Showing 61 - 70 of 107 annotations in the genre "Treatise"

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

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).

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This densely packed book follows Oschman's Energy Medicine: The Scientific Basis (2000, see annotation) with applications to medical treatment and--very briefly--human performance (athletics, dance, music). Oschman, a cell biologist, shows how electroencephalograms, electrocardiograms, and pulsing electromagnetic fields (which can heal broken bones) are accepted medical technologies, while theoretically related Healing Touch, Therapeutic Touch, Qi Gong, Reiki, Reflexology, massage, etc. are widely used and effective but generally (and inaccurately) considered to be alternative medicine.

According to Oschman, contributions from quantum physics explain that the energies of the body are subtle, instantaneous, and highly efficient in regulation and healing at the cellular level. The body is best understood as a living crystal, which can semiconduct energy, translate physical energy (such as touch) to piezoelectricity, and maintain coherence and continuity. Given our evolutionary heritage, we can sense from healers their intention, empathy, and healing energy. Our bodies heal themselves with energy provided by both standard and nonstandard medicine.

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The Hour of Our Death

Ariès, Philippe

Last Updated: Jan-09-2006
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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Healy focuses on the social and cultural meaning of disease in Britain during the early modern period (roughly the sixteenth and seventeenth centuries). Her chapter on "The Humoral-Paracelsan Body" discusses how the humoral theory of Galen, at this time still dominant in constructing a notion of the human body and its functions, was challenged by a new Paracelsan medicine, with its emphasis on spirit and on experiment instead of book-learning, and by the emergence of syphilis. She also establishes the genre of the "regimen[t]," a text advising how to achieve personal and social order.

Her two chapters on "The Plaguy Body" review the late-medieval and Renaissance history of the plague and argue that the social meaning of the plague as a trope of violence and rebellion shifts over the course of the sixteenth century, from a judgment on Britain's "rich extortioners," careless of the welfare of the poor, to the threat represented by London's unruly urban underclass.

Healy's two chapters on "The Pocky Body" argue that the new disease of syphilis became another dominant metaphor for social disorder because it helped focus anxieties about cultural hypocrisy, corruption, and degeneration, linked to the problems of sin generally and excessive appetite in particular. Her final chapter examines "The Glutted, Unvented Body," another powerful figure of excessive appetite, threatening that the body (and its appetites) would dethrone the head (the site of reason).

Healy demonstrates the importance of debates over the glutted, headless body as a way for British writers to negotiate the problems of a trade imbalance and the tricky terrain of resistance against the intemperate Stuart monarchs, culminating in the execution of Charles I in 1649. In the book as a whole, Healy reads literary and historical texts by authors as diverse as William Bullein, Thomas Dekker, Lucretius, Erasmus, William Shakespeare (Measure for Measure and Pericles), and Milton (Comus).

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Moller is a sociologist who takes us into the world of the urban poor; he focuses on half a dozen individuals, giving intimate and moving portraits of them. An opening character is called Cowboy (a pseudonym); he lives under a bridge with his dog Cowgirl and dies a slow death of lung cancer. In an Epilogue (pp. 163-184) Moller calls him "an urban Thoreau." This respect for the dying poor pervades the book.

Besides descriptions of the characters, there is much dialogue, including extended quotations, but also some 100 small photographs, usually close-ups, inserted into the text. One photo shows a man in his coffin. Clearly Moller gets close to his characters, and so does the reader.

Moller argues that the dominant society--to its shame--neither supplies adequate care for this sector of society nor even recognition that such people exist. He calls the dying poor "an invisible world." It's a disturbing world, with the pain and neglect, but also an inspiring one, because of the caregivers such as social workers and nurses and the heroism and dignity of the patients presented.

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Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Among animals only humans have difficulty giving birth. While other primates deliver their babies with little fuss, women experience painful labor and childbirth. The explanation for this discrepancy lies in the size of the human head at birth. As hominids evolved ever larger and larger brains, the fetal head had to increase in size at birth. Eventually the head almost outstripped the female pelvis's ability to expand enough to allow it through the birth canal. This delicate balance between fetus and pelvis accounts for human fetal and maternal morbidity and mortality.

As a response to the growing threat of childbirth, human females evolved away from estrus (i.e. sexual receptivity only when ovulating) to the menstrual cycle and continuous sexual receptivity. The mysterious moon-related cycle led women to formulate the concept of "time" and make the connection between sex and pregnancy. It also allowed them to refuse sex when they were ovulating.

Women then taught time consciousness to men, and men used their growing self-consciousness to begin to establish control over nature (and women). The sense of being-in-time led inevitably to awareness of mortality. This, in turn, stimulated humans to create gods and religion in order to ward off death anxiety.

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Dr. Flaherty, a practicing neurologist, sets out to explore the act of writing and, more broadly, creativity, in the context of both neuroscience and emotion. She begins by describing several brain conditions that seem to enhance the need to write, even to the extent of obsessive hypergraphia. Next she turns to the opposite state, writer's block, looking at both psychological and neuroscientific perspectives.

Using some of the recent studies of the relationships between certain brain centers and language related phenomena, Flaherty further clarifies some of the cognitive bases for creating literature. Finally, the study turns specifically to the temporal lobe as the possible organic site of the perceived voice of the muse in religious and creative inspiration.

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This treatise is part of the Madeleva Lecture Series in Spirituality, an annual presentation sponsored by the Center for Spirituality, Saint Mary's College, Notre Dame, Indiana. Margaret Farley's lecture begins with a brief introduction to the successes and failures of the global response to AIDS and HIV both worldwide and in Africa. Her aim is to demonstrate that "compassion needs to be normatively shaped, both as an attitude and as the generator of actions," and that the form compassion and help take must be directed in part by the "real needs" of the individuals involved.

What follows in this brief book is an excellent review of traditional and feminist ethics, from the moral concepts of "individual autonomy," "nonmaleficence," "beneficence," and "distributive justice" to Carol Gilligan's "ethic of care." Farley looks at these and other ethical precepts with a keen eye, and then proposes a blended moral response she calls compassionate respect. Her intelligent, focused discussion of what compassionate respect might encompass includes a look at the role of compassion within various religions and how caregivers might modulate giving, mercy, and love into compassion and care.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In 1869, national and medical attention was focused on a poor family in Wales. The daughter, twelve year-old Sarah Jacob, was bedridden with a strange ailment characterized by paralysis, staring fits, and anorexia. Yet she did not waste away. On the contrary, she seemed to survive comfortably with only few drops of water daily. Credulous folk came to visit, knowing that such abstinence had been the practice of many Christian saints; they would leave a few coins as an offering, although the family protested that money had never been requested. Others claimed it was a hoax.

Eventually the doctors and vicars became curious. An initial investigation upheld the family’s position that the girl did not eat. A more rigorous second investigation was designed by medical professors from Guy’s Hospital in London and carried out by trained nurses who sat knitting at the bedside. It resulted in the girl’s death.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.

The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)

The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).

Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.

Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.

Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)

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