Medical Humanities最新文献

{"title":"Psychiatrists' experiences of involuntary care in South Africa: dilemmas for practice in challenging contexts.","authors":"Alex Morung Freeman, Laila Asmal, Leslie Swartz","doi":"10.1136/medhum-2024-012929","DOIUrl":"10.1136/medhum-2024-012929","url":null,"abstract":"<p><p>Providing for people with psychosocial conditions in crisis is a complex and controversial endeavour that has gained significant attention over the past decade. This increased focus is driven by global calls to reduce coercion, including by the United Nations Committee on the Rights of Persons with Disabilities, who interpret Article 12 of the United Nations Convention on the Rights of Persons with Disabilities in General Comment 1 to advocate for the replacement of substituted decision-making with supported decision-making. Psychiatrists occupy a central role in determining how to care for and respond to individuals with psychosocial conditions in crisis in the midst of these debates. They must protect the rights of people with psychosocial conditions in crisis and provide appropriate support within challenging and dynamic contexts. This responsibility includes promoting the autonomy of people with psychosocial condition while ensuring their long-term health, safety and well-being.In this study, we conducted a phenomenological analysis with a sample of nine psychiatrists in South Africa to explore their experiences with involuntary care and the complex dilemmas they face in delivering healthcare to individuals with mental health conditions. Our findings indicate that psychiatrists encounter significant challenges in preserving patient autonomy, particularly within the resource-limited context of South Africa. Pervasive stigma and insufficient support infrastructure complicate efforts to prioritise autonomy. At the same time, professionals must address the critical need to ensure the long-term safety and well-being of their patients. The absence of involuntary care can exacerbate a person's vulnerability to community stigma and inadequate community support, posing severe risks to their welfare. Balancing between protecting a person's autonomy and addressing the limitations of support structures creates a complex predicament for mental health professionals, often resulting in feelings of isolation and moral distress among psychiatrists.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"67-75"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociocultural aspects of the medicalisation of infertility: a comparative reading of two illness narratives.","authors":"Annie James, Manjusha G Warrier, Ann Treessa Benny","doi":"10.1136/medhum-2024-012977","DOIUrl":"10.1136/medhum-2024-012977","url":null,"abstract":"<p><p>This paper is a comparative reading of variations in the medicalisation of infertility caused by sociocultural aspects, in two illness narratives by patients: Elizabeth Katkin's <i>Conceivability</i> (2018), a story of navigating a fertility industry with polycystic ovarian syndrome and antiphospholipid syndrome in America and Rohini Rajagopal's <i>What's a Lemon Squeezer Doing in My Vagina</i> (2021), a discussion from India of a growing awareness of medicalisation in treatment of unexplained infertility. For this purpose, it first charts scholarship on illness narratives and medicalisation, noting a historical association. Following this, it shows how infertility, a physiological symptom of reproductive incapacity or failure to show clinical pregnancy, is generally medicalised. This paper reads the texts as showing hitherto unaddressed sociocultural aspects of infertility's medicalisation. At the same time, drawing from existing sociological and anthropological scholarship, it shows how a reading of sociocultural aspects in medicalised infertility nuances understanding of it's medicalisation. This comparative reading attends to sociocultural values and norms within the texts, including pronatalism, fetal personhood, kinship organisation, purity/pollution, individual reliance, sacred duty and so forth. It draws from scholarship on embodiment, rhetorical strategies and the language of medicine. It also shows how a patient's non-medicalised, affective history of 'deep' sickness caused by the biographical disruption of infertility is not that of a 'poor historian'. In laying out the particularisation of such sociocultural values and norms across America and India, medicalisation's migration from its origins to the margins reveals subjectivised, stratified reproduction in infertility illness narratives. This paper is part of a turn in scholarship away from understanding the medicalisation of infertility as naturalised and decontextualised.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"76-85"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there truth in fiction? Lessons from readers' responses to dementia fiction.","authors":"Jane Lugea, Carolina Fernandez-Quintanilla, Gemma Carney, Paula Devine","doi":"10.1136/medhum-2024-012976","DOIUrl":"10.1136/medhum-2024-012976","url":null,"abstract":"<p><p>This paper addresses the question 'is there truth in fiction?', by synthesising a range of disciplinary approaches to the issue, as well as drawing on empirical research carried out with readers of fiction about dementia (hereafter, dementia fiction). We argue that fiction-perhaps because of its fictional status and apparatus-invites readers to consider its truth value, to explore the possibilities of human experience and interrogate issues relative to their subjective experience, community or society. The findings have significant implications for the Medical Humanities' use of fictional texts to explore lived medical conditions and experiences, as well as claims made about the potential for fiction to affect real-world understandings, awareness and empathy around the conditions depicted. We show that the techniques used in fictional language may be artifice, but they simulate a truth that corresponds with reality.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"129-139"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox in the news: social representations, identity, stigma and coping.","authors":"Brigitte Nerlich, Rusi Jaspal","doi":"10.1136/medhum-2023-012786","DOIUrl":"10.1136/medhum-2023-012786","url":null,"abstract":"<p><p>In May 2022, when the COVID-19 pandemic began to recede from public view, another infectious disease surprised the world-mpox (formerly monkeypox). It appeared to disproportionately affect gay, bisexual and other men who have sex with men (GBMSM). Using qualitative thematic analysis and social representations theory, we analysed a corpus of 91 items from a variety of news outlets that included GBMSM community members' personal accounts of living through an mpox outbreak. The aim was to study the various ways in which members of a marginalised group created social representations of mpox and to ascertain whether these challenged older representations related to HIV and AIDS and newer ones related to COVID-19. Commentators anchored mpox to known, culturally accessible phenomena to render this previously unfamiliar disease familiar; objectified aspects of mpox, especially pain, through emotive language, making it 'real' and psychologically tangible; personified it by linking it to accounts of celebrity activists; and ontologised it through visually vivid descriptions. Challenging stigma was a cross-cutting theme in people's accounts. In contrast to the stigmatising imagery of health issues affecting GBMSM, these accounts contribute to the development of social representations designed to challenge such stigmatisation, which, in the contexts of HIV and AIDS and COVID-19, has hindered effective medical interventions, promoted misinformation and fuelled denigration.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"161-171"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Finally making sense': graphic medicine and ADHD diagnosis in adulthood.","authors":"Sathyaraj Venkatesan, Prerna Tolani","doi":"10.1136/medhum-2024-012991","DOIUrl":"10.1136/medhum-2024-012991","url":null,"abstract":"<p><p>This article aims to examine the lived experiences of attention-deficit/hyperactivity disorder (ADHD) diagnosis in adulthood, emphasising its revelatory nature and diverse emotional responses it provokes. The diagnosis serves as a pivotal moment of self-discovery, often evoking feelings of validation and identity affirmation. However, it also triggers a complex array of emotions, including grieving for the childhood self, frustration with society's failure to recognise the legitimate challenges and evolving self-concept post diagnosis. Through a close reading of digitally published comics by Laura Balcerek, Amber Lewis and Juliette Yu-Ming Lizeray, this article studies how the graphic medium conveys these nuanced experiences. By dissecting narrative and visual elements inherent in the comics, the article studies the affordances of the comic medium to capture the lived experiences of ADHD diagnosis in adulthood. Ultimately, this article intends to deepen understanding of the diverse lived realities and underscores the expressive potential of graphic narratives of neurodivergence.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"172-179"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformational healing: the phenomenology of fulfilment in the face of adversity.","authors":"Drew Leder, Kevin Aho","doi":"10.1136/medhum-2024-012993","DOIUrl":"10.1136/medhum-2024-012993","url":null,"abstract":"<p><p>In the last two decades, there has been an explosion of scholarship in the phenomenology of health and illness of great practical significance for clinicians and the allied health professions. 'Healing' has been distinguished from medical 'cure' insofar as it involves a process of existential re-integration even in the face of ongoing illness and incapacity. This article goes further than much existing literature in the field: it examines ways in which illness can trigger for some '<i>transformational</i> healing'-that is, not simply a return to previous functioning, but positive alterations that open one's life to enhanced fulfilment, authenticity and/or connection. Using philosophical resources and 'pathographies', first-person accounts of illness and healing, we examine six forms, often interconnected, of transformational healing. These involve, in turn: <i>vulnerability, intimacy, resilience, presence, gratitude and transcendence</i> In placing a spotlight on ways in which serious illness, injury and disability can inform positive transformations, we are not minimising the suffering often associated with such conditions. Nonetheless, many individuals experience life-enhancements despite, or even because of, the effects of suffering which can reveal personal strengths, deepened intimacy with others and heightened appreciation of life. The possibility of transformational healing, while far from a universal experience, has personal, philosophical and clinical significance not to be overlooked.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"59-66"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectation, emotion and the built environment: experiences of occupying hospital spaces as a loved one nears the end of life.","authors":"Rebecca Mclaughlan","doi":"10.1136/medhum-2024-012989","DOIUrl":"10.1136/medhum-2024-012989","url":null,"abstract":"<p><p>Following a 3-year long research project that gathered 146 views, including those of palliative care patients, family members, medical staff, administrators, architects and government representatives, this paper explores the hypothesis that motivated this work; a hunch that the built environment affects us most during times of intense vulnerability. Of these 146 people, only a small handful could provide insight relative to the experience of occupying hospital spaces as a loved one nears the end of life. This article honours these stories and discusses them in relation to my own observations and experiences. The article is thus part observation, part participant interview, part autoethnography. Findings already published from the broader study have spoken to the importance of fresh air, access to nature, spaces for spending time with family, as well as alone, and ensuring people feel comfortable to enact rituals of home within the hospital. Yet the accounts discussed here are different. They speak to the subtle ways that hospital environments communicate when emotions are raw, and people are at their most exhausted. They speak to the ways that aesthetics are <i>felt</i>; and make evident that notions of homeliness must encompass far more at the end of life. A sense of welcome is not a nicety but a need, as is comfort, and what might be termed 'imaginative respite'-the idea that the built environment might somehow alleviate the focus on an unbearable reality. These accounts speak to the difficulty of navigating grief, and a hopeful expectation that the built environment might somehow soften the edges of this experience. In focusing on these stories, this article contributes a deeper understanding of what is really at stake when we design for palliative care.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"86-95"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients as knowledge partners in the context of complex chronic conditions.","authors":"Vox Jo Hsu, Megan Moodie, Abigail A Dumes, Emily Lim Rogers, Chelsey Carter, Emma Broder, Daisy Couture, Ilana Löwy, Emily Mendenhall","doi":"10.1136/medhum-2024-012957","DOIUrl":"10.1136/medhum-2024-012957","url":null,"abstract":"<p><p>This article conveys how taking patient knowledge seriously can improve patient experience and further medical science. In clinical contexts related to infection-associated chronic conditions and other complex chronic illnesses, patient knowledge is often undervalued, even when clinicians have limited training in diagnosing and treating a particular condition. Despite growing acknowledgement of the importance of patients as 'stakeholders', clinicians and medical researchers have yet to fully develop ways to evaluate and, when appropriate, meaningfully incorporate patient knowledge-experiential, scientific, social scientific, historical or otherwise-into clinical practice and research. We argue that there are opportunities for clinicians and researchers to collaborate with patients and colleagues from the social sciences and humanities. We use two examples to demonstrate why patient knowledge should inform medical engagement with chronic and complex conditions. The first comes from a disability studies scholar who describes the social biases that can sideline patient expertise, and the second is from an anthropologist whose reading in medical humanities led to an effective treatment for her recovery. Rather than merely acknowledging 'lived experience', clinical and research teams should include patients with complex chronic conditions as 'knowledge partners'. These patients occupy unique and valuable epistemological positions, and their knowledge should be considered with as much openness and rigour as other forms of medical knowledge. As more medical schools, residency programmes and hospitals emphasise the need for 'deep listening' and patient input, we encourage meaningful engagement with patients whose insights can provide crucial knowledge for clinical and scientific advancement.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"34-38"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the GP-patient relationship: a historical narration.","authors":"Emma Ladds","doi":"10.1136/medhum-2024-012916","DOIUrl":"10.1136/medhum-2024-012916","url":null,"abstract":"<p><p>The relationship between patients and their doctor is a fundamental concept-particularly within general practice. Many patients and general practitioners (GPs) have a 'common-sense' recognition of the interpersonal connection, usually over time, that makes a relationship meaningful. GPs have consistently striven to emphasise the importance of this connection. While much research has explored the components and influences affecting intersubjective connections, less attention has focused on how the historical, professional, sociopolitical and philosophical contexts have influenced their experience and portrayal. However, recent claims of a crisis in UK general practice resulting from declining relational encounters suggest these are important considerations. In this paper, episodic narration (chronicling) is used to explore five different ages of UK general practice: the emergent period (1815-1948); the expansion of coverage (1949-1965); the professionalisation of general practice (1966-1988); the age of marketisation and neoliberalisation (1989-2004); and the age of technology and fragmentation (2004-present day). A range of sources illustrate micro and macro viewpoints within each period-personal reflections, professional publications, political directives or policies, and representations from the fields of art and literature. This allows for a deeper exploration of contextual influences on the codification and enactment of GP-patient relationships over time and their interpretation and perception. Significant epidemiological and biomedical realities and their respective social interpretation(s), the socioprofessional nature of the GP, that is, their role, societal position and framework of practice, and broader sociopolitical and philosophical factors are explored. Ideological frameworks (from socialism to free market policies and neoliberalism) were particularly important. These determine approaches to funding, service/provider structures, and regulation and governance, which incentivise, enable, or inhibit choices and behaviours among individuals and society, thus impacting the enactment of the GP-patient relationship. If meaningful GP-patient connections are valuable and desirable-as GPs consistently claim they are-we require an honest discussion about the contexts necessary to enable and retain them.</p>","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":" ","pages":"112-122"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Editor's farewell.","authors":"Brandy Schillace","doi":"10.1136/medhum-2025-013259","DOIUrl":"https://doi.org/10.1136/medhum-2025-013259","url":null,"abstract":"","PeriodicalId":46435,"journal":{"name":"Medical Humanities","volume":"51 1","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}