Showing 91 - 100 of 106 annotations in the genre "Treatise"

AIDS and Its Metaphors

Sontag, Susan

Last Updated: Jul-03-1998
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This essay was written ten years after the author's Illness as Metaphor (see this database). Sontag begins by explaining the stimulus for her earlier essay: her own experience as a cancer patient. During that time, she discovered that cultural myths about cancer tended to isolate and estrange cancer patients. They suffered needlessly because of "meaning" attributed to their illness by society. A decade later, Sontag observes that attitudes about cancer have become more open and truthful. However, a new illness (AIDS) has arisen to carry forward the metaphorical banner.

AIDS brings together two powerful metaphors about illness. First, AIDS develops further the theme (seen earlier in cancer) of disease as invader: the enemy invades and destroys you from within. Thus, AIDS strengthens the use of military metaphors in medicine. The war against cancer is reincarnated as a war against AIDS. Secondly, because AIDS is a sexually transmitted disease, it also evokes the theme of plague-as-punishment.

Sontag's project in this essay is more focused than in the earlier book. She acknowledges that the medical and public health response to AIDS explicitly counters these myths. She concludes that "not all metaphors applied to illnesses and their treatment are equally unsavory and distorting" (p. 94). The metaphor she is most anxious to see eliminated is the military metaphor, both on an illness level (illness invades the person) and a societal level (social problems invade society).

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In this book written for the layman, linguist George Lakoff and philosopher Mark Johnson cogently argue that metaphor is integral, not peripheral to language and understanding. Furthermore, "metaphor is pervasive in everyday life, not just in language but in thought and action. Our ordinary conceptual system, in terms of which we both think and act, is fundamentally metaphorical in nature." (p. 3)

The authors adopt a broad definition of metaphor, examine common phrases for metaphorical interpretation, and offer a classification system of metaphor. For example, orientational metaphors are found in our ordinary language and are part of the spatial organization of our lives. When one says, "He dropped dead" or "He's at the peak of health," one is using the orientational metaphor that we live by: "Health and life are up; sickness and death are down." This orientation is not arbitrary; the authors point out that one lies down when one is ill.

Other types of metaphors categorized by the authors are structural and ontological (e.g., making a non-entity into an entity: "We need to combat inflation," or setting a boundary on a non-entity: "He's coming out of the coma"). The authors also differentiate metaphor from other figures of speech, such as metonymy, which relies more completely on substitution: "The ham sandwich wants his check."

The second half of the book address issues more philosophical in nature, such as theories of truth and how we understand the world, including the "myths" of "objectivism," "subjectivism," and "experientialism." These theories are reviewed with metaphor in mind. For example, objectivism relies on the separation of man from the environment and the subsequent mastery over the environment. Hence objectivism is rife with metaphors which confirm such ideas as "knowledge is power."

The authors conclude by stating that metaphors provide "the only ways to perceive and experience much of the world. Metaphor is as much a part of our functioning as our sense of touch, and as precious."

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Summary:

William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.

Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In his study, Professor Starr examines the evolution of the practice and the culture of medicine in the United States from the end of the colonial period into the last quarter of the twentieth century. His major concerns are with the development of authority, and the Janus image of professionalization as medicine has gained power, technical expertise, and effective modes of diagnosis and treatment and at the same time seems to be getting further from the patient.

At the time of publication, our society had finally begun to take a hard look at the impracticality and the inhumanity of continuing on the trajectory of American medicine developed one hundred years ago. Starr invites the reader to consider the impact of modern stress on the profession and, more intently, on the constituency it is dedicated to serve.

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Bedside Manners

Shorter, Edward

Last Updated: Mar-05-1998
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).

The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The writer, a comparative literature professor, elected to spend one full semester as an up-close observer in a medical school anatomy lab during the student dissection experience. He approached the experiment with the clearly articulated intention of writing about the lab, the instructors, the students, and their subjects. The book takes the reader dissection by dissection through the socialization process, as well as the technical content, of the class--from the first cut to the final memorial services for the cadavers at the closure of the term.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This history of western medicine focuses on British life in the eighteenth century. Williams begins his treatise by wondering if "we realize sufficiently what we have escaped by being alive in the twentieth, not the eighteenth, century." He then catalogues in the subsequent 12 chapters the agonies not only of illness but also of medical treatment in the 1700’s.

Topics are wide-ranging and include blood-letting, parturition, infant malnutrition, rampant infectious diseases, maltreatment of the insane, surgery prior to anesthesia, water therapy, and military medicine. Primary source quotations interspersed in the narrative add to the drama. For example, the deposition of a widower (his wife died while pregnant) is quoted: " . . . Being taken ill of a paine in her right side under her short ribb together with a great difficulty of breathing having but 14 weeks to go with Child Mr Hugh Chamberlen Senr was sent for to take care of her, who thereupon gave her in the space of nine days four vomitts, four purges, and caused her to be bled three times to the quantity of eight ounces each time: Then gave her something to raise a spitting after which swellings and Ulcers in her mouth followed . . . . " (p. 31)

A few medical advances at the close of the century are also described, notably the smallpox vaccine developed by Jenner and the administration of First Aid to wounded soldiers at the frontlines (developed by Larrey). The text is accompanied by black and white illustrations, such as an inside view of Bedlam (Bethlehem Hospital) by William Hogarth (A Rake’s Progress, plate VIII).

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This thoroughly researched book helps us understand John Keats's life and work in terms of his medical training. Goellnicht argues that, contrary to some critics' view that Keats was "anti-scientific" or "anti-intellectual," Keats incorporated much of the knowledge gained from his six years of medical training into his poetry.

The book begins with a chapter of biographical information about Keats, emphasizing the nature of medical training in the early nineteenth century, but includes Keats's self-diagnosis of tuberculosis. The heart of the book consists of four chapters, organized by scientific topic, which relate the specifics of Keats' s medical training to his writing: Chemistry, Botany, Anatomy and Physiology, and Pathology and Medicine.

Excerpts of Keats' poetic and epistolary writing are examined in each of these chapters in light of Keats' scientific and medical knowledge. For instance, in the chapter on Botany, the uses of specific botanical species in his writing are examined in terms of what was known of materia medica (see annotation for Ode on Melancholy. Furthermore, the author explores Keats's interest in plants and trees as metaphors for life, such as his interest in "the flower as a vital, but passive, being that exists in a state akin to negative capability."

The author concludes the book with a summary statement about each of the chapters (e.g., " . . . from pathology he adopted the approach of viewing aspects of life, in particular love and poetic creativity, in terms of morbid and healthy states . . . ") and also the caveat that the book is not meant to in any way diminish other profound influences on Keats, such as his interactions with other Romantic poets. Goellnicht notes, however, that Keats himself united the worlds of medicine and poetry in his poem, "The Fall of Hyperion," in which he describes the poet as a physician.

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Showalter identifies clusters of syndromes, or mini-epidemics, which she suggests represent late-twentieth century manifestations of the entity which was called hysteria in nineteenth century western culture. Opening with the history of psychiatry's involvement in hysteria in the time of Charcot and Freud, she traces the replacement of hysteria or conversion reaction by modern hysterical analogues such as: chronic fatigue syndrome, recovered memory, Gulf War syndrome, multiple personality syndrome, satanic ritual abuse, and alien abduction.

In separate chapters she examines each of these entities--how it presents, how it fits into her theory of mass hysteria as a cultural response to the millennium, and how it is being handled by health care professionals. Showalter contends that "Redefining hysteria as a universal human response to emotional conflict is a better course than evading, denying, or projecting its realities." (p. 17)

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Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is a fascinating book on the relationship of science, medicine, and medical education to the rise of modernism in literature. Crawford uses Williams' work to connect the worlds of literature and medicine. He discovers in Williams' early poems and stories the dominant themes of clarity, cleanliness, objectivity, and authority; these themes also characterize early 20th century science. In Williams' later work, Crawford shows how the poet moved toward a more subjective and relativistic aesthetic, a change that reflects subsequent developments in science, especially physics, and signifies the emergence of "post-modernism" in literature.

Williams' first principle was clarity. As a physician, it was important that he observe human reality with a clear eye so that he could intervene to transform it. Direct apprehension of reality was also for him the source of poetry. He found beauty in the concrete experience of everyday life, but was skeptical of theories and abstractions. Along with clarity, cleanliness and objectivity also characterize Williams' worlds.

But clarity is not, in reality, so clear. To see clearly in a medical way, the physician must first learn to observe the world in a specialized manner in the "theater of proof," a metaphorical extension of the stage on which professors demonstrate anatomical structures or surgeons demonstrate operations. Like medical educators, the poet also creates a theater of proof. While the reader may experience clarity and simplicity in the poem, these effects are actually staged by the poet, who chooses "clean" words and manipulates reality to achieve the desired simplicity. In both medicine and poetry, the practitioner unveils the truth by using manipulative and authoritarian techniques.

In the last chapter, Crawford shows that Williams' later work presages a post-modern, relativistic world. While the earlier Williams speaks of clarity, simplicity, science, and authority, Patterson and the post-World War II poems reveal complexity, fragmentation, and subversion.

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