In this article, the author explores a model of alternative medical education being pioneered at Loyola University Chicago Stritch School of Medicine. The five-year Global Health Fieldwork Fellowship track allows two students per year to complete an extra year of medical education while living and working in a free rural clinic in the jungle lowlands of Bolivia. This alternative curricular track is unique among other existing models in that it is longitudinally immersive for at least one full additional year of (...) medical education, grounded in clinical and service learning, and heavily focused upon global health and the social components of medicine. Studies have shown that both longitudinal alternative medical curricular tracks and short-term global health electives have long-term benefits upon the professional development of participants, suggesting that the GHFF is likely to do the same. The author also argues that the GHFF is an advantageous model of global health education compared to standard offerings and provides a unique curricular model by which to foster the development of social values—such as professionalism, advocacy, and social justice—that are widely considered lacking in today’s medical education. (shrink)

To inform medical education reform efforts, we systematically collected information on the level of arts and humanities engagement in our medical school community. Attitudes regarding incorporating arts and humanities-based teaching methods into medical education and patient care were also assessed. An IRB-approved survey was electronically distributed to all faculty, residents, fellows, and students at our medical school. Questions focused on personal practice of the arts and/or humanities, as well as perceptions of, and experience with formally incorporating these into medical teaching. (...) Of 13,512 community members surveyed, 2,775 responded. A majority of respondents agreed or strongly agreed that medical education and patient care could be "enhanced" by the integration of the arts. There was enthusiastic support for the creation of a formal program in the arts at our medical school. Integration of the arts into medical education may have a role in improving the quality of medical training and would likely be well received by teachers and learners. (shrink)

In 2013, in accordance with a provision in the Patient Protection and Affordable Care Act, the U.S. government began fining hospitals with “excessive” patient readmission rates. Those working to respond to this issue have identified discharge communication with patients as a critical component. In response to this exigency and to contribute to the conversation in the medical humanities about the field’s purview and orientation, this article analyzes studies of and texts about communication in health and medicine, ultimately arguing that the (...) on-going circulation of compliance rhetoric and assumptions has limited efforts to improve patient communication. The article, furthermore, considers that humanist ideals of agentic action, the patient-centered care movement’s emphasis on the patient, and biomedicine’s tendency to treat evidence-based knowledge as fixed and given may have combined to support a rationale for using patient adherence to treatment guidelines as metrics in measurement studies designed to identify effective communication strategies. Finally, the article proposes that those working in the medical humanities consider the value of interdisciplinary posthumanist scholarship—specifically, its treatment of agency and knowledge as emergent, distributed, and contingent—and its potential to transform or extend in productive ways the conversation about what constitutes effective communication with patients. (shrink)

On Tuesday evenings at New York University School of Medicine, the anatomy lab is transformed into an art studio. Medical students gather with a spirit of creative enterprise and a unique goal: to turn anatomy into art. They are participants in Art & Anatomy, an innovative drawing course within the Master Scholars Program in Humanistic Medicine —a component of NYUSoM, which offers elective courses across a range of interdisciplinary topics in medical humanities. Art & Anatomy has had approximately four hundred (...) fifty participants since its inception in 2009. The educational intention of the course is to use drawing as an active mode of learning that enhances visual-perceptual ability and three-dimensional spatial understanding of the body's interior; however, the course also opens a creative space for participants to process the emotional complexities of cadaver dissection and the anatomy lab experience. The anatomy lab can be the training ground for clinical detachment, but many U.S. medical schools are beginning to attend more closely to the emotional aspects of dissection. The authors maintain that the inherently expressive nature of drawing makes the Art & Anatomy course a novel and effective approach to this endeavor. Select student artwork and a curriculum overview are provided. (shrink)

Sometime ago, I found myself using the diagnosis of a student’s depression as a critical tool of interpretation, searching for signs of mental illness in her essay that explored order and disorder in T. S. Eliot’s The Waste Land. I realised that my reading had become a creative act, combining poem, poet, student essay and author to create, in a sense, one readable text. The present paper is a reflection upon the processes of order and disorder located in a diagnosis (...) of “madness” and the readings of writer and text this diagnosis initiated. I look to deconstruct acts of reading and diagnosis. (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities (...) content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

This article analyzes narrative illustrations in genetic counseling textbooks as a way of understanding professional habitus--the dispositions that motivate professional behavior. In particular, this analysis shows that there are significant differences in how the textbooks' expository and narrative portions represent Down syndrome, genetic counseling practice, and patient behaviors. While the narrative portions of the text position the genetic counseling profession as working in service to the values of genetic medicine, the expository portions represent genetic counselors as neutral parties. Ultimately, this (...) article argues that this ambiguity is harmful to the production of a professional habitus that is consistent with espoused professional values concerning respect for persons with disabilities and the promotion of psychosocial counseling. (shrink)

Much has been said about the formative process that occurs via the “hidden curriculum” of medical education during which many students experience a disconnect between the professional values espoused within the formal curriculum and the implicit values communicated through interactions with peers and mentors. Less attention, however, has been paid to the formation of the future medical self that takes place during students’ premedical years, a time in which many undergraduate students seek out immersive clinical experiences —such as medical scribing— (...) before applying to medical school. Despite the fact that medical scribes undoubtedly are affected by their clinical experiences, scribes are rarely offered opportunities to reflect on them. The authors contend that the developmental processes of medical scribes, especially those who intend on pursuing a career in the health professions, ought to be supported. This can be achieved, at least in part, through engaging in well-designed reflective sessions with other scribes. Encouraging students to reflect on their experiences can help them make sense of troubling events and give voice to the inconsistencies and value conflicts within medical practice that are so often ignored. The authors describe the development of their new Reflective Scribe program and offer suggestions for future directions. (shrink)

Medical students’ mask-making can provide valuable insights into personal and professional identity formation and wellness. A subset of first- and second-year medical students attending a medical school wellness retreat participated in a mask-making workshop. Faculty-student teams examined student masks and explanatory narratives using visual and textual analysis techniques. A quantitative survey assessed student perceptions of the experience. We identified an overarching theme: “Reconciliation/reclamation of authentic identity.” The combination of nonverbal mask-making and narrative offers rich insights into medical students’ experience and (...) thinking. This activity promoted reflection and self-care, while providing insight regarding personal and professional development. (shrink)

In response to the need for a more diverse workforce, our medical school developed new policies and procedures that focus on the recruitment and selection of diverse students with a specific focus on those considered underrepresented in medicine. To understand what these students bring to the practice of medicine, researchers investigated their perception of their cultural assets and how they plan to use these assets as physicians. A cross-section of 23 ethnically, culturally, and geographically diverse medical students were interviewed and (...) data were analyzed through phenomenographical methods. The results indicate that students view themselves as having multiple assets that could be of significant value in their future practice of medicine, including: a) an interest in science and access to family members in medicine, b) personal and familial struggles with health, c) self and family as immigrants, and d) strong family and community orientations. Students perceived these as cultural assets because they could directly identify where these assets could be valuable in medicine but questioned how to maintain them throughout medical school. Now that our institution has identified these assets, next steps include administrators' investigation of ways to leverage them through curricular and educational programs. (shrink)

Although the importance of spirituality is increasingly recognized in clinical medicine, spirituality is rarely mentioned in the practice, literature, or training programs of global health. To understand the role of spirituality in global health practice and identify factors that influence and limit its expression, I initiated conversations and informal interviews with more than 300 global health leaders, students, and practitioners during 2010-2014. Four spiritual themes or challenges emerged: compassion at a distance; dichotomous thinking; conspiracy of silence; and compulsion to save (...) the world. Practitioners expressed strong interest in bringing spirituality more fully into global health discourse, which could help the field realize its potential. (shrink)

Scholars have mostly analyzed information from mental health practitioners, attorneys, and institutions to critique mental health practices in the War on Terror. These sources offer limited insights into the suffering of detainees. Detainee accounts provide novel information based on their experiences at Guantánamo. Mohamedou Ould Slahi’s Guantánamo Diary is the only text from a current detainee that provides a first-person account of his interrogations and interactions with health professionals. Despite being advertised as a diary, however, it has undergone redaction from (...) American government officials. This article examines Slahi’s account of his interrogations and representations of mental health at Guantánamo and considers its role within the narrative function of the nation. At stake is the right of detainees to narrate, scholars to critique medical practices in the War on Terror, and the nation’s attempts to control its narration. (shrink)

Wit explores modes of reading representations of death and dying, both through the play’s sustained engagement with Donne’s Holy Sonnets and through Vivian’s self-reflexive approach to her illness and death. I argue that the play dramatizes reparative readings, a term coined by Eve Kosofsky Sedgwick to describe an alternative to the paranoid reading practices that have come to dominate literary criticism. By analyzing the play’s reparative readings of death and dying, I show how Wit provides lessons about knowledge-making and reading (...) practices in the field of health humanities. (shrink)

Although it has disappeared as a clinical diagnosis, a Disability Studies perspective on Civil War nostalgia offers an opportunity to recover the process by which understanding around a medical event occurs. By incorporating and examining the interplay between and among participants in the conversation surrounding nostalgia as they operate within various site specific temporal and social contexts, this method of analysis offers an opportunity to arrive at an understanding not only of the factors that contribute to different perspectives on an (...) illness, but also into how some voices become ascendant in constructing medical understanding and why others become subordinate, dismissed, or disappear. (shrink)

Narrative medicine explores the stories that patients tell; this paper, conversely, looks at some of the stories that patients are told. The paper starts by examining the ‘story’ told by the Shambaa people of Tanzania to explain the bubonic plague and contrasts this with the stories told by Ghanaian communities to explain lymphatic filariasis. By harnessing insights from memory studies, these stories’ memorability is claimed to be due to their use mnemonic devices woven into stories. The paper suggests that stories (...) can be unpatronising, informative, and appropriate vehicles for communicating medical information to all age groups across all cultures. (shrink)

Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium’s particular combination of words and (...) images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others. (shrink)

The US psychologist Gail Hornstein’s monograph, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness, is an important intervention in the identity politics of the mad movement. Hornstein offers a resignified vision of mad identity that embroiders the central trope of an “anti-colonial” struggle to reclaim the experiential world “colonized” by psychiatry. A series of literal and figurative appeals makes recourse to the inner world and cultural world of the mad as well as to the ethno-symbolic cultural materials of (...) dormant nationhood. This rhetoric is augmented by a model in which the mad comprise a diaspora without an origin, coalescing into a single transnational community. The mad are also depicted as persons displaced from their metaphorical homeland, the “inner” world “colonized” by the psychiatric regime. There are a number of difficulties with Hornstein’s rhetoric, however. Her “ethnicity-and-rights” response to the oppression of the mad is symptomatic of Western parochialism, while her proposed transmutation of putative psychopathology from limit upon identity to parameter of successful identity is open to contestation. Moreover, unless one accepts Hornstein’s porous vision of mad identity, her self-ascribed insider status in relation to the mad community may present a problematic “re-colonization” of mad experience. (shrink)

Research linking reading literary fiction to empathy supports health humanities programs in which reflective writing accompanies close readings of texts, both to explore principles of storytelling and to promote an examination of biases in care. Little attention has been paid to the possible contribution of guided fiction-writing in health humanities curricula toward enhancing cultural competence among health professionals, both clinical and community-based. Through an analysis of the short story “Pie Dance” by Molly Giles, juxtaposed with descriptions of specific writing exercises, (...) this paper explains how the demands of writing fiction promote cultural competency. (shrink)

In relationships ‘I’ and ‘you’ become ‘we’; despite individual differences, couples obtain an interdependent identity due to their shared interactions. During a serious illness, biological and biographical disruptions can put any reciprocal relationship under strain. Through intermedial analysis of Judith Fox’s photographic project, I Still Do: Loving and Living with Alzheimer’s, I will explore ways the couple make sense of illness, how illness is communicated through text and image and also to identify the limits of representation. Here the photographs, I (...) argue, solidify their relationship and echo the stuck-in-the-present state of mind brought on by Alzheimer’s. (shrink)

Parents whose child is diagnosed with a serious disease such as trisomy 18 first rely on the medical community for an accurate description and prognosis. In the case of trisomy 18, however, many families are told the disease is “incompatible with life” even though some children with the condition live for several years. This paper considers parents’ response to current medical discourse concerning trisomy 18 by examining blogs written by the parents of those diagnosed. Using interpretive humanistic reading and foregrounding (...) Cathryn Molloy’s recuperative ethos theory, we find that parents demonstrate recuperative ethos in response to physicians’ descriptions of trisomy 18, particularly in rhetoric addressing survival, medicalized language, and religious and/or spiritual rhetoric. We argue that, by using language such as “incompatible with life,” physicians distance themselves from families, creating not care, but the very gulf that requires recuperation. We conclude that medical professionals would do well to engage with the trisomy 18 community—including learning from blogs and online forums— employ palliative care practices, and seek more accurate, descriptive language that is compatible with care. (shrink)

In this article, we discuss decision making during labor and delivery, specifically focusing on decision making around offering women a trial of labor after cesarean section. Many have discussed how humans are notoriously bad at assessing risks and how we often distort the nature of various risks surrounding childbirth. We will build on this discussion by showing that physicians make decisions around TOLAC not only based on distortions of risk, but also based on personal values rather than medical data. As (...) a result of this, we will further suggest that the party who is best epistemically situated to make decisions about TOLAC is the woman herself. (shrink)

Using birth stories as our object of inquiry, this article examines the ways in which normative discourses about gender, disability and Down syndrome construct the birth stories of three mothers of children with Down syndrome. Their stories are composed of the mothers’ recollections of the first hours after birth as a time when their infants are separated from them and their postpartum needs are ignored. Together, their stories illustrate socio-cultural tropes that position Down syndrome as a dangerous form of the (...) “other” and mothers who give birth to children with Down syndrome as implicated in transgressing cultural norms. (shrink)

The Disney movie Frozen is the fifth highest grossing movie of all time. In order to better understand this phenomenon and to hypothesize as to why the movie resonated so strongly with audiences, we have interpreted the movie using psychodynamic theory. We pay particular attention to the themes of puberty, adolescence and sibling relationships and discuss examples of ego defenses that are employed by the lead character in relation to these concepts.

This article examines the women-led natural deathcare movment in the early 21st century U.S., focusing upon the movement’s non-coincidental epistemological and gender-political similarities to the natural childbirth movement. Adopting an interdisciplinary approach and drawing upon the author’s intensive interviews with pioneers and leaders of the U.S. natural deathcare movement, as well as from the author’s own participation in the movement, this article argues that the political similarities between the countercultural natural childbirth and natural deathcare movements reveal a common cultural provocation—one (...) that spans the natal transition and the fatal transition. (shrink)

Collaborative memoirs by co-writers with and without autism can enable the productive interaction of the voices of the writers in ways that can empower rather than exploit the disabled subject. Carly's Voice, co-written by Arthur Fleischmann and his autistic daughter Carly, demonstrates the capacity for such life narratives to facilitate the relational interaction between writers in the negotiation of understandings of disability. Though the text begins by focusing on the limitations of life with autism, it develops into a collaboration which (...) helps both writers move toward new ways of understanding disability and their own and one another's life stories. (shrink)

John Cleland’s 1740s pornographic novel, Memoirs of a Woman of Pleasure repeatedly depicts and eroticises the act of defloration. As such it is a revealing illustration of what Ivan Bloch termed the ‘defloration mania’ of the eighteenth century. This article maps narrative events on to contemporary medical depictions of first intercourse to show the ways that the theories and ideas presented in medical and pseudo-medical texts transferred into erotic fiction and demonstrates how in some instances the bloody defloration scenes can (...) be read as being sex during menstruation, an act which was culturally forbidden at this time. (shrink)

Through her stories and mine, my sister and I allow the outside world to see the ways in which we grapple with a critical health incident along her journey of living with lupus. Lupus is a chronic, autoimmune disease that is difficult to recognize and to diagnose. The ambiguous nature of the disease creates considerable confusion for the ill person as well as her support system. Using an illness narrative, I analyze a real life event linked to chronic illness, invisibility, (...) living loss, liminality and family—and more specifically, to social support within the sibling relationship. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

In 1997, David Foster Wallace published “The Depressed Person,” a short story about a privileged, deeply unhappy woman dedicated to exploring and recounting the texture and etiology of her chronic depression. This essay argues that “The Depressed Person” challenges the long-standing assumption that narrativizing the pain of depression is crucial to overcoming it, and the contemporary view that empathic responses from others promote recovery of the depressed. Taken together, these two critiques inform Wallace’s portrayal of chronic depression as an interactive (...) phenomenon that is articulated, sustained, and regenerated through problematic contexts of interaction. Written at a time when public knowledge of and talk about depression was surging, “The Depressed Person” holds an important, if presently under-recognized place, in the expansive corpus of depression texts that emerged in the 1990s. (shrink)

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as “mental illness,” take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional ecologies (...) in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that “uncivilizes” mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health. (shrink)

In this essay, the author describes how he faced institutionalized homophobia during his psychiatric training, and how he later wrote a play inspired by the life of a gay psychiatrist. Despite Freud’s supportive stance, homosexuality aroused the antipathy of American organized psychiatry and psychoanalysis and came to be listed as an illness in the Diagnostic and Statistical Manual. Dr. John E. Fryer outed himself as “Dr. H Anonymous” at a 1972 meeting of the American Psychiatric Association, and the next year (...) homosexuality was removed from the DSM. The 2014 play Doctor Anonymous offers a fictionalized account of this watershed moment in the history of the gay rights movement. The author discusses his own psychotherapeutic work with gay male patients, including those who had previously been treated with conversion therapy, and explores how the play mirrors his own life experience and the experience of his patients. (shrink)

Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals’ moral systems are in large measure developmentally and socially derived and interpreted. (...) Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual’s formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with issues of religion, faith, and spirituality for many individuals, and recognizing that much of the current focus on moral injury is emanating out of healthcare contexts, we devote particular attention to how chaplains might be more intentionally engaged in healthcare systems such as the Veterans Health Administration to provide non-judgmental, person-centered, culturally-relevant care rooted in communities of practice to veterans with moral injury. (shrink)

This essay examines a challenge to common literary representations of female mental illness in the Early Modern period—the hysterical woman—in a collection of French short stories contemporary to Vesalius's De Fabrica: Jeanne Flore's Tales and Trials of Love. Jeanne Flore's tales depict several mentally disturbed female protagonists, young women prone to paroxysms of madness and self-mutilation. This study maintains that while Tales and Trials of Love superficially participates in the literary tradition that grew out of those accepted social and medical (...) beliefs, it also questions the long-accepted paradigm of female hysteria and points to a shift in the socio-medical climate. Jeanne Flore's fictional narratives suggest that mental illness no longer consists in the realignment of a uterine imbalance, but rather in the telling of personal stories, a precursor to psychoanalysis and narrative medicine. (shrink)

One Flew Over the Cuckoo's Nest by Ken Kesey and The Devil in Silver by Victor LaValle are two novels that focus on mental hospitalization as a medical and social practice. Published fifty years apart, however, the books possess important differences in setting, method, and message reflecting the times that spawned them. The purpose of this paper is to examine the changing documentary and metaphorical uses of the asylum novel by comparing an iconic work in the genre with a respectful, (...) but divergent, successor. What emerges from this comparison is an appreciation of the literary conventions shared by Kesey and LaValle but also the ingredients that separate their work. Whereas Kesey produced an enduring tribute to the virtue of nonconformity, LaValle's social criticism expresses itself as a disturbing portrayal of class-based disparities and administrative dysfunction inside the contemporary American mental health system. (shrink)