Medical Humanities最新文献

This work explores recent industrial action by doctors in the British National Health Service (NHS) through a psychoanalytic lens, exploring psychosocial context and the role of unconscious phantasy. Doctor strikes are conceptualised as a protest against devaluation. Expressed motivation for strike action, a real-term pay reduction, is symbolic of deeper societal devaluation of healthcare and those who provide it; pay restoration serves as a phantastic object through which amends can be made. Layers of holding and containment are identified, from the function of the health, or rather anti-death, service in containing deep-rooted anxiety around illness and death, to the holding, typically in limited supply, experienced by staff members working in health services, to the containing function individual staff provide for their patients.Strike action shatters the NHS as a container, primitive anxieties emerge and primitive defences are activated. Anger expressed through protest causes an impact, expressing a demand to be recognised and valued. The time and space of the strike has generative potential; implications of breaking the 'broken' NHS give impetus to finding a way forward. Exploration of unconscious phantasy underpinning industrial action and public response may bring insight to negotiations, enabling grounded and coherent solutions to be derived.

The present study aims at establishing if anything has been learnt from 140 years of modern architecture when it comes to designing for inpatient mental health and to identifying how architecture can contribute to the development of low stress psychiatric units. Creative architects have generally rejected the 'classical language' of architecture. The principles of modern architecture can be applied to the design of psychiatric units. The effects of living conditions on the human mind had already been addressed in the 1920s. More recent studies have looked at links between ward design and aggression, aimed at identifying environmental stress-reducing factors. Environmental psychology studies, along with the work of 261 architects over a span of 140 years and of 32 major architectural firms, were reviewed. Aggression seems to be linked to factors such as crowding, noise, lack of privacy and the lack of stress-reducing positive distractions. Out of 261 architects, 22 (8.42%) designed hospital buildings and only five (1.91%) were involved in designing psychiatric hospitals. Out of 69 recently built modern hospitals, 18 were psychiatric hospitals (26.08%). Principles of modern architecture have been sporadically implemented in older hospital buildings, rarely in psychiatric units, more frequently in some recently built psychiatric hospitals, hopefully to create low stress environments that could speed up recovery, reduce costs, enhance staff satisfaction and recruiting.

The development of replacing human organs with those from genetically modified pigs holds immense potential for alleviating the shortage of organs necessary for patients in need of transplants. This medical advancement is also accompanied by significant social changes, including the emergence of a bioeconomy, new modes of biotechnology governance, altered human-animal relations and increased public engagement. Some aspects, such as the impact on the transplant allocation system, effects on clinical practice and healthcare provision, global trajectories and most importantly the consequences for patients and their families remain unpredictable. Given that xenotransplantation occurs within a societal context and its success or failure will not be confined to technical feasibility alone, it is essential to engage a social sciences perspective to highlight the social implications and emphasise the importance of social research in accompanying future developments.

The article scrutinises Rohini S. Rajagopal's work, what's a lemon squeezer doing in my vagina (2021), to illustrate the escalating medicalisation of infertile bodies. In a cultural context where reproductive concerns are construed as medical disorders demanding treatment and surveillance, medical professionals and pharmaceutical companies exploit these sociocultural dynamics to provide infertile couples with immediate solutions through Assisted Reproductive Technologies. Consequently, the study contributes a critical perspective to the field of medical humanities, initiating a nuanced discourse that interrogates the impact of terms such as 'living laboratories', 'baby machine', 'mother machine' and 'hope technology' on our comprehension of future motherhood. Drawing on feminist critiques of medicalisation, the article argues that biotechnology perpetuates the eighteenth-century biomedical metaphor of the body as a machine with replaceable parts. Notably, contemporary advancements in reproductive medicine allow for the replacement of perceived 'flawed' body parts, further objectifying them within this framework.

In Malawi, there exists a group of medical professionals known as clinical officers (COs) who assume responsibilities typically carried out by doctors due to the current scarcity of the latter. This paper seeks to explain how the introduction of COs as part of implementing task shifting in healthcare, unintentionally became a terrain for the contestation of power between COs and physicians. The research from which this paper originates used a qualitative research approach. It was carried out in state-owned facilities, encompassing four district hospitals and one central hospital in Malawi. This paper develops a conceptual framework on power and then uses it to demonstrate that task shifting through the introduction of COs as substitutes for physicians, became a source of interprofessional conflicts. The paper argues that unequal power relations between COs and physicians in healthcare contribute to interprofessional conflicts. The paper further demonstrates that unequal power relations between COs and physicians are manifested through differences in educational backgrounds and work experiences as well as unequal responsibility and authority. The paper concludes that the interprofessional conflicts between COs and physicians arising from unequal power relations ultimately aggravate poor psychosocial well-being among COs.

Providing for people with psychosocial conditions in crisis is a complex and controversial endeavour that has gained significant attention over the past decade. This increased focus is driven by global calls to reduce coercion, including by the United Nations Committee on the Rights of Persons with Disabilities, who interpret Article 12 of the United Nations Convention on the Rights of Persons with Disabilities in General Comment 1 to advocate for the replacement of substituted decision-making with supported decision-making. Psychiatrists occupy a central role in determining how to care for and respond to individuals with psychosocial conditions in crisis in the midst of these debates. They must protect the rights of people with psychosocial conditions in crisis and provide appropriate support within challenging and dynamic contexts. This responsibility includes promoting the autonomy of people with psychosocial condition while ensuring their long-term health, safety and well-being.In this study, we conducted a phenomenological analysis with a sample of nine psychiatrists in South Africa to explore their experiences with involuntary care and the complex dilemmas they face in delivering healthcare to individuals with mental health conditions. Our findings indicate that psychiatrists encounter significant challenges in preserving patient autonomy, particularly within the resource-limited context of South Africa. Pervasive stigma and insufficient support infrastructure complicate efforts to prioritise autonomy. At the same time, professionals must address the critical need to ensure the long-term safety and well-being of their patients. The absence of involuntary care can exacerbate a person's vulnerability to community stigma and inadequate community support, posing severe risks to their welfare. Balancing between protecting a person's autonomy and addressing the limitations of support structures creates a complex predicament for mental health professionals, often resulting in feelings of isolation and moral distress among psychiatrists.

This paper is a comparative reading of variations in the medicalisation of infertility caused by sociocultural aspects, in two illness narratives by patients: Elizabeth Katkin's Conceivability (2018), a story of navigating a fertility industry with polycystic ovarian syndrome and antiphospholipid syndrome in America and Rohini Rajagopal's What's a Lemon Squeezer Doing in My Vagina (2021), a discussion from India of a growing awareness of medicalisation in treatment of unexplained infertility. For this purpose, it first charts scholarship on illness narratives and medicalisation, noting a historical association. Following this, it shows how infertility, a physiological symptom of reproductive incapacity or failure to show clinical pregnancy, is generally medicalised. This paper reads the texts as showing hitherto unaddressed sociocultural aspects of infertility's medicalisation. At the same time, drawing from existing sociological and anthropological scholarship, it shows how a reading of sociocultural aspects in medicalised infertility nuances understanding of it's medicalisation. This comparative reading attends to sociocultural values and norms within the texts, including pronatalism, fetal personhood, kinship organisation, purity/pollution, individual reliance, sacred duty and so forth. It draws from scholarship on embodiment, rhetorical strategies and the language of medicine. It also shows how a patient's non-medicalised, affective history of 'deep' sickness caused by the biographical disruption of infertility is not that of a 'poor historian'. In laying out the particularisation of such sociocultural values and norms across America and India, medicalisation's migration from its origins to the margins reveals subjectivised, stratified reproduction in infertility illness narratives. This paper is part of a turn in scholarship away from understanding the medicalisation of infertility as naturalised and decontextualised.

This paper addresses the question 'is there truth in fiction?', by synthesising a range of disciplinary approaches to the issue, as well as drawing on empirical research carried out with readers of fiction about dementia (hereafter, dementia fiction). We argue that fiction-perhaps because of its fictional status and apparatus-invites readers to consider its truth value, to explore the possibilities of human experience and interrogate issues relative to their subjective experience, community or society. The findings have significant implications for the Medical Humanities' use of fictional texts to explore lived medical conditions and experiences, as well as claims made about the potential for fiction to affect real-world understandings, awareness and empathy around the conditions depicted. We show that the techniques used in fictional language may be artifice, but they simulate a truth that corresponds with reality.

A recent review of face transplants argues that overall, they have been successful. But this verdict is based on surgical measures rather than patient-reported outcomes (PROMs), which for historical reasons are in their infancy. These measures are critical to understanding the nature of success in face transplants, and the evidence from mixed systems of healthcare, as in the USA, reveals that there are significant ethical and social concerns about the well-being of patients. Medical humanities research that focuses on the lived experience of patients and their caregivers can contribute significantly to the discussion by focusing on patient voices and the measures that matter outside of surgical contexts. This article builds on existing work and original interviews with face transplant recipients and their families from an emotion history perspective. It argues that surgical measures used in isolation can be misleading. We need a more holistic understanding of outcomes-financial, psychological and emotional as well as medical-that requires the insights drawn from the humanities and transforms the definition and measurement of 'success'.

In May 2022, when the COVID-19 pandemic began to recede from public view, another infectious disease surprised the world-mpox (formerly monkeypox). It appeared to disproportionately affect gay, bisexual and other men who have sex with men (GBMSM). Using qualitative thematic analysis and social representations theory, we analysed a corpus of 91 items from a variety of news outlets that included GBMSM community members' personal accounts of living through an mpox outbreak. The aim was to study the various ways in which members of a marginalised group created social representations of mpox and to ascertain whether these challenged older representations related to HIV and AIDS and newer ones related to COVID-19. Commentators anchored mpox to known, culturally accessible phenomena to render this previously unfamiliar disease familiar; objectified aspects of mpox, especially pain, through emotive language, making it 'real' and psychologically tangible; personified it by linking it to accounts of celebrity activists; and ontologised it through visually vivid descriptions. Challenging stigma was a cross-cutting theme in people's accounts. In contrast to the stigmatising imagery of health issues affecting GBMSM, these accounts contribute to the development of social representations designed to challenge such stigmatisation, which, in the contexts of HIV and AIDS and COVID-19, has hindered effective medical interventions, promoted misinformation and fuelled denigration.