Narrative Medicine Theory and Practice: the Double Helix Model

The genesis of the medical humanities as a discrete academic discipline engendered a need for a theoretical framework, a function taken on by the growing narrative medicine movement. More recently, scholars have begun to develop a critical medical humanities, an analytical movement that emphasises the fundamental enmeshment of the sciences and humanities. Building on Helene Scott-Fordsmand's work on reversing the medical humanities, this paper develops an alternative to the current version of narrative medicine. We propose a new interpretive heuristic, the Double Helix Model, and place it in critical dialogue with the Columbia School's close reading based-approach. Through this new conceptual frame, we suggest that critical narrative medicine may empower clinicians to contribute to the reorientation of the roles of the sciences and humanities, benefiting providers, scholars and patients.

Narratives of childhood sexual abuse: healing through music in Ian McEwan's On Chesil Beach

Narratives of survivors or by survivors offer useful and compelling insights into the experiences of abuse and its consequent effect on health. Reading such narratives can help a physician or clinician to understand the complexities of abuse. Furthermore, the critical study of narratives can open multiple therapeutic options for survivors of abuse to cater both their mental health and medical problems. In this article, we deal with the genre of childhood sexual abuse survivor's narrative and its clinical application adding to the discourse of medical humanities and then critically examine one such narrative (On Chesil Beach by Ian McEwan) in particular and explore the therapeutics of music in abused victim's clinical care.

Can 'life writing' be therapeutic in response to trauma? An exploratory research project in Medical Humanities in South Africa

The therapeutic benefit of expressive writing has been well researched in the Global North but there is no literature from the Global South. Potentially healing interventions need to be investigated in different contexts, particularly where there is a need to build social cohesion. South Africa has a violent past and is a highly stressed society. An exploration of self-reports by a diverse group of South Africans on the effects of life writing on their health and well-being was conducted using qualitative methods. Twenty members of a writing collective, the Life Righting Collective (LRC: www.liferighting.co.za), were purposively sampled and interviewed by medical students as part of a Medical Humanities special study module. Five major interconnected themes emerged. The LRC as a specific intervention was central to the benefits described. The findings of this study indicated that life writing is a useful non-medical, cost-efficient method to improve resilience to trauma, as well as improving the psychological well-being of the participants. In addition, participants reported positive experiences regarding personal development, overall wellness and mental health, and that life writing can engender a sense of community. Resource-constrained countries in the Global South, like South Africa, where there have been historical and ongoing multiple traumas, need interventions for healing and wellness that are low cost and can be replicated.

Laing and Rogers in London: An unfortunate meeting or something else?

BACKGROUND

In the summer of 1978 a large 1-day event was scheduled to take place in the Grand Ballroom at the Hilton Hotel in Park Lane, London between the psychotherapists Carl R. Rogers (1902-1987), and his associates, and Ronald D. Laing (1927-1989) and his group. From among all the eyewitness accounts of that meeting, I have found only the testimonies of Maureen O'Hara, Ian Cunningham, Charles Elliot, and Emmy van Deurzen. According to O'Hara, Laing behaved in a rude, impolite, and aggressive way toward his American colleague Rogers. For his part, Cunningham says that Rogers came over as he had expected: a genuinely nice, caring, humane person. Laing, though, was even more impressive in person than in his books. Similarly, Elliot observes that Laing and Rogers held a genuine encounter, one in which both sat like two real mutually respecting persons who asked each other questions, while the perspective of van Deurzen is more in line with that of O'Hara than that of Elliot.

AIMS

Taking into account the different versions given on the Laing-Rogers event, I will analyze whether this encounter was only an unfortunate meeting or something else.

METHODS

Narrative review; combining eyewitness accounts with the few sources found in the literature on this topic.

RESULTS/CONCLUSIONS

As I will show here, all these accounts taken jointly paint a picture of Laing as a brilliant clinician and as a terrible man. Without exculpating Laing for committing all sorts of mischief, I will offer a tentative account of his behavior sustained by his own psychic dynamics. In doing so, I will attempt to explain why Laing reacted in so censurable a way, going beyond Thomas S. Szasz's (1920-2012) condemnation in his essay on antipsychiatry, which gives credence only to O'Hara's version without quoting more sources or posing more questions.

Efficient pneumonia detection using Vision Transformers on chest X-rays

Pneumonia is a widespread and acute respiratory infection that impacts people of all ages. Early detection and treatment of pneumonia are essential for avoiding complications and enhancing clinical results. We can reduce mortality, improve healthcare efficiency, and contribute to the global battle against a disease that has plagued humanity for centuries by devising and deploying effective detection methods. Detecting pneumonia is not only a medical necessity but also a humanitarian imperative and a technological frontier. Chest X-rays are a frequently used imaging modality for diagnosing pneumonia. This paper examines in detail a cutting-edge method for detecting pneumonia implemented on the Vision Transformer (ViT) architecture on a public dataset of chest X-rays available on Kaggle. To acquire global context and spatial relationships from chest X-ray images, the proposed framework deploys the ViT model, which integrates self-attention mechanisms and transformer architecture. According to our experimentation with the proposed Vision Transformer-based framework, it achieves a higher accuracy of 97.61%, sensitivity of 95%, and specificity of 98% in detecting pneumonia from chest X-rays. The ViT model is preferable for capturing global context, comprehending spatial relationships, and processing images that have different resolutions. The framework establishes its efficacy as a robust pneumonia detection solution by surpassing convolutional neural network (CNN) based architectures.

Climate-driven invasion and incipient warnings of kelp ecosystem collapse

Climate change is progressively redistributing species towards the Earth's poles, indicating widespread potential for ecosystem collapse. Detecting early-warning-signals and enacting adaptation measures is therefore a key imperative for humanity. However, detecting early-warning signals has remained elusive and has focused on exceptionally high-frequency and/ or long-term time-series, which are generally unattainable for most ecosystems that are under-sampled and already impacted by warming. Here, we show that a catastrophic phase-shift in kelp ecosystems, caused by range-extension of an overgrazing sea urchin, also propagates poleward. Critically, we show that incipient spatial-pattern-formations of kelp overgrazing are detectable well-in-advance of collapse along temperate reefs in the ocean warming hotspot of south-eastern Australia. Demonstrating poleward progression of collapse over 15 years, these early-warning 'incipient barrens' are now widespread along 500 km of coast with projections indicating that half of all kelp beds within this range-extension region will collapse by ~2030. Overgrazing was positively associated with deep boulder-reefs, yet negatively associated with predatory lobsters and subordinate abalone competitors, which have both been intensively fished. Climate-driven collapse of ecosystems is occurring; however, by looking equatorward, space-for-time substitutions can enable practical detection of early-warning spatial-pattern-formations, allowing local climate adaptation measures to be enacted in advance.

Role of public health professionals in the climate and ecological crisis: a qualitative study

BACKGROUND

The climate and ecological emergency is the single biggest health threat facing humanity, yet it is not clear to what extent the public health workforce have been involved in work on this topic. This research aimed to establish what public health consultants working in local authorities in England perceive their role to be, whether the climate crisis is seen as a core component of public health and to identify barriers to action.

METHODS

Semi-structured interviews were undertaken with a purposive sample (n=11) of local authority public health consultants in England. Participants were recruited via public health organisations, social media or snowballing. Thematic content analysis was used to identify codes and themes.

RESULTS

Public health professionals have started work on climate change but reported being unclear about their role and feeling isolated working on this topic. Barriers to action included shortage of financial resources, communication tools and capacity, limited sharing of best practice, lack of local expertise and conflict between the need for action on climate change and other urgent issues.

CONCLUSION

We highlight the need to urgently address existing barriers to enable this important part of the public health workforce to play their role in tackling the climate and ecological crisis.

What Might It Mean to Embrace Emancipatory Pedagogy in Medical Education?

An emerging and important goal of professional health training and education is to develop a workforce that is equipped to address patients' social and structural determinants of health and to contribute to health equity. However, current medical education does not adequately achieve this vision. Emancipatory teaching, as described by scholars such as Paulo Freire and bell hooks, equips students with tools to identify and challenge oppressive systems. It helps students achieve freedom for themselves, thereby contributing to more emancipatory and humanistic patient care. Changing teaching in this way would help reverse implicit curricular values that tend to enshrine hierarchy and oppression. Humanities and bioethics scholars working within health professional schools thus should promote a more critical, emancipatory pedagogy in their institutions.

AI-Enabled Medical Education: Threads of Change, Promising Futures, and Risky Realities Across Four Potential Future Worlds

BACKGROUND

The rapid trajectory of artificial intelligence (AI) development and advancement is quickly outpacing society's ability to determine its future role. As AI continues to transform various aspects of our lives, one critical question arises for medical education: what will be the nature of education, teaching, and learning in a future world where the acquisition, retention, and application of knowledge in the traditional sense are fundamentally altered by AI?

OBJECTIVE

The purpose of this perspective is to plan for the intersection of health care and medical education in the future.

METHODS

We used GPT-4 and scenario-based strategic planning techniques to craft 4 hypothetical future worlds influenced by AI's integration into health care and medical education. This method, used by organizations such as Shell and the Accreditation Council for Graduate Medical Education, assesses readiness for alternative futures and effectively manages uncertainty, risk, and opportunity. The detailed scenarios provide insights into potential environments the medical profession may face and lay the foundation for hypothesis generation and idea-building regarding responsible AI implementation.

RESULTS

The following 4 worlds were created using OpenAI's GPT model: AI Harmony, AI conflict, The world of Ecological Balance, and Existential Risk. Risks include disinformation and misinformation, loss of privacy, widening inequity, erosion of human autonomy, and ethical dilemmas. Benefits involve improved efficiency, personalized interventions, enhanced collaboration, early detection, and accelerated research.

CONCLUSIONS

To ensure responsible AI use, the authors suggest focusing on 3 key areas: developing a robust ethical framework, fostering interdisciplinary collaboration, and investing in education and training. A strong ethical framework emphasizes patient safety, privacy, and autonomy while promoting equity and inclusivity. Interdisciplinary collaboration encourages cooperation among various experts in developing and implementing AI technologies, ensuring that they address the complex needs and challenges in health care and medical education. Investing in education and training prepares professionals and trainees with necessary skills and knowledge to effectively use and critically evaluate AI technologies. The integration of AI in health care and medical education presents a critical juncture between transformative advancements and significant risks. By working together to address both immediate and long-term risks and consequences, we can ensure that AI integration leads to a more equitable, sustainable, and prosperous future for both health care and medical education. As we engage with AI technologies, our collective actions will ultimately determine the state of the future of health care and medical education to harness AI's power while ensuring the safety and well-being of humanity.

Postdigital health practices: new directions in medical humanities

Digitalisation has changed the way we understand and practice health. The recent pandemic has accelerated some of the developments in digital health and brought about modifications in public access to information. Taking this into consideration, this programmatic paper sets the stage for and conceptualises postdigital health practices as a possible field of inquiry within medical humanities. While delineating some central aspects of said practices, I draw attention to their significance in contemporary strategies of knowledge production. Spotlighting online environments as the point of ingress for the analysis of these practices, I propose three possible foci of critical and methodological engagement. By spotlighting the serialisation, multimodality, and transmediality of such environments, I argue, we have a chance to both augment and go beyond the field's long-standing preoccupation with narrative, attend to various strategies of communicating illness experience, and re-frame them within larger questions of systemic inequalities. On this basis, and taking as examples COVID-19 and Long COVID, I sketch some of the directions that future strands of medical humanities may take and some of the questions we still have to ask for the field to overcome its own biases and blind spots.

'You just emotionally break': understanding COVID-19 narratives through public health humanities

News reports that feature the experiences of healthcare workers have shaped public conversations about the pandemic from its earliest days. For many, stories of the pandemic have been an introduction to the way public health emergencies intersect with cultural, social, structural, political and spiritual determinants. Such stories often feature clinicians and other providers as characters in pandemic tales of heroism, tragedy and, increasingly, frustration. Examining three common categories of provider-focused news narratives-the clinician as a uniquely vulnerable front-line worker, clinician frustration with vaccine and masking resistance, and the clinician as a hero-the authors argue that the framework of public health humanities offers useful tools to understand and potentially shift public conversation of the pandemic. Close reading of these stories illuminates frames that relate to the role of providers, responsibility for the spread of the virus and how the US health system functions in a global context. Public conversations of the pandemic are shaped by and shape news stories and have important implications for policy. Acknowledging that contemporary health humanities in all its iterations considers how non-clinical factors, such as culture, embodiment and power, impact our understanding of health, illness and healthcare delivery, the authors locate their argument amid critiques that focus on social and structural factors. They argue that it is still possible to shift our understanding of and telling of those stories towards a more population-focused frame.

Does medical humanities matter? The challenge of COVID-19

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.

The future of translational medical humanities: bridging the data/narrative divide

This essay argues that emerging forms of translational work in the field of medical humanities offer valuable methods for engaging with communities outside of academic settings. The first section of the essay provides a synthetic overview of definitions and critical engagements with the concept of 'translation' in the context of medical humanities, a field that, in the wake of the COVID pandemic, can serve as an exemplar for other fields of the humanities. The second section explains the 'data/narrative' divide in medicine and health to demonstrate the need for new translational methodologies that can address this nexus of concern, particularly in collaboration with constituencies outside of academic settings. The third section maps out the sites and infrastructures where digital medical humanities is poised to make significant translational interventions. The final section of the essay considers data privacy and health ecology as conceptual frameworks that are necessary for bridging the data/narrative divide. Examples are drawn from the 'Translational Humanities for Public Health' website, which aggregates projects worldwide to demonstrate these emerging methodologies.

Cripping the pain scale: literary and biomedical narratives of pain assessment

This article analyses the literary representation of pain scales and assessment in two chronic pain narratives: 'The Pain Scale', a lyric essay by Eula Biss, and essays from Sonya Huber's collection Pain Woman Takes Your Keys, and Other Essays from a Nervous System Establishing first a brief history of methods attempting to quantify pain before my close reading, I read both Biss' and Huber's accounts as performative explorations of the limitations of using linear pain scales for pain which is recursive and enduring. Considering both texts as cripistemologies of chronic pain, my literary analysis attends to their criticism of the pain scale, including its implicit reliance on imagination and memory, and how its unidimensionality and synchronic focus prove inadequate for lasting pain. For Biss, this surfaces as a quiet critique of numbers and a disturbance of their fixity, while Huber's criticism employs the motif of pain's legibility across multiple bodies to spell out alternative meanings of chronic pain.Crucially, this article proposes a crip and embodied approach for reading and responding to accounts of chronic pain's measurement, including Biss' and Huber's literary accounts, and the biomedical account of pains scales which this article reads alongside them. The article's analysis draws on my personal experience of chronic pain, neurodivergence and disability to demonstrate the generativity of an embodied approach to literary analysis. Rather than bowing to the impulse to impose false coherence on my reading of Biss and Huber, my article foregrounds the impact of the re-reading, misreading, cognitive dissonance and breaks necessitated by chronic pain and processing delays on this analysis. In bringing an ostensibly crip methodology to bear on readings of chronic pain, I hope to invigorate discussions on reading, writing and knowing chronic pain in the critical medical humanities.

Solidarity during the COVID-19 pandemic: evidence from a nine-country interview study in Europe

Calls for solidarity have been an ubiquitous feature in the response to the COVID-19 pandemic. However, we know little about how people have thought of and practised solidarity in their everyday lives since the beginning of the pandemic. What role does solidarity play in people's lives, how does it relate to COVID-19 public health measures and how has it changed in different phases of the pandemic? Situated within the medical humanities at the intersection of philosophy, bioethics, social sciences and policy studies, this article explores how the practice-based understanding of solidarity formulated by Prainsack and Buyx helps shed light on these questions. Drawing on 643 qualitative interviews carried out in two phases (April-May 2020 and October 2020) in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, The Netherlands, German-speaking Switzerland and the UK), the data show that interpersonal acts of solidarity are important, but that they are not sustainable without consistent support at the institutional level. As the pandemic progressed, respondents expressed a longing for more institutionalised forms of solidarity. We argue that the medical humanities have much to gain from directing their attention to individual health issues, and to collective experiences of health or illness. The analysis of experiences through a collective lens such as solidarity offers unique insights to understandings of the individual and the collective. We propose three essential advances for research in the medical humanities that can help uncover collective experiences of disease and health crises: (1) an empirical and practice-oriented approach alongside more normative approaches; (2) the confidence to make recommendations for practice and policymaking and (3) the pursuit of cross-national and multidisciplinary research collaborations.

Four Past Path-Builders Incorporated the Humanities and Arts Into Gerontology's Scientific Frontiers

Scholars and practitioners in the humanities and arts are collaborating with bio-medico-psycho-social scientists and clinicians in projects that illuminate current understandings of how "aging" processes unfold and what they may mean in creating the future of the Gerontological Society of America. Moving ahead by connecting backwards, we should emulate past path-builders who imagined an interdisciplinary agenda that incorporated humanistic perspectives as they imparted scientific age-based insights to experts and lay audiences. Elie Metchnikoff, G. Stanley Hall, Robert N. Butler, and Gene D. Cohen demonstrated critical humanist thinking about aging and dying in advancing gerontology's scientific frontiers.

Aging as Adaptation

In traditional gerontological terms, adaptation is usually understood as the production of physical aids to mitigate the impairment effects caused by age-related disabilities, or as those alterations organizations need to make under the concept of reasonable adjustment to prevent age discrimination (in the UK, e.g., age has been a protected characteristic under the Equality Act since 2010). This article will be the first to examine aging in relation to theories of adaptation within cultural studies and the humanities. It is thus an interdisciplinary intervention within the field of cultural gerontology and cultural theories of adaptation. Adaptation studies in cultural studies and the humanities have moved away from fidelity criticism (the issue of how faithful an adaptation is to its original) toward thinking of adaptation as a creative, improvisational space. We ask if theories of adaptation as understood within cultural studies and the humanities can help us develop a more productive and creative way of conceptualizing the aging process, which reframes aging in terms of transformational and collaborative adaptation. Moreover, for women in particular, this process of adaptation involves engagement with ideas of women's experience that encompass an adaptive, intergenerational understanding of feminism. Our article draws on interviews with the producer and scriptwriter of the Representage theater group's play My Turn Now. The script for the play is adapted from a 1993 coauthored book written by a group of 6 women who were then in their 60s and 70s, who founded a networking group for older women.