Showing 151 - 160 of 203 annotations tagged with the keyword "Psycho-social Medicine"
This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.
Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.
Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.
Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?
One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).
This documentary video follows the making of an opera, based on the illness experiences of four Australians who have been diagnosed and treated for cancer. Their feelings about these experiences are translated into music (with lyrics) as they work closely with music therapist/composer, Emma O'Brien. As the three women and one man tell their stories of physical debility and emotional pain, the music therapist asks them to think in terms of color (they choose purple, black) and tones and rhythms that she plays for them on the piano.
When the narratives and their musical representations have evolved sufficiently, trained singers take on the roles "written" for them by the four former patients; the latter continue to be intimately involved in the opera's production, directed by David Kram. At the end of the project, which is also the conclusion of the film, the opera is performed in front of an audience (with musicians playing instruments, singing, and dramatic enactment) and the four people whose illness experience is performed take their bows together with the singers.
Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.
Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)
He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)
An artist, suffering from psoriasis, believes he is "loathsome to love" because of his scaly skin. "The name of the disease, spiritually speaking, is Humiliation." The narrator creates gorgeous pottery--flawless, smooth--the opposite of his rough, splotchy skin. His retailer, Himmelfahrer (he who travels through Heaven), calls him a genius. His girlfriend, Carlotta, loves him the way he is.
However, as the narrator goes through drug and light treatments under the care of a dermatologist, his skin begins to clear, but his pottery gets ugly and rough, Himmelfahrer expresses distress at the loss of quality, and the love relation with Carlotta cools. The artist declares himself beautiful, his girlfriend leaves, and Himmelfahrer won't buy any of his "gargoylish" pottery.
In 1950 London, lower middle-class (but upper middle- aged) Vera Drake (Imelda Staunton) devotes herself to family and "helping" others. With empathic cheeriness, she visits shut-ins, provides tea for the bedridden, feeds lonely men, and "brings on their bleeding" for girls in trouble. She also tends her cantankerous, ailing mother, who has never revealed the identity of Vera’s father.
The men in Vera’s life are bruised and confused by end of the war. Exuding affection, she cooks, irons, sews, and listens to their litanies of loss and derring-do. Her son, Sid, is an extroverted clothing salesman and her dowdy daughter, Ethel (Alex Kelly), is a pathologically shy factory-worker; neither seems adequate for the task of living alone. But Vera and her husband, Stan (Phil Davis), are happy in each other, their offspring, and their modest existence.
Only the friend, Nellie, knows of the help for young girls. She extracts a secret two-guinea fee for advising the girl, but Vera receives not a penny. Over the years, the two women have solved problems for mothers with too many children, mothers with no man, and mothers who were raped. They also safely abort insouciant party girls who are blas?about men, sex, and consequences.
But a young girl falls seriously ill following an abortion and is sent to hospital. Under pressure from police, the girl’s mother divulges Vera’s name. The police barge in to arrest her just as the Drake family celebrates Ethel’s engagement to one of the lonely men, Reg (Eddie Marsan).
The criminal charges come as a complete surprise to the family. Sid seethes with anger and disbelief, but Stan’s implicit faith in his wife brings him and the others to support her through the long trial. The judge hands her a stiff thirty-month sentence intended "as a deterrent." But in prison, Vera meets two other abortionists who tell her that she is lucky: both are serving much longer, second sentences, because their "girls" had died.
Professor Sandra Bertman founded the Medical Humanities Program at the University of Massachusetts Medical Center and holds certificates in grief counseling and death education. This handbook outlines how she uses the visual and literary arts to "improve our professional abilities to deal with death and dying." Her premise is that the arts provide a valuable vehicle for exploring and making bearable the prospect and fact of death.
Bertman illustrates her presentation technique (Chapter 2) of juxtaposing dual images around six central themes, here abbreviated: the chosen death; death and afterlife; existential aloneness; loss of control, unmentionable feelings, grief; the land of the sick vs. the land of the well; the moment of death. The book offers dozens of paintings, sketches, and photographs (reproduced in black and white), as well as many literary excerpts. Classic works are represented (David's painting, The Death of Socrates; Michelangelo's sculpture, "Pieta"; Tolstoy's novel, The Death of Ivan Ilyich) but there are many unusual representations as well--greeting card messages, epitaphs, cartoons.
In addition, some groups with whom she works (for example, medical students studying Gross Anatomy) have submitted their own drawings and commentary. These are shown in Chapter 3, along with written responses to a follow-up Death Attitude Questionnaire. Responses are from junior and senior high school students; college students; medical students; graduate nurses; hospice volunteers.
Chapter 4 gives suggestions for how to use images and texts and for how to approach discussions of loss and grief. The course syllabus for "Dissection, Dying, and Death," taught with Gross Anatomy, is appended, and there is an extensive bibliography.
Summary:This book contains six medical case studies in which hope, or lack of it, played a role in the outcome. Five stories are of Groopman's cancer patients, the sixth the story of his own recovery from severe chronic lower back pain. The book concludes with an account of Groopman's search for scientific answers to the questions that inspired the book: How is the cognitive-emotional complex of hope formed in the mind? How might that complex affect the chemistry of the brain? And how might that, in turn, affect the physiology of the body in a way that would be relevant to healing?
Gabriel Garcia Marquez was born in 1928 and is best known in the English-speaking world for his novel, One Hundred Years of Solitude, which appeared early in his career in Spanish (1967) and later in English (1970). He was awarded the Nobel Prize in Literature in 1982 and in 1988 published the novel, 0008 (see annotation), which received considerable attention for its evocative story of love and memory.
Garcia Marquez's autobiography is recent (2002, 2003); it covers the first twenty-seven years of his life in Columbia, ending in 1955 when he is sent as a journalist to Geneva to cover the Big Four Conference for his newspaper in Bogota. Although he remained in Europe for three years after that the book does not cover that period.
Garcia Marquez was born in Aracataca, Columbia in his grandparents' home, the first child in a family that grew to include ten younger siblings. He had a hectic childhood being reared by his parents' large extended family, which included several children sired by his father with women other than his mother.
Finances were always tenuous; when he worked as a journalist he was an important supporter of the family. He received a broad classical education at the Jesuit College in Bogota, where he began his writing career. Later he studied law and journalism but did not finish law school. He read extensively from all genres of literature.
Garcia Marquez's family relationships and personal experiences were traumatic in many ways as was the political situation in Columbia. It was a tumultuous initiation to a life of creative writing. His words quoted on the flyleaf describe the book: "Life is not what one lived, but what one remembers and how one remembers it in order to recount it."
Old Chuan and his wife, the proprietors of a small tea shop, save their money to buy a folk medicine cure for their son, Young Chuan, who is dying of tuberculosis. The story opens with Old Chuan leaving their shop and going to the home of the person selling the cure, a "roll of steamed bread, from which crimson drops were dripping to the ground." The crimson drops, we soon learn, are blood from a young man recently executed, apparently for revolutionary activities.
The cure does not work and the mother of Young Chuan meets the mother of the executed revolutionary in the cemetery. Here they both behold a mysterious wreath on the revolutionary's grave, a wreath that Lu Hsun, in his introduction to this collection (which he entitled A Call to Arms), describes as one of his "innuendoes" to "those fighters who are galloping on in loneliness, so that they do not lose heart." (p. 5)
As James Morris, the author was the dashing journalist who covered the first successful ascent of Everest in 1953 for The Times of London; a member of the elite and quintessentially male 9th Queen's Royal Lancers ("famous for their glitter and clublike exclusivity"--p. 27); the husband who married Elizabeth, fathering several sons. But, as the writer says in the first sentence of the book, "I was three or perhaps four years old when I realized that I had been born into the wrong body, and should really be a girl. I remember the moment well [James was sitting beneath his mother's piano], and it is the earliest memory of my life."
Realizing he was a member of a tangled (a favorite word of the author) group of transsexuals, James felt himself trapped in a conundrum of gender (he felt and considered himself female) versus sex (he was genotypically and phenotypically male). "To me gender is not physical at all, but is altogether insubstantial; it is soul, perhaps, it is talent it is the essentialness of oneself" (25). (Morris goes on to quote C. S. Lewis's Perelandra.)
After some fruitless interactions with the medical profession, Morris travels to Casablanca in the summer of 1972 to undergo sex-changing surgery and becomes Jan Morris. Unlike many if not most transsexuals, post-operatively Morris fared quite well emotionally and has, to date, been quite happy with the change (see below). Jan Morris's writing is as humorous and eloquent as James Morris's was. She describes (magazines like Rolling Stone and publishers like Random House and thousands of readers have never cared what gender or sex was holding the pen) how life changed in clubs, restaurants, and in taxi-cabs, where Jan met the first man to kiss her, post-surgery, "in a carnal way" (151). (Morris records that "all I did was blush.")