Thursday, July 2, 2015
Bulgakov - Baptism by Rotation, Embroidered Towel, Steel Windpipe
DOCTORS AT WIT’S ENDS
- Williams and Bulgakov: Doctors AND writers - russian literature
1. ethics of relationship with the patient & DEONTOLOGY of the medical practice - how he is recognised as “healer” - social authority
2. dramatize relationships of conflict and collaboration - doctor is cultural/social economically removed - williams and bulgakov do not share same socio-economic and cultural-linguistic background w/ their patients
3. 1920s-1930s context
BULGAKOV
- the stories we read are the first - city doctor thrown into rural village, displacement of the doctor
DOCTOR’S PERSPECTIVE - similarities & differences
- half of the 20th century: rural area in soviet and eastern united states (williams) - impoverished social context
- dramatic encounters: focus on doctor’s ability to rise to the occasion - life and death situation
- bulgakov: dramatize coming into being a young doctor into his own role as an authoritative professional - trial by fire
- williams: ongoing challenges of an experienced doctor
- bulgakov: comedian and satirical writer, williams: lyrical
THE PRACTICE
- “often after i have gone….” “this is why as a writer….” medicine nurtured as writer - healing for the doctor - meaningful experience to his own practice for story-making / brody: what he insists on
- relational ethics, attention given to patient
- “poem of life” - stylistic mark
- what he tries to extract: (125) physician enjoys a wonderful opportunity actually to witness the words being born / they say the same thing and then a new beginning starts to intervene - literature captures the surface of medicine - makes visible
- juxtaposition of role of practice medicine w/ literature - heightened, complementary relations: lyrical aspect,
“the physician, listening from day to day…”
MIND AND BODY
- relational ethics (brody)
- the patient’s story: dramatizes how patients want a name for a disease, on-going search (rambling) from the patient’s experience - page 1
- williams interjecting every now and then - sympathetic listener, occupies his role, giving reader where she’s from alternated w the patient’s story itself
- patient trusts doctor
- “oh you have read that too, she said and seemed pleased…”
- placebo effect - someone to tell troubles is what we need
- the doctor gives a physical condition for her - a relational ethics
- him becoming a professional doctor
PARALLEL STORIES
- “use of force” & “steel windpipe” : deal with cases of diphtheria
> bulgakov: vaccination didn’t exist
> williams: vaccination has been made
>> overpowering moment of the doctor
>> he confesses to having attack the child: “pleasure to attack her” “social necessity”
- “a night in june” and baptism by rotation”: stories about birth
>> a night in june: experienced doctor who knows her patient well
>> baptism: first birth this doctor is attending - life and death situation drama
>>”then i fell asleep….” medicine moving into scientific standards, minimise humanity
>> foreshadowing of avoidance of culture of pain - doctors try to minimize discomfort
>> cultural relation to pain
- attention and deference both doctors pay to the midwives of the story
- stories of doctors know best attitude - they need rationalisation, overpowering moment of the doctor
- doctors the enlightened one vs. ignorance - not knowing what to do, doctor configures himself as someone who got the patient’s back
> use of force: “disgust” - “damned little brat” (60)- social necessity that doesn’t only affect the patient but also everyone
> steel windpipe: conflict between medical institutions vs. advocates of patients -
Davis - The Wayfinders
THE EARTH AS ONE SYSTEM
Planet Earth: planet as an interconnected web of history and possibilities - culture and medicine
WHY THE WAYFINDERS?
- Asks us to consider how profoundly connected is culture/environment and health.
- Journeys of various indigenous cultures
- Fascinating: window into culture - modes of being human/consciousness for our species; adapt to various environments and develop unique ways of interacting
- Humbling: ongoing disasters of the history of arrogant and dismissal of too many indigenous cultures - last 500 years of colonial encounter, technological acceleration in Western culture
- Driven by environmental crises - we need to look at this - alarming rate we are losing Earth (cultures & language) “the ethnosphere”
- Modernity threatens to destroy the planet and our own existence.
- Davis acknowledges speciesiation: e.g. Latin language and its disappearance
> Dying of different species and languages moving in a faster rate
“Healing Journey” - Anthropological and ecological perspective
- “Constitutive relation between forms of life and the material-cultural environments that sustain or impede their thriving”
- strong interconnection between biosphere and ethnosphere
- specifics of anthropological:
> sets attention to specific set of beliefs, rituals and forms of sociality which we make sense of our experiences of illness and of wellbeing: asset to doctors of anthropological details
> impossible to think without taking account health or illness into the dynamic interactions with the social and environmental worlds through which they manifest.
> insight through anthropology.
> importance of context.
ISSUES IN WAYFINDERS
1. BIOSPHERE & ETHNOSPHERE
- Biosphere: biological web or matrix of life on our planet - “being severely eroded by the destruction of habitat and the resultant loss of plant and animal species, so too is the ethnosphere, only at a far greater rate” (2)
- Ethnosphere: social web of life - “the sum total of thought and intuitions, myths and beliefs, ideas and inspirations brought into being by the human imagination since the dawn of consciousness” (page 2)
- Language loss - increasing hegemony - “canary in the coal mine”
READING QUESTION: WHAT OTHER INDICATORS OF ERODING ETHNOSPHERE?
- Provide specific examples
2. POTENCY OF BELIEF
- Davis argues: not realness of culture against scientific testing, but the potency of belief that produces certain realities for the people/individual living.
- “the manner in which conviction plays out in the day to day lives of a people, for in a very real sense this determines the ecological footprint of a culture, the impact that any society has on its environment” (122-123)
- Reminds us that Western system of evaluation is not objective/the best, esp when it comes to environmental sustainability. (124) “a child is….” mountain to be mined
- How we see the world affects how we use it
READING QUESTION: HOW “POTENCY OF BELIEF” RESONATE WITH “THE REMEDIES”
“songs of healing”
ON METAPHOR
- Metaphor more than a literary device, it is a cognitive device
- Each culture has their own set of powerful metaphors that guide into very real ways
3. THE PROBLEM OF MODERNITY AND GLOBALIZATION
- Demystification of our notion of modernity as the pinnacle of civilisation
- Relativizes our ‘modernity’ of ethnosphere - one-sided progress for Western society - listen to other cultures towards our well-being of the planet
THE PROBLEM WITH OUR BLIND FAITH IN TECHNOLOGY
Page 193: “Modernity, whether….” “merely a constellation of beliefs, one way of doing things”
- Terrible thrive in sustainability, spiritual intuitions and generosity (195)
- “Extreme” civilisation
- Age of disintegration:
> Urbanization (201)
> lack of attention to sustained DIVERSITY - hegemony
> The brute fact of domination - colonisation and “chaotic cultural encounters” - cultures polluted: social illnesses and pollution as a result of that
CONCLUSION
- Matrixes of connectivity sustain our lives - social, environmental, familial - Indigenous health relies on this
- Individual health interconnected to the greater webs of connection, social and environmental health
Brody - Stories of Sickness / Kleinman - The Illness Experience
Wade Davis: how the Earth can be protected/sustainability - whole communities
In contrast, the readings highlight the doctor-patient relationship: nucleus of medical practice is never isolated - “social reciprocities” - web of matrix connectivities
MAJOR POINTS (BRODY)
1. Story-telling is essential to medicine as a practice: “patients come with broken stories as much as they come with broken bones” (p 16)
- Suffering as illness: “broken stories” - build/recraft this
2. Concepts of sickness in relation to narrative
- Sickness is different from suffering: sickness is profoundly social
- idea of sickness as a disruption of one’s own LIFE STORY AND SELF-RESPECT
- The sick role as literary analysis
3. Ethical role of doctor - “peer review group”
- Doctor should not impose his/her story in the patient’s
- Healing is about ENABLING the patient to tell her own BETTER story
STORYTELLING AND MEDICINE
- Medicine is a practice situated between science and art: purpose of restoring health (p 52)
- Relation between doctor and patient is required
- Doctors listen and understand the patient’s experience of suffering
- Patient’s story can and frequently does diverge from doctor’s story - full healing only comes when the stories converge and be co-authored - doctor exercises authority and power responsibly (ETHICS)
- Healing lies in the crafting of a joint story, for a better story
SICKNESS, SUFFERING AND STORY
- Articulated in social model (story)
- Suffering: “produced and alleviated by the meaning that one attaches to one’s experience”
- One can bring suffering in and out of one’s experience of sickness “PRIMARILY BY TELLING STORIES ABOUT IT.”
- Attaching a meaning to the experience
Function of story
- Stories are profoundly social
- “Serve to relate individual experience to the explanatory constructs of the society and culture and also to place the experience within the context of one’s life story” (13)
- The placebo effect: “placebo or healing by symbolic means occurs to the optimal degree when the meaning of the illness experience is altered in a positive direction” (13)
3 components in healing process via telling the story of one’s illness (13):
1. Explanation of illness experience must be acceptable and recognisable within worldview and system of belief of the patient.
2. The patient must be surrounded by caring group of individuals.
- group respect enhances self-respect
- “peer review group”
3. Patient must achieve a sense of mastery of her own life - maker of her own story than illness
READING QUESTION: DESCRIBE HOW BRODY’S 3 COMPONENTS OF STORYTELLING AS HEALING CAN APPLY TO A WHOLE COMMUNITY OF PPL
Chapter 4 in The Wayfinders - ada the 3 components
1st component:
Power of physician is in the power of naming, of giving an explanation - comfort relies on naming the complaint
- This separates the person from the disease
- Suffering includes element of person taken over by the disease - creating distance between the person and state of suffering
- Done through storytelling
KLEINMAN - ILLNESS, DISEASE AND SICKNESS
- Illness: refers to how the sick person and family or wider social network perceive, live with, and respond to symptoms and disability (3)
> Subjective experience of suffering
> Illness is always socially shaped - how to behave when sick
- Disease: illness from medical perspective (5)
> Doctors trained to extract disease from illness
> Something essential is lost in the process - deprived of value and meaningfulness
> Illness experience is stored in sickness experience
- Sickness: disorder in its generic sense across a population in relation to macro social (economic, political, environmental) …. reflection of political oppression (6) - healing not just about telling stories but could lead to cultural and political activism
HOW BRODY TALKS ABOUT SICKNESS
- Not differentiated by Brody
- Halfway between illness and sickness, Brody emphasises social dimension
- Draw attention to individually mapped experience of illness onto our “life-story”
- Conventional ways we build out life-story in Western capitalist, individual and work-oriented society
- Kleinman: illness attached and assume different meaning to various cultural universes
> more anthropology oriented
> Brody: philosophy-oriented
- Both: critical target of sickness as simple biomedical phenomena - practice of medicine is pervasive
THE BIOMEDICAL VS BIOPSYCHOSOCIAL MODEL OF SICKNESS
- Biomedical: Symptom of illness to mechanical problem of the body. - can be repaired
- Biopsychosocial: dialectic integration between physical, psychological and environmental problems (kleinman, 6)
- both are critical of narrow biomedical perspective
BIOPSYCHOSOCIAL MODEL
BRODY:
- One level of hierarchy of “natural systems” - interpreted to molecules to society
- Each level is connected to flows of information - affects hierarchies of the system
- Health - maintenance of harmony of “homeostasis” - growth and adaption
- Disease: system is disrupted either by environmental challenge or a weakness within.
- Causes and effects manifests in different levels - not from one source
- Most up-to-date, 2003
KLEINMAN:
- Integrative, dialectic and dynamic
- Doctor has to pay simultaneous attention to: natural system of hierarchies & its different lvls
> Physiological processes - e.g. hypertension - cardiovascular activity
> Psychological states e.g. panic/stress
> Social and environmental factors e.g. pollution
- Brody can’t say which one comes first, but Kleinman disagrees
READING QUESTION: COMPARE AND CONTRAST THE BIOPSYCHOSOCIAL MODELS BETWEEN BRODY AND KLEINMAN
SICKNESS AND THE SOCIAL ORDER
- Sickness is a social phenomena
- “Being sick forces us to become unpleasantly conscious of factors that previously escaped our attention” (Brody, 58)
- Disruption in our social world, we turn to normalising ideologies
- Sickness renegotiates of what normal means altogether
WHAT ARE SYMPTOMS AND ILLNESS IDIOMS?
- Symptoms: always tied to cultural beliefs and shared (learned) knowledge about the body
- to understand meanings of symptoms and illnesses, we must understand the normative conceptions - culturally relative
- Illness idioms: denote how bodily and behavioural patterns are given meaning to different cultures, and acquire different valences.
> dynamic between bodily processes and cultural categories
> indicate culturally learned ways of showing distress
THE SICK ROLE (BRODY 54-58)
- Social role we take up and are expected to play when we identify as suffering from an illness
- Important in literary analysis - records pattern of behaviour and how it could/should be managed
- Parson’s definition:
> Sickness as a form of ‘excusable’ deviant behaviour
- One you are not held accountable
- You seek social authority that will help you return to ‘normal’
- Critiques to Parson:
> We need to be approach medical authority more critically
> There is more than one sick role: ‘normality’ within cultures
> Temporal trajectory of illness is neither linear nor self-contained. Kleinman especially draws patterns of chronic illness. Illness ain’t clean cut.
Literary device used as a pattern of behaviour
Allows us to imagine sickness, experience of illness, as one that bounds to social scripts and conventions/rituals about how we are expected to behave one an illness is identified.
HOW THE SICK ROLE IS INTEGRATED IN THE LIFE-STORY/LIFE-PLAN
- Life story - comprised of a “complex network of social reciprocity”:
> consciously/unconsciously construct ourservels as significant characters within what we regards as MEANINGFUL LIFE STORIES” (Johnson, quoted in Brody, 72)
- Life-plan: ability to articulate one’s life in relation to a coherent set of expectations from oneself
> peer-review group of reference for self respect
* Sickness interrupts disrupt the self and one’s life-story and life-plan *
Critiques:
- Life-story and life-plan culturally bound: social order and expectations of our life plans
> e.g. disease associated with laziness or bad eating habits, individualisation of responsibility
> society that values work above a number of things
- Society views sickness as disorder and individuality’s responsibility as the restoration of order (Brody 57)
- In contrast, Kleinman encourages an ethnographic awareness in dealing with different “illness idioms.”
CONCLUSION
- Listening and empathy in primary care of RELATIONAL ETHICS in medicine (Brody 263)
- Doctor’s use of responsible power
- Puts patient into centerstage and the doctor’s assistance in doing so
Fadiman - The Spirit Catches You and You Fall Down
Lecture 7 - Fish Soup
ABOUT FISH SOUP
- 55 pages of references about hmong
- gives readers incentives to become experts in hmong culture
tragedy
- lia, permanent damage to the protagonist - she dies
provided info
everything is connected
not should only rely on lia’s medical records
Lecture 8 - SEE PRESENTATION
Sacks - The Man Who MIstook His Wife for a Hat - Romantic Science
Lecture 9
- reason why sacks loves lauria: puts subject back to the disease
sacks interview
- importance of storytelling to the scientific aspect of the discovery
- case history of science with sensibilities and structure of a novel
- “portraits of patients”
sack’s critiques of the neurosciences of his time
- a science that includes narrative is what he calls “romantic.”
- analytical complement by narrative
3 main ingredients to romantic science:
1. privileges subject and lived experience of illness - kleinman: experience of suffering - abstract qualities of an illness divorced with the subject
2. privileges story-telling and narrative over conceptual classification
3. exploration of the elemental and the concrete comes before than bowers of abstract and categorisation
- concerns existential dimension of neurological diseases
> how disease affect personality/individual being of his patients
“SUBJECT” : what is a subject without a reality?
CRITIQUE OF IMPERSONAL NEUROLOGY
- brain as a computational organ - forgets the patient’s essential being
- brain disorders in indextricable conjunction with patient’s experience
- intersection of body and mind between physiological and the physical
- story-telling is an important aspect in scientific understanding, compiling explanations
PATIENTS ARE TRAVELLERS
- patients are travellers in unimaginable land
- another dimension of human existence we have no access to
- not victimising the patient, but rather exploration and curiosity - empowering
> looking at disease differently, outside of simple binary
DISEASE AND CREATIVITY
- archetypal sense of a hero: his patients strive to overcome limitations from disease
- although in all cases there’s no happy ending bcs of incurable diseases, each provide profound moral lessons - highlight resilience of human being themselves, keen to highlight the creative sense
- sacks wonder about the soul of his patients - korsokov’s syndrome “lost of mariner” story - “de-souling”
- pithed: loss sense of within - no longer having the sense of the body - the disembodied lady
- diseases put subject into question - erases subject before he/she got the disease
- how patient thrives in his/her own way - creation plays crucial role in this
> Dr. P’s paintings: can recognise abstract shapes but not regular faces
“There is often a struggle, and sometimes even more interestingly, a collusion
REDEFINING DISABILITY AND DISEASE
- ray, suffers from turret syndrome: turning his own disease into resource of artistic creation
- emphasising on the creative moment - what can the body still do instead of fixing it
“a disease is never a mere loss or excess. There is always a reaction on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be.” (4)
BRODY CONNECTION: PATIENT-DOCTOR RELATIONSHIP - observing and listening
Lecture 10
ROMANTIC SCIENCE PT 2
- “clinical tales” - stories of a doctor’s observations and recollections of a patient’s specific disease.
> why “tales”?
- they have some fiction, narrative formula
- they have a moral lesson
> tales related to recognised neuropathologies
4 thematic sections:
- losses
- excesses
- transports
- the world of the simple
sacks add short intro to each section - the main concept
how the concept:
BOTH
ORGANISES our scientific understanding of the neurological disorder
i.e. diseases as a loss, scientifically classifying the disease
AND
LIMITS our ability to fully recognize and appreciate the resillience, uniqueness and creativity of each of his patients
i.e. world of the simple - ppl with down syndrome - ppl who have these disorders have a different value of experiencing the world that is more valuable, has a set of values - offers shift of perspective
RHETORICAL PATTERNS OF SACKS’ CLINICAL STORIES
- “rhetorical” pattern: arrangement of arguments and story - one story reinforces the other
> thematically group stories
process of every story:
- each story has a general description of how he met the patient
- moment of perplexity: followed by a test of some kind with the problem related both to the nature of the disease and to the way the patient lives it
- what his story is, general diagnosis, moment of perplexity - encounter with the patient, relate the problem back with the scientific literature to work out his own solution
- focus turns back to patient (turning point), doctor observes patient in his/her own environment, outside of codified testing (medical lab)
- observing the patient in her own environment produces the most important revelations and insights
> i.e. rebecca in her home - pg 178/chapter 21: how she perceives her own home, sacks for once sees her to appreciate her powers to see her world as poetic, intelligent and whole.
> i.e. twins: only when he sits down with the twins, joins prime numbers game rather than have them respond to him, he gets a glimpse of their iconic memory
THE THERAPEUTIC MOMENT
- observing patients in their own environment makes the doctor coequals with patient - page 75 - “are coequals, on the same level, each learning from and helping the other and between them arriving at new insights and treatment.”
- “the actual moment of discovery” (72)
THE QUESTION OF SOCIAL ADAPTION
- social effect: deficit and function
- i.e. twins got separated to make them socially adaptable, and individually they did. but together, their shared pleasure in numbers, they have lost “the personal and emotional centre of their lives” (200).
> medical institution don’t take into account the emotional aspect of keeping people together
WHOSE INTERESTS DO MEDICINE SERVE WHEN IT COMES TO SOCIAL ADAPTION?
Subscribe to:
Comments (Atom)