevenson, and Mary Elizabeth Braddon. It traces Victorians' interest in altered consciousness and the effects of drugs on agency, and it argues for an analogy between the intersubjective relations of mesmerist/subject, doctor/patient, and narrator/reader. The final chapter reads Freud's "Rat Man" and "Wolf Man" against three novels by William James. Tougaw sees both these authors as putting forward a complex epistemology based on interpretation and intersubjectivity rather than assertion or individuality. The Afterword reframes Tougaw's arguments in the context of contemporary debates over the doctor-patient relation and the patient narrative; that "the real work of autobiography is the establishment of an intersubjective rapport between writer and reader" (21).

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Sicko

Moore, Michael

Last Updated: Jan-08-2008
Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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Summary:

In 1999, eighteen years after Project HOPE began publishing the journal "Health Affairs," the founding editor, John Iglehart, began a new column: Narrative Matters. This book contains 46 of the 80 essays published to date, and an inspiring foreword by Abraham Verghese. The essays are contained in eight chapters-- "Writing to Change Things: Essays on the Policy Narrative," "Dollars and Sense: Hard Financial Realities," "Bearing Witness: Patient's Stories," "The Maddening System: Frustrations and Solutions," "Trouble in the Ranks: Professional Problems," "Drug Resistance: Battling Undue Influences," "Disparity Dilemmas: Stories on Race and Ethnicity," and "Values and Choice: Stories of Practical Ethics." Familiar voices include those of Fitzhugh Mullan (one of the editors), Abigail Zuger, Howard Brody, Richard Lamm, John Lantos, Danielle Ofri, and Carol Levine. The essays in the first section strike an important cautionary tone, reminding readers that the plural of anecdote too often is taken for policy and that the repetition of anecdote should not be seen as evidence.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).

The book is divided into Introduction, five chapters on specific memoirs, and Conclusion. Chapter 1, "Patients and Biopower: Disciplined Bodies, Regularized Populations, and Subjugated Knowledges," draws on Foucault's theory of power to discuss two mid-20th-century memoirs of institutionalization for tuberculosis. Betty McDonald's the Plague and I is compared with Madonna Swan: A Lakota Woman's Story. Dividing practices and regularization are shown to serve different functions in these two incarcerations, figurative in the case of Betty McDonald, and literal in the case of Madonna Swan.

Chapter 2, "Politicizing Patienthood: Ideas, Experience and Affect," draws on Foucault's approach to the subject and on his discussion of "practices of the self" in contrasting Audre Lorde's The Cancer Journals with Susan Sontag's Illness as Metaphor and AIDS and Its Metaphors (see annotations). Diedrich also brings into her analysis Eve Sedgwick's theory of queer performativity and Sedgwick's own illness narrative, White Glasses. Diedrich views all of these as counter narratives to the clinical medical narrative of illness but she shows how they differ in stance.

Chapter 3, "Stories For and against the Self: Breast Cancer Narratives from the United States and Britain" looks at "the arts of being ill" as they are represented in two cultures, two "conceptions of the self in these countries at a particular historical moment" (61). The narratives discussed are Sandra Butler and Barbara Rosenblum's narrative, Cancer in Two Voices and Ruth Picardie's Before I Say Goodbye (see annotations). Diedrich associates Cancer in Two Voices with an American notion of self-improvement and Before I Say Goodbye with a British "emphasis on the cultivation of an ironic self" (55). The author works in this chapter with Freud's idea of the uncanny, Benedict Anderson's concept of "imagined political communities" and Elaine Scarry's discussion of pain, language, and the unmaking of the self.

Chapter 4, "Becoming-Patient: Negotiating Healing, Desire, and Belonging in Doctors' Narratives," treats Oliver Sacks's illness narrative, A Leg to Stand On, Abraham Verghese's autobiographical My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS, and Rafael Campo's book of essays, The Poetry of Healing (see annotations). Here Diedrich considers "the possibility that doctors, especially AIDS doctors, might become patients through desiring-and writing-productions" (83) and she utilizes the rhizome model of Deleuze and Guattari to make her case. She discusses how Verghese and Campo are each both cultural insiders and outsiders and how they each "bring the body into language through their writing" (88).

Chapter 5, "Between Two Deaths: Practices of Witnessing," focuses primarily on Paul Monette's writing about the loss of his partner to AIDS, and on John Oliver Bayley's books about the loss of his wife, Iris Murdoch, to Alzheimer's, and her ultimate death (see annotations in this database). In this chapter Diedrich invokes Lacan's concept of the real and his formulation of "the ethical possibility of being between two deaths" (117). She draws also on trauma theory and the work of Kelly Oliver, a contemporary feminist philosopher who has written on witnessing.

Finally, in her "Conclusion: Toward an Ethics of Failure," Diedrich returns to Elaine Scarry's "phenomenological discussion of the experience of pain" and brings in Jean-François Lyotard's concept of incommensurability and his suggestion between the two poles of what is seemingly incommensurable one might search, in Diedrich's words, for "new rules for forming and linking phrases between . . . subject positions" (150). In that context she analyzes physician Atul Gawande's discussion of medical uncertainty and error in his book, Complications (see annotation) and philosopher Gillian Rose's book, Love' s Work. Diedrich concludes that the basic incommensurability between doctor and patient can be a starting point for a new ethics, an ethics of failure and risk "because by taking such risks [of failure, of relations], we open up the possibility of new routes, new treatments: in and between art, medicine, philosophy, and politics" (166).

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How Doctors Think

Groopman, Jerome

Last Updated: Aug-06-2007
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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Sutton's Law

Orient, Jane; Wright, Linda

Last Updated: Jun-28-2007
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Intern, Maggie Altman, begins her postgraduate training in a large Texas hospital where a new computerized system has been implemented to improve service. She pours heart and soul into her work, but her admissions always seem to be the sickest patients who keep dying, sometimes inexplicably. Maggie becomes suspicious of her colleagues and of Dr. Milton Silber, an irrascible, retired clinician with no fondness for the new technology. Silber also happens to be a financial genius. Overhearing conversations and finding puzzling papers, Maggie imagines a scam, in which her supervisors may be eliminating dying patients to reduce costs, improve statistics, and siphon funds to their own pockets.

The bad outcomes for Maggie's patients are noticed and criticized, and she is pressured to drop out, switch hospitals, or go back into research. She senses that the perpetrators are aware of her suspicions and send her the worst patients in an effort to eliminate her. She trusts no one. These worries are compounded by her own illness and her accidental discovery in the morgue of a traffic in unclaimed bodies. With the help of excellent clinical skills, true friends, Dr. Silber, and a new love interest who is a budding financial genius, she survives physical and emotional violence and solves the mystery of patient homicides, poisonings, and fraud.

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When the Emperor Was Divine

Otsuka, Julie

Last Updated: May-25-2007
Annotated by:
Aull, Felice

Primary Category: Literature / Fiction

Genre: Novel

Summary:

This short novel tells the story of a Japanese-American family’s internment during World War II. They are living comfortably in Berkeley, California, when their nightmare begins. Soon after Pearl Harbor the husband/father is arrested by the FBI--taken away in his housecoat and slippers. We learn of this through the narration of the eight-year-old son, his ten-year-old sister, and their mother--who are rounded up several months later and sent to a camp in Utah. The father remains shadowy--a figure of memory, wishful thinking, and censored letters stamped "Detained Alien Enemy Mail." The reason for his arrest is never explained, as if there is no reason to question the man’s loyalty.

After her husband’s arrest, the mother is left to take care of her children and the house. A few months later she must pack up the household belongings, give away the family cat, kill and bury the family dog, tell her daughter to let loose the pet macaw. They are allowed to bring with them--where to they do not know--only what they can carry. They take an endless train ride through the Nevada desert to reach an internment camp in Utah, "a city of tar-paper barracks behind a barbed-wire fence on a dusty alkaline plane high up in the desert" (49).

Here they remain until the war ends, some three and a half years later. They learn to live in one room with a single light bulb; to stand on line for everything; to eat in the mess hall; to avoid rattlesnakes, scorpions, and the sun; and to "never say the Emperor’s name out loud" (52). They are unable to avoid the desert dust that covers and gets into everything. The children attend makeshift classes, play cards, are bored, lonely, and confused. The boy misses and has fantasies about his father, the girl reaches adolescence and becomes cynical, the mother is too depressed to eat or read.

At the end of the war, the three are allowed to go home "with train fare and twenty-five dollars in cash" (117). Their house has been vandalized; neighbors, teachers, and classmates either ignore them or are openly hostile. Finally their father is released from detention in New Mexico, a changed man both in appearance and spirit.

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Memoirs of Hadrian

Yourcenar, Marguerite

Last Updated: May-25-2007
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Memoirs of Hadrian is a historical novel in the form of a long letter written by the Roman Emperor Hadrian to his young friend and eventual successor, Marcus Aurelius. Alas, Hadrian is "growing old, and is about to die of a dropsical heart." The Emperor begins by describing his recent visit with his physician Hermogenes, who "was alarmed, in spite of himself, at the rapid progress of the disease" (3). In light of his physical deterioration, Hadrian begins to reflect on his life and work, and to share his wisdom with his young correspondent.

Hadrian tells of his early life as the protégé of the Emperor Trajan, his military and political victories, and his eventual adoption by Trajan, a move that guaranteed the succession when his adoptive father died. While Trajan, whose victories brought the Roman Empire to its greatest size, was a military man to the core, Hadrian considers himself essentially peace loving--his personal life devoted to simplicity and harmony; and his public life to prosperity and justice. Nonetheless, he has always recognized that, in order to govern effectively, ruthless action is sometimes required.

Hadrian's marriage to the Empress Sabina was simply a matter of convenience. The love of his life was a beautiful young man named Antinous. The two men were deeply committed to one another, but at the same time the middle-aged emperor had "a certain dread of bondage" ( 177) that kept him from fully giving himself to Antinous with the abandon of youth. They were visiting Alexandria when the despondent Antinous committed suicide in a way that mimicked a religious ritual, essentially sacrificing himself to the deified Emperor.

Hadrian was crushed with grief and descended into a long period of depression. However, he eventually overcame his depression through his love of literature and ideas, as well as his sense of duty to the Empire (no SSRIs being available at the time), although not before attempting to enlist his physician in assisted suicide. Unable to refuse his emperor's request, the physician himself commits suicide rather than violating his Hippocratic Oath.

Hadrian's final military engagements involve crushing Jewish insurgents in Palestine, completing the destruction of Jerusalem, and founding a new Roman city on its site. The aged Emperor reflects frequently on his tolerance for all religions, except for politically disruptive fanatics like the followers of a Jewish prophet called Christ. As to the Jews in Palestine, he cannot understand why they continue to engage in self-destructive rebellion, most recently with Bar Kokhba and Rabbi Akiva as their leaders.

In his final years Hadrian adopts Lucius, one of his former lovers (in this account), as his son and heir, but Lucius soon dies, presumably from tuberculosis. Eventually, the Emperor adopts Antinous Pius as his heir and further arranges for Marcus Aurelius to succeed Antinous Pius. At the end of his letter, Hadrian writes, "I could now return to Tibur, going back to that retreat which is called illness, to experiment with my suffering, to taste fully what delights are left to me, and to resume in peace my interrupted dialogue with a shade." [i.e. Antinous, his lost love (271)].

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