Medical Humanities最新文献

This essay explores the enduring relevance of Isaiah Berlin's fox and hedgehog metaphor, famously applied to Tolstoy, to contemporary psychiatric practice. Psychiatry, historically grounded in rich theoretical traditions, has seen its focus shift over time towards structured diagnostic systems that emphasise clarity and manageability. While these developments brought important clinical advances, they also risked reducing the complexity of mental suffering to narrow categories. Drawing on phenomenological psychiatry and recent psychotherapy research, this essay argues for a renewed emphasis on subjective experience, patient agency and co-constructed meaning. Tolstoy's scepticism towards grand explanatory narratives and his sensitivity to the contingent, fragmented nature of human behaviour resonate deeply with these contemporary concerns. However, a fully Tolstoyan stance poses its own risks too: loss of patient agency, clinician disengagement and increased vulnerability to burnout.The essay proposes that psychiatry must navigate the tension between coherence and complexity, resisting both rigid theoretical allegiance and total relativism. Rather than choosing between the hedgehog's unifying vision and the fox's multiplicity, clinicians are called to adopt a more flexible and ethically grounded position. The concluding metaphor of the sphinx suggests a practitioner capable of holding multiple perspectives, sustaining meaning and acting with discernment amid uncertainty. In this light, Tolstoy's unfinished worldview may offer not only a literary insight but also a profound clinical ethic.

Pregnancy has historically been framed as both biologically and morally significant, where maternal choices carry social and ethical weight. Recent statements by President Donald Trump, linking acetaminophen use in pregnancy to autism and urging women to 'fight like hell' rather than medicate, illustrate how political rhetoric can exploit these cultural frameworks. This essay examines how purity discourse intersects with medical decision-making and maternal pain, situating Trump's remarks within broader historical and contemporary contexts. Drawing on moral psychology, feminist theory and clinical perspectives, we argue that purity rhetoric transforms scientific uncertainty into moral imperatives, valorising endurance and self-denial while stigmatising ordinary medical interventions. Parallels are drawn with orthorexia nervosa, highlighting the social pathology of purity as a marker of virtue and control. The analysis considers implications for clinical practice, including increased maternal stress, physiological and psychological consequences, and challenges to patient autonomy. By contextualising political statements within enduring narratives of purity, this essay advocates for evidence-based, compassionate care that supports informed maternal decision-making and resists moralisation.

Healthcare courses typically approach Sustainable Development Goals (SDGs) education from a 'translational science' perspective. Students are taught about 'evidence-based' interventions, which are developed through scientific research (hence, assumed to be politically neutral), implemented with 'fidelity' (ie, in a standardised way in diverse contexts) and then 'rolled out'. Progress is measured using standardised indicators. We argue for a shift to 'translational humanities', in which students are supported to engage critically with the cultural and political dynamics and epistemic uncertainties underpinning the setting of SDG targets, the development and implementation of programmes, and the measurement of success. Translational humanities seeks to surface alternative framings and measures of success, especially by giving voice to marginalised and ignored communities. This radical approach, informed by political philosophy, recognises that conflict among stakeholders and the uncertainty it generates are inevitable and can be a productive force (eg, if surfaced and used to inform multifaceted debate and values-driven action).Whereas a translational science approach to SDG education emphasises objectivity, technical precision and (the pursuit of) certainty, a translational humanities approach seeks to foster human and interpretive qualities such as reflection, critical thinking, commitment to human rights and fairness, appreciation of complexity, epistemic humility and flexibility, willingness to examine problems from multiple angles, the capacity to adapt, and tolerance of uncertainty. In a worked example of how this can be achieved, we introduce the 'critical datathon'-a group exercise in which students engage deeply with case studies of SDGs, examine the assumptions and interests behind conventional solutions, and navigate diverse implementation contexts.

Children's hospitals are often thought to be special places, marked by particular attention to emotions and careful consideration of inclusive design. Photographs of children's hospitals, or design for children within general hospitals, often showcase primary colours and playfulness. Such aesthetic qualities are, at first glance, exceptional for healthcare environments and reinforce the idea that children's hospitals are special or unique. This article, however, reconsiders this notion of exceptionalism in two ways. First, it uses the history of modern British hospitals to show that some of these qualities-such as bright colour and playfulness-might have once been a special feature of design for children, but were qualities of some adult hospital design by the end of the twentieth century. It makes this point, further, through a collection of interviews with professionals working in hospital art, architecture and design. In so doing, it places greater emphasis on process; interviews show the general expansion of person-centred design, and indicate that it has closed the gap between design for children and adults in both process and outcome.

In the context of South Africa's quadruple burden of disease, which includes a high prevalence of both infectious (particularly AIDS and tuberculosis) and non-communicable diseases, the COVID-19 pandemic has been signified by excess deaths. Although never officially acknowledged by the State, communities across the country have witnessed and experienced this excess. Departing from a syndemics approach, this paper focuses on the experiences of black African communities from low-resourced urban areas in selected central regions of South Africa.The paper delves into participants' experiences of the losing family and community members, as well as the disruption of their grief work resulting from the changes effected by the COVID-19 restrictive procedures on funerals and burials. Death and mourning practices, among the 20 participants in this study, are otherwise guided by the intertwining of Christian and African cultural traditions. Based on participant interviews, the paper reflects on the incompleteness of ritual associated with the disruption of COVID-19 restrictions and its impact on mourning in a context of excess death resulting in unaccomplished grief work In so doing, this paper raises critical issues regarding physical, emotional and mental health alongside pandemic responsibility, cultural diversity and human rights.

Finland's New Children's Hospital (NCH) opened in 2018 after a high-profile charity campaign. Through an analysis of the campaign, we illustrate how debates about children's hospitals and charities are simultaneously shaped by universal debates over the ownership and funding of healthcare services, and by the particularities of historical context and local institutional arrangements. Such debates also draw from and contribute to shaping cultural repertoires, particularly shared beliefs and values concerning children, the state and charity. In Finland, the NCH marked a break from an established model of publicly funded hospitals, and a return to the pre-welfare state era when charities played a role in healthcare. The campaign thus generated substantial public debate, in which we identify three core claims: (1) Hospitals must be built with public funding and oversight. (2) Children are suffering because politicians have failed, and a new model is needed. (3) The NCH further strengthens Finland's excellence in paediatric healthcare and promotes health technology exports. Over the course of the campaign, critique faded away, and the second and third lines of argument came to dominate public debate. Through a reflection on the historically changing relations between state, charity and children that shaped what we conceptualise as the NCH assemblage, we show how clichéd cultural tropes naturalised the political shift toward a post-welfare state that is embedded in the NCH campaign. As citizens without voter rights, children are exceptionally easy for politicians to sidestep when allocating funds. Yet, as what Sara Ahmed describes as 'objects of feeling', children are also exceptionally potent targets for charity, who, in the NCH case, came to serve as tools for the neoliberal disassembling and reassembling of healthcare services in Finland.

This article argues that gynaecology has historically understood Black women's reproductive organs as a site of resource extraction, not healing and that contemporary performance offers a way to make the power relations entailed in this abstract visible. The histories of the transatlantic slave trade and gynaecology are intertwined and inform how the medical system interacts with Black women today. 'Father of gynaecology' and 19th-century American physician J. Marion Sims (1813-1883) was dependent on slavery in order to conduct experiments on enslaved Black women's reproductive organs-notably for developing a cure for vesicovaginal fistula that later benefitted wealthy white women. Turning to three recent performances, Black Youth Project 100's (BYP100) performance protests, Charly Evon Simpson's Behind the Sheet and Mojisola Adebayo's Family Tree, I analyse how performance can reveal medicine's history of using the bodies of Black women as the raw material to develop medical innovations that prolong white life. BYP100's performance protests at the statue of Sims in New York City made visible the racial violence he enacted on enslaved Black women's bodies. The play Behind the Sheet gives voice to the enslaved Black women omitted from the archive. The play Family Tree draws connections between Sims and instances of medical racism in the 20th and 21st centuries, including Henrietta Lacks (1920-1951), whose cervical cells were taken for medical research without her consent, and Black nurses who died during the COVID-19 pandemic working for the UK's National Health Service. Through performance, these three works draw attention to how the drive to read medical innovations as strictly positive 'advancements' often requires the erasure of coloniality's racialising function within the production of knowledge.

Research suggests that the impact of the COVID-19 pandemic on disabled people was magnified compared with the impact on non-disabled people; however, little is known about the experiences of disabled people living in rural areas, particularly those in the Global South. Disabled people living in rural areas experience significant challenges related to poverty, food insecurity and access to information and healthcare. Data were collected in the Nkomazi East Municipality in Mpumalanga, South Africa. Interviews with two key informants were conducted in English. Eight semistructured interviews were conducted in Siswati with people with disabilities. Five family members of people with disabilities were also interviewed. All data were transcribed and translated into English, then analysed using inductive thematic analysis and interpreted through the lens of corporeal vulnerability. Findings revealed increased isolation, stigma, discrimination and financial and food insecurity during the pandemic, giving rise to a sense of embodied precarity. Access to healthcare was influenced by the presence of gatekeepers and informal triage systems. Experiences were compounded by food supply challenges, limited public transport and the complexities of trying to maintain social distancing, intensifying the experience of social inequality. Findings suggest that the COVID-19 pandemic magnified the experience of oppression and discrimination because of a communal sense of threat to survival. They highlight the need for increased awareness, social support and policy reform in response to the challenges imposed by the pandemic, with a specific focus on basic human rights, including access to information, healthcare and nutrition and ensuring the dignity of all community members. Additional efforts are needed in planning for future healthcare crises to ensure that responses are authentically disability inclusive.

This paper examines how the biostatistical theory (BST), as endorsed by Norman Daniels' account of just health, can be integrated with the capabilities approach to address the 'lowering functioning objection'. This objection argues that the BST could mistakenly define a population as healthier if the prevalence of a certain pathology increases and becomes the new statistical norm. To tackle this issue and offer a more coherent and normatively robust account of just health, the paper introduces a two-tiered model. The first tier retains the biostatistical model to provide a non-comprehensive, evidence-based foundation for health, focusing on the distribution of biological functionings within a population. The second tier introduces a capabilitarian survey that normatively assesses whether the new statistical norm supports or hinders the achievement of valuable capabilities. This integration enables a more holistic, flexible, pluralistic and context-sensitive understanding of health, framing it as a quasi-normative meta-capability-namely, a capability grounded in biological functionings but not reducible to them, which is essential for achieving other valuable capabilities. After explaining the rationale for this integration and outlining a Rawlsian-inspired approach to selecting valuable capabilities, I conclude by suggesting the implications of this model for Daniels' theory.

Patient mobility is a complex phenomenon, involving both outward and inward flows, and treatments that are more and less complex and where choice may be driven by quality and availability rather than solely cost. Public health systems in high-income and middle-income countries are facing increasing financial pressures given population ageing, a rapid rise in chronic and non-communicable diseases and fiscal restraint. In this context, the intersection of patient mobility and commodification of care provides opportunities for generating additional revenue, particularly for hospitals with a reputation for clinical excellence and innovation. The National Health Service (NHS) is often seen as an iconic public service in the UK, with primarily state funding and state provision of services. Over the past few decades, however, successive governments have introduced more market-style relations and commercialism into the NHS under new public management and more recently, public sector entrepreneurialism. Whereas historically there has been ambivalence around private activity, international patients and joint ventures are identified as a possible route to lessening pressure on NHS resources. Specialist NHS hospitals treat inward medical travellers with complex tertiary procedures (including paediatrics and heart surgery), maternity services and ophthalmic surgery. In this paper, we present documentary research on the case study of Great Ormond Street Hospital, a specialist NHS children's hospital in London which has a tradition of treating patients travelling from outside the UK. We review the practices around commercialisation in relation to children's services to offer a novel analysis on specialist children's services. In so doing, we expand academic and policy debates around commercialisation in public health systems and provide theoretical insights, drawing on Karl Polanyi's 'double movement' to help explain the apparent paradox whereby commercial income is increasingly justified by NHS organisations due to an apparent need to support NHS services.