Medical semiotics, as a branch of general semiotics, has never really gained a foothold in either semiotics itself or medical science, despite the fact that the discipline of semiotics traces its roots to the medical domain in the ancient world and especially to Hippocrates. With several key exceptions, such as Jakob von Uexküll in 1909 and in the 1990s with Thomas A. Sebeok, there is no evidence that medical semiotics is a (...) significant and growing area of research either within semiotics or medical practice. The purpose of this book is to revive interest in this field examining the historical and epistemological principles that would make it highly relevant today in the global village where conceptions of disease and health are in constant flux. The book is written it in a non-technical way-that is, no assumptions are made on the part of the reader of technical semiotics. Our hope is that this book will bring out the importance of semiotics to the practice of medicine. It can be considered to be a textbook in the field of medical semiotics, constituting to the best of our knowledge the first of its kind. (shrink)

NOTE: Series number is not an integer: n/a.

Medical semiotics in the 18th century was more than a premodern form of diagnosis. Its structure allowed for the combination of empirically proven rules of instruction with the theoretical knowledge of the new sciences, employing the relation between the sign and the signified.

This essay sets out to explain how educational semiotics as a discipline can be used to reform medical education and assessment. This is in response to an ongoing paradigm shift in medical education and assessment that seeks to integrate more qualitative, ethical and professional aspects of medicine into curricula, and develop ways to assess them. This paper suggests that a method to drive this paradigm change might be found in the Peircean idea of suprasubjectivity. This semiotic concept (...) is rooted in the scholastic philosophy of John of St Thomas, but has been reintroduced to modern semiotics through the works of John Deely, Alin Olteanu and, most notably, Charles Sanders Peirce. I approach this task as both a medical educator and a semiotician. In this paper, I provide background information about medical education, paradigm shift s, and the concept of suprasubjectivity in relation to modern educational semiotic literature. I conclude by giving examples of what a suprasubjective approach to medical education and assessment might look like. I do this by drawing an equivalence between the notion of threshold concepts and suprasubjectivity, demonstrating the similarities between their positions. Fundamentally, medical education suffers from tensions of teaching trainee doctors the correct balance of biological science and situational ethics/judgement. In the transcendence of mind-dependent and mind-independent being the scholastic philosophy of John of St Thomas may be exactly the solution medicine needs to overcome this dichotomy. (shrink)

Doctor-patient interaction has gained increasing attention among sociologists and linguists during the last few decades. The problem with the studies performed so far, however, has been a lack of a theoretical framework which could bring together the various phenomena observed within medical consultations. Mikhail Bakhtin's philosophy of language offers us tools for studying medical practice as socio-cultural semiotic phenomenon. Applying Bakhtin's ideas of polyphonic, context-dependent and open-ended nature of human communication opens the possibilities to develop prevailing theoretical and (...) empirical approaches to the study of medical consultations. (shrink)

This paper analyses the immunological response of breast cancer patients through the lens of medical semiotics. From this perspective both psychological and physiological symptoms are treated as a set of transitive signs. The symptomatic journey of breast cancer patients was documented through an ethnographic engagement with a breast cancer charity. This journey consists of diagnosis, treatment and remission, where both the physical and psychological trauma maybe irreversible. Equally the genetic disposition of each patient and the variability of the (...) treatment give rise to a plethora of possible immunological responses. The case study organization provided both therapeutic treatment but also sold oncology products to its patients, matching the products’ composition to the specific immunological responses caused by breast cancer treatment, e.g., brittle skins or hair loss, etc. This paper explores how the varied and transient nature of immunological semiosis is identified and commoditized into an economic process. This challenging social context is of interest from a semiotic stand point because it offers a singular paradigm to explain the evolution of signs and symptoms into sales. (shrink)

The "semiotic threshold" is U. Eco's metaphor of the borderline between the world of semiosis and the nonsemiotic world and hence also between semiotics and its neighboring disciplines. The paper examines Eco's threshold in comparison to the views of semiosis and semiotics of C. S. Peirce. While Eco follows the structuralist tradition, postulating the conventionality of signs as the main criterion of semiosis, Peirce has a much broader concept of semiosis, which is not restricted to phenomena of culture (...) but includes many processes in nature. Whereas Eco arrives at the conclusion that biological processes, such as the ones within the immune system, cannot be included in the program of semiotic research, Peirce's broader defmition of semiosis has meanwhile become thefoundation of semiotic studies in biology and medicine and hence in biosemiotics and medical semiotics. (shrink)

Ethical problems connected with biological and medical discoveries in genetic engineering, neurobiology and pharmaceutical research, reach a unified and critical point of view in bioethics as a specific discipline. But even before reaching this stage, ethical problems already belong to two totalities: the semiobiosphere. and the current social form of global communication. Coherently with its philosophical orientation, bioethics must necessarily keep accountof this double contextualisation. The semiobiosphere is the object of study of global semiotics or the semiotics (...) of life. Global semiotics is of particular interest to bioethics not only because of the broad context it provides for the problems treated by bioethics, but also because it provides bioethics with an adequate contextualisation both in terms of extension, of quantity, as well as of quality. From this point of view, "contextualisation" also means critical reformulation. We are now alluding to the need of viewing bioethical problems in the light of today's socio-economic context, that is, in the context of global communication-production. These contextualisations are closely related from the viewpoint of ethics. Semiotics as global semiotics or semiotics of life must accept the responsibility of denouncing incongruencies in the global system, any threats to life over the entire planet inherent in this system. (shrink)

Despite growing scientific interest in the placebo effect and increasing understanding of neurobiological mechanisms (Finniss et al. 2010), theoretical conceptualization of the placebo effect remains primitive (Miller, Colloca, and Kaptchuk 2009). Mechanistic research on this phenomenon appears largely free-floating, with little guidance by any systematic theoretical paradigm. A partial explanation is the pervasive conceptual confusion that characterizes thinking about the placebo effect. The philosopher of science Adolf Grunbaum noted that "the medical and psychiatric literature on placebos and their effects (...) is conceptually bewildering, to the point of being a veritable Tower of Babel" (Grunbaum 1994, p. 286). .. (shrink)

Patients with persistent pain who lack adetectable underlying disease challenge thetheories supporting much of biomedicalbody-mind discourse. In this context,diagnostic labeling is as inherently vulnerableto the same pitfalls of uncertainty that besetany other interpretative endeavour. The endpoint is often no more than a name ratherthan the discovered essence of a pre-existentmedical condition. In 1990 a Committee of theAmerican College of Rheumatology (ACR)formulated the construct of Fibromyalgia in anattempt to rectify a situation of diagnosticconfusion faced by patients presenting withwidespread pain. It was (...) proposed thatFibromyalgia existed as a ``specific entity'',separable from but curiously able to co-existwith any other painful condition. Epistemological and semiotic analyses ofFibromyalgia have failed to find any sign,clinical or linguistic, which coulddifferentiate it from other diffusemusculoskeletal pain states. The construct ofFibromyalgia sought to define a discernablereality outside the play of language and topass it off as a natural phenomenon. However,because it has failed both clinically andsemiotically, the construct also fails the testof medical utility for the subject inpersistent pain. (shrink)

The metaphor of parasites or parasitism has dominated literary critical discourse since the 1970s, prominent examples being Michel Serres in France and J. Hillis Miller in America. In their writings the relationship between text and paratext, literature and criticism, is often likened to that between host and parasite, and can be therefore deconstructed. Their writings, along with those by Derrida, Barthes, and Thom, seem to be suggesting the possibility of a semiotics of parasitism. Unfortunately, none of these writers has (...) drawn enough on the biological foundation of parasitism. Curiously, even in biology, parasitism is already a metaphor through which the signified of an ecological phenomenon involving two organisms is expressed by the signifier of “[eating] food at another’s [side] table”. This paper will make some preliminary remarks on semiotics of parasitism, based on the notions of Umwelt (Jakob von Uexküll) and structural coupling (Maturana and Varela). It will look into the phenomenon of co-evolutionary process in community ecology. With reference to empirical history, the project will briefly surveythe literary and medical praxis of the 17th century England where large number of creative writings referred to the phenomenon of parasitism, which was deeply embedded in religious practice (e.g., the Eucharist) and political life (e.g., the courtier ecology in monarchy) of the times. Finally, it will touch upon the possible ‘parasitic’ relationship between language and biology. (shrink)

Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. (...) With special reference to a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. (...) Drew Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

The call for a biosemiotic perspective within medical semiotics has been steadily increasing over the late twentieth and early twenty-first centuries. In _Food and Medicine: A Biosemiotic Perspective_, Yogi Hale Hendlin, Johnathan Hope, and the nine contributions in their edited volume boldly seek to bridge the segregation between nature and culture in the medical sciences as well as in the medical humanities. To a large extent, they achieve this aim by explicating the sign relations _in_ food (...) and medicine, the sign relations _of_ medical theory and practice, and the sign relations _between_ the biology in medicine and medicine of society. Taking up a semio-historical approach, I contextualize two select contributions from Hendlin and Hope’s _Food and Medicine_ with the medical semiotics of the Hippocratic tradition. By comparing the biological semiotics from the contributions to the medical semiotics from the Corpus, I critically explicate the ways in which biosemiotics moves this subdiscipline forward and why the perspective is significant not only for the health of humans, but also for the health of other animals, and indeed for the health of the planet that we all inhabit together. On these grounds, I propose a turn from medical semiotics to _health semiotics_. This program for semiotics would encompass not only food and medicine, but also lifestyle and wellbeing, as well as the subjective, qualitative perspectivism that makes biosemiotics frontier research, thereby constituting a biosemioethics and promoting a semiotic fitness. (shrink)

This article serves as a demonstration of how certain models of literary analysis, used to theorize and analyze fiction and narrative, can also be applied to scientific communication in such a manner as to promote the accessibility of science to the general public and a greater awareness of the methodology used in making scientific discovery. The approach of this article is based on the assumption that the principles of structuralism and semiotics can provide plausible explanations for the divide between (...) the reception of science and literature. We provide a semiotic analysis of a scientific article that has had significant impact in the field of molecular biology with profound medical implications. Furthermore, we show how the structural and semiotic characteristics of literary texts are also evident in the scientific papers, and we address how these characteristics can be applied to scientific prose in order to propose a model of scientific communication that reaches the public. By applying this theoretical framework to the analysis of both scientific and literary communication, we establish parallels between primary scientific texts and literary prose. (shrink)

In this paper we address the objectivist logic of bipolar gender attribution, the entitlement of ideal masculine virtues, and the repression of so-called non-male characteristics in persons who live with chronic disabling conditions. More specifically, we show how the living experience of chronic disability continues to be co-opted by patriarchal strategies designed to keep particular bodies both invisible and silent.

Medicine maintains a distinction between the medical symptom -- the patient''ssubjective experience and expression, and the privileged medical sign -- the objective findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the undefined, medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within (...) a sociopolitical context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault''sideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women''shealth, illness and disease. (shrink)

The article analyzes the philosophical and cultural view of 'doctor’s professional culture' as a result of centuries-old practice of human relations, which is characterized by constancy and passed from generation to generation. Medicine is a complex system in which an important role is played by: philosophical outlook of a doctor, philosophical culture, ecological culture, moral culture, aesthetic culture, artistic culture. We have found that within the system “doctor-patient” the degree of cultural proximity becomes a factor that influences the health or (...) life of a patient. Thus, the following factors are important here: 1) communication that suppresses a sick person; 2) the balance of cultural and intellectual levels; 3) the cultural environment of a patient which has much more powerful impact on a patient than the medical one. At the present stage, the interdependence of professional and humanitarian training of future specialists is predominant, as a highly skilled specialist can not but become a subject of philosophizing. We outlined the sphere where the doctors present a genre variety of philosophizing. This tradition represents the original variations in the formation of future doctor’s communicative competences, which are formed in the process of medical students’ professional training. A survey conducted among medical students made it possible to establish their professional values, which are indicators of the formation of philosophical and culturological competence. It was found out that 92% of respondents believed that a doctor should demonstrate a high level of health culture 99% of respondents favoured a high level of personal qualities of a doctor which would allow methods and forms of medical practice to assert higher human ideals of truth, goodness and beauty that are the subject area of cultural studies and philosophy. (shrink)

March 2020 has become a moment of change in communication mode and quality. Previously, the media paid attention to the current affairs, however, never earlier the journalistic discourse has been so influentially affected by the ongoing phenomenon as in the case of COVID-19. Almost overnight the new terminological phenomena with specific legal or medical reference were introduced into everyday language mainly via mass media and become an important part of a pandemic related narration. The strong influence on the shape (...) of the mentioned linguistic changes has mainly the adoption of new legal regulations due to the unexpected outbreak of the pandemic. The aim of the following paper is to investigate how COVID-19 pandemic affected the specialisation of the journalistic discourse and how different domains are being influenced by new terminology and in other way round, how for example law and medicine influence new “COVID language”. In order to take the interdisciplinary nature of the issue into account, the degree of hybridity of the selected texts will be examined by means of selected material analysis. The methodology applied in the paper uses an empirical approach and comparative analysis. The material used for the analysis comes from the selected Polish quality and boulevard press. The paper concerns the linguistic influence of the “invisible enemy” on the language presented in press. The main findings reveal the intense use of neologisms, borrowings, and it shows that the discourse was changed linguistically thanks to Student’s t-test. (shrink)

The purpose of this paper is to introduce an approach to clinical practice aiming to resolve the dilemma of choosing between a mechanistic and a phenomenological model. The approach is an extension of Polanyi's epistemology. Michael Polanyi, devised an epistemology of science which overcomes the problem of detachment, inherent in the mechanistic approach, and resolves the problem of subjectivity troubling phenomenologists. His epistemology is known as Personal Knowledge. An extension of this epistemology, a Neo-Polanyian proposal, is offered as a more (...) successful model for clinical practice than previous suggestions addressing the dilemma. (shrink)

We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

Dubin S, Lane M, Morrison S, et al. Medically assisted gender affirmation: when children and parents disagree. ….

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.