Background: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data were (...) collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

Alongside the institutionally constructed European identity, research shows that insights into citizens’ sense of belonging are valuable as well in assessing questions of identity. The tendency to conflate European identity with EU identity has spurred debates about the components that underlie European identification. The online subsidiarity adopted by the EU through e-platforms has allowed for a new form of citizenship where e-citizens legitimate the issues under debate. This article examines the contents of European and national identities in the e-debaters’ comments (...) posted on the Debating Europe platform. Drawing on narrative and discursive approaches, we propose a framework to operationalize the legitimation and identification categories used by e-debaters within their discursive construction of European identity. The qualitative empirical research shows three main legitimation clusters: the “EU as a loss,” “inclusive gain,” and “exclusive gain.” We discuss these findings within the broader context of Europeanization, identity multiplicity, and the conditions of the EU enlargement policy. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion (...) Tool—a dialogical and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

The narrative approach to teaching Peace and Justice attempts to address the division between activists and church-goers that is often found on Catholiccampuses. The former, who advocate for social change, tend to regard religious faith as self-serving, while the latter, who emphasize community service, tend toregard activism as “radical.” By studying the life-stories of individuals whose contributions to the struggle for justice reflect the unfolding of a spiritual journey, students come to see that religious faith can be integral (...) to a life dedicated to social change. Barack Obama’s autobiography exemplifies the youth’s journey to self-acceptance which the theologian John Dunne identifies as the second of the four great tasks of an individual’s life. The stages of this journey involve breaking free of narcissism and what theologian Miroslav Volf calls “embracing” the other. (shrink)

The use of narrative – in this case a fictional dialogue – has been a time-honoured way of exploring ideas and most importantly indispensable for learning, at least since the time of the Sophists. Indeed, the dialogues of Plato exemplify this thesis because the qualities and characteristics of philosophy and philosophising are revealed through their lives. Extending on this premise, we would argue that we learn to understand both the unity and complexity of philosophy – particularly in education and (...) educational research – not by formal philosophical arguments, necessary as they are in some contexts, but by narratives that are relevant, narratives that make the actions of one or more characters intelligible and justifiable. As a result, this article uses a narrative approach for the dual purpose of exhibiting the relevance of philosophy intelligibly exhibited through the examples of the characters put forward, but at the same time characters we our... (shrink)

The essay argues that narrative approaches to human personhood which conceptualize the goal of human personhood in terms of the fulfillment of a capacity for self-constitution by means of deliberate choices tend to make inordinate and inhuman claims for human agency. The narrative approaches of the psychoanalyst and psychoanalytic theorist, Roy Schafter, and of the theologian and ethicist, Stanley Hauerwas, illustrate this. Both thinkers implicitly deny the permanent vulnerability of human agency in the area of the appropriation of (...) narratives. In the case of Hauerwas, this also implies a denial of theneed for God’s grace in the area of the appropriation of narratives. The work of the philosopher, Paul Ricoeur, serves as a contrast to Schafer and Hauerwas and demonstrates that a narrative approach to human persons does not need to make inordinate claims for an autonomous human capacity for self-constituion. The last part of the essay shows how the rejection of the need for God’s grace in the area of the appropriation of narratives is connected to a rejection of the idea of innocent suffering. (shrink)

Humanities researchers have expressed concern about the uncritical adoption of information visualization techniques originating in the sciences by digital humanities classrooms. This paper describe...

Narratives have always played a prominent role in both bioethics and medicine; the fields have attracted much storytelling, ranging from great literature to humbler stories of sickness and personal histories. And all bioethicists work with cases--from court cases that shape policy matters to case studies that chronicle sickness. But how useful are these various narratives for sorting out moral matters? What kind of ethical work can stories do--and what are the limits to this work? The new essays in Stories and (...) Their Limits offer insightful reflections on the relationship between narratives and ethics. (shrink)

This popular textbook has been thoroughly revised and updated to reflect recent global developments, whilst retaining its unique and compelling narrative-style approach. Using ancient stories from diverse religions, it explores a broad range of important and complex moral issues, resulting in a truly reader-friendly and comparative introduction to religious ethics. A thoroughly revised and expanded new edition of this popular textbook, yet retains the unique narrative-style approach which has proved so successful with students Considers the ways (...) in which ancient stories from diverse religions, such as the Bhagavad Gita and the lives of Jesus and Buddha, have provided ethical orientation in the modern world Updated to reflect recent discussions on globalization and its influence on cross-cultural and comparative ethics, economic dimensions to ethics, Gandhian traditions, and global ethics in an age of terrorism Expands coverage of Asian religions, quest narratives, the religious and philosophical approach to ethics in the West, and considers Chinese influences on Thich Nhat Hanh's Zen Buddhism, and Augustine's Confessions Accompanied by an instructor's manual which shows how to use the book in conjunction with contemporary films. (shrink)

This popular textbook has been thoroughly revised and updated to reflect recent global developments, whilst retaining its unique and compelling narrative-style approach. Using ancient stories from diverse religions, it explores a broad range of important and complex moral issues, resulting in a truly reader-friendly and comparative introduction to religious ethics. A thoroughly revised and expanded new edition of this popular textbook, yet retains the unique narrative-style approach which has proved so successful with students Considers the ways (...) in which ancient stories from diverse religions, such as the Bhagavad Gita and the lives of Jesus and Buddha, have provided ethical orientation in the modern world Updated to reflect recent discussions on globalization and its influence on cross-cultural and comparative ethics, economic dimensions to ethics, Gandhian traditions, and global ethics in an age of terrorism Expands coverage of Asian religions, quest narratives, the religious and philosophical approach to ethics in the West, and considers Chinese influences on Thich Nhat Hanh's Zen Buddhism, and Augustine's Confessions Accompanied by an instructor's manual which shows how to use the book in conjunction with contemporary films. (shrink)

In nursing ethics the role of narratives and dialogue has become more prominent in recent years. The purpose of this article is to illuminate a relational-narrative approach to ethics in the context of palliative nursing. The case study presented concerns a difficult relationship between oncology nurses and a husband whose wife was hospitalized with cancer. The husband’s narrative is an expression of depression, social isolation and the loss of hope. He found no meaning in the process of (...) dying and death. The oncology nurses were not able to recognize his emotional and existential problems. A narrative perspective inspired by relational ethics indicates that participants may develop a relational narrative that seeks good for all involved in a situation. In palliative nursing this entails open communication about the fragility of life and approaching death. In relational narratives, answers to these ethical dilemmas are co-authored, contingent and contextual. (shrink)

The text places special emphasis on the ethical co-operation that emerged between religious traditions during the civil right-Vietnam war era.

Though others have surveyed the different methods in comparative religious ethics, relatively little attention has been given to different approaches to pedagogy. The field of comparative religious ethics has now reached a level of maturity so that there are a variety of ways such courses can be taught. In this review I consider the approaches to comparative religious ethics found in four recent texts by Jacob Neusner, Darrell Fasching and Dell deChant, Regina Wolfe and Christine Gudorf, and Sumner Twiss and (...) Bruce Grelle. In the essay I note the strengths and weaknesses of each text, with special attention given to how the texts might work in the classroom. I then argue that the different texts reflect different understandings of the goal of teaching comparative religious ethics, and I make these goals explicit in order to help teachers decide how they might approach the teaching in this growing field. (shrink)

This paper argues that the newspaper Notre Journal enshrined the importance of narrative in the revolutionary psychiatry of its founder and editor, Frantz Fanon. Anchoring my analysis in the interdisciplinarity of the medical humanities, I demonstrate how care at Hôpital Blida-Joinville in colonial Algeria was mediated by the written word. I examine Fanon’s physician writing and editorial texts detailing the use of narrative approaches in the clinic. As an object of care, Notre Journal’s promotion of psychic healing, social (...) actions, and engaged professional practice shaped the interactions and experiences of patients and staff. Printed and distributed to the wider institution, the newspaper created community—during an oppressive French Occupation and at the outset of the War of Independence—in addition to nurturing creativity, curiosity, solidarity, and accountability. Still, Fanon would come to recognize the limits of narrative methods amidst cultural oral traditions, illiteracy, and divergent attitudes about narrating the self. (shrink)

This article presents the results of an inductive, interpretive case study. We have adopted a narrative approach to the analysis of organizational processes in order to explore how individuals in a financial institution dealt with relatively novel issues of corporate social responsibility (CSR). The narratives that we reconstruct, which we label 'idealism and altruism', 'economics and expedience' and 'ignorance and cynicism' illustrate how people in the specific organizational context of a bank ('Credit Line') sought to cope with an (...) attempt at narrative imposition. In particular, our work exemplifies how people in organizations draw on shared discursive resources in order to make sense of themselves and their organizations. We illustrate how many people within the bank found it hard to integrate the normative case for CSR with their version of a narrative identity which had, and continued to be, centred on economic imperatives for new initiatives. Our article demonstrates both the value of the analysis of shared narratives, and represents an attempt to deal adequately with the polyphony of organizational voices, in case studies of CSR. (shrink)

The potential of memory modification techniques (MMTs) has raised concerns and sparked a debate in neuroethics, particularly in the context of identity and authenticity. This paper addresses the question whether and how MMTs influence authenticity. I proceed by drawing two distinctions within the received views on authenticity. From this, I conclude that an analysis of MMTs based on a dual-basis, process view of authenticity is warranted, which implies that the influence of MMTs on authenticity crucially depends on the specifics of (...) how memory modification would eventually work. Therefore, I continue with a systematic analysis of possible properties of MMTs in which I distinguish between the dimensions of memories and the kinds of experiences that can be modified as well as the properties of the process of memory modification. The impact of MMTs on authenticity is analyzed regarding the possible properties of MMTs and based on a narrative approach to authenticity which fulfills the requirements of a dual-basis, process view of authenticity. Lastly, I explore the potential of MMTs to shift the balance between self-discovery and self-creation within authenticity and thereby alter the concept itself as well as the value of authenticity. (shrink)

In this article, a semiotic approach is proposed to explain how human agents use and give meaning to art in complex contexts. Inspired by the psycho-historical approach on art appreciation, which attempts to embrace psychological and cognitive aspects of art sense-making, as well as the art-historical context dependence of artworks, an extended theory is suggested: an agent's art use and interpretation can be described using three general categories of meaning grounding: phylogenetic recurrence, ontogenetic recurrence and collective recurrence. These (...) categories explain how a certain meaning of a sign is possible and justifiable, supported by human agents' capabilities and purposes. This article also proposes that it is possible to narrate, using such categories of meaning grounding, how different agents enact art, that is, give meaning and act upon art in different circumstances. Finally, I offer some examples about how the model can be used in real art contexts. The objective of this narrative-enactive approach, even though it offers a limited and edited focus, is to offer an orderly and comprehensible method to explain the dynamic nature of art meaning and how biologic, individual and collective grounding and purposes intertwine. (shrink)

Various debates on the desirability and rationality of life-extending enhancements have been pursued under the presupposition that a generic psychological theory of personal identity is correct. I here discuss how the narrative approach to personal identity can contribute to these debates. In particular, I argue that two versions of the narrative approach offer good reasons to reject an argument against the rationality of life-extending enhancements.

This paper offers an account of how individuals act as agents when we employ a narrative approach to explaining their personal identities. It applies Korsgaard's idea of a "reflective structure of consciousness" to provide foundations for a richer account of the individual economic agent, and uses this to explain and distinguish the concepts of personal identity, individual identity, and social identity. The paper argues that individuals' personal identities may be in conflict with their socially constructed individual identities. Individuals' (...) social identities are represented as a link between personal identity and individual identity. The overall framework is proposed as an alternative to the atomistic individual conception and a contribution to the socially embedded individual conception. (shrink)

Digital technology has prompted philosophers to rethink some of the fundamental categories we use to make sense of the world and ourselves. Particularly, the concept of ‘identity’ and its reconfiguration in the digital age has sparked much debate in this regard. While many studies have addressed the impact of the digital on personal and social identities, the concept of ‘collective identity’ has been remarkably absent in such inquiries. In this article, I take the context of social movements as an entry (...) point to discuss the reconfiguration of collective identity in social media environments. I do so by introducing a narrative approach to collective identity. I argue that Twitter’s affordances invite new ways of constructing collective identities and imply a shifting relationship between the individual and the collective. (shrink)

This paper will explore one aspect of the relationship between pretence and narratives. I look at proposals about how scripts play guiding roles in our pretend play practices. I then examine the views that mental representations are needed to guide pretend play, reviewing two importantly different pictures of mental guiders: the Propositional Account and the Model Account. Both accounts are individualistic and internalistic; the former makes use of language-like representations, the latter makes use of models, maps and images. The paper (...) will discuss some worries with the notion of mental guiders, and offer some positive suggestions about what else might be playing the guiding role in pretence. I propose that environmental affordances and socially scaffolded engagements provide the basis of pretence guiders, and suggest that engagement in narrative practices further frames and allows elaborations of acts of pretend play. I take first steps in developing a new embodied, enactive and intersubjective understanding of pretence, showing why it is a viable alternative to the mental representational accounts of pretence. (shrink)

The use of qualitative research in empirical bioethics is becoming increasingly popular, but its implementation comes with several challenges, such as difficulties in aligning moral epistemology and methods. In this paper, we describe some problems that empirical bioethics researchers may face; these problems are related to a tension between the different poles on the spectrum of scientific paradigms, namely a positivist and interpretive stance. We explore the ideas of narrative construction, ‘genres’ in medicine and dominant discourses in relation to (...) empirical research. We also reflect on the loss of depth and context that may occur with thematic or content analyses of interviews, and discuss the need for transparency about methodologies in empirical bioethics. Drawing on insights from narrative approaches in the social sciences and the clinical-educational discipline of Narrative Medicine, we further clarify these problems and suggest a narrative approach to qualitative interviewing in empirical bioethics that enables researchers to ‘listen (and read) in new ways’. We then show how this approach was applied in the first author’s research project about euthanasia decision-making. In addition, we stress the important ethical task of scrutinizing methodologies and meta-ethical standpoints, as they inevitably impact empirical outcomes and corresponding ethical judgments. Finally, we raise the question whether a ‘diagnostic’, rather than a ‘problem-solving’, mindset could and should be foregrounded in empirical ethics, albeit without losing a commitment to ethics’ normative task, and suggest further avenues for theorizing about listening and epistemic (in)justice in relation to empirical (bio)ethics. (shrink)

The master narrative of Apartheid South Africa created a specific identity for white boys and men and, together with this identity, a very particular role and place within the South African context. This identity was exemplified in the men who were conscripted into the military from 1967 until 1994, and who participated in operations on the border regions of Namibia and Angola as well as within local townships in the war of liberation against apartheid and minority rule. Many veterans (...) have been left grappling not only with the traumas associated with combat but also with the loss of their identities as war heroes in a country under changed political control. As a result, many of their personal stories and experiences of combat have been silenced by society at large and also, to varying degrees, within their own families, the Church, and among the younger generation who have grown up under a different dispensation. The conflict between vacillating narratives of villains who fought on the wrong side of history and victims of a closed socialisation system has supported the identity struggle faced by many veterans today. Against this backstory, this article explores the effects of storytelling as a trauma release using a narrative approach.Contribution: This article offers a contribution to the use of storytelling in pastoral conversations as a trauma release for untold stories. This insight links to the focus and scope of the journal as a pastoral narrative approach has been used under the umbrella of Practical Theology. (shrink)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (shrink)

The purpose of this article is to portray the ethics of suffering based on the published literature. Narrative use has become common in the fields of nursing education and curriculum development and in the determination of practice competencies. Understanding the ethics of suffering implies a hermeneutic movement between alienation and dedication. To understand the ethical significance of human suffering, the scene of suffering is described through the concepts of: to endure, to struggle, to sacrifice life and health, and to (...) become. To respond, to discover, to approach, to touch and to shape patients' different patterns of life implies responsibility: to see, to affirm their dignity by being, and to express this in ethical words. Narration plays a crucial role in transforming suffering, that is, reformulating patients' stories. It is vital that educators should create a learning environment where students can find the courage and intention to be present and listen to patients' narratives. (shrink)

While a large body of research has provided quantitative data on children’s levels of happiness, positive emotions and life satisfaction, the literature reflects a dearth of studies that analyze these dimensions from a narrative and qualitative point of view. Folk and fairy tales may serve as ideal tools for this purpose, since they are concerned with several concepts scientifically investigated by research in the field of positive psychology, such as resilience, self-realization, personal growth and meaning in life. The aim (...) of the present study was to explore children’s well-being and positive emotions using an innovative narrative approach, which involved interviews and group discussions, as well as the analysis of fairy tales written and discussed in a group context. The sample included 95 school children who were asked to report and discuss in a group setting situations or experiences which triggered positive emotions and happiness in them. Guided by their teachers and a school psychologist, they were then asked to write their own original fairy tale drawing on the positive emotions that had previously emerged. Positive emotions were found to be triggered mainly by interpersonal relationships with peers as well as with family members. Hobbies and leisure time were also strongly associated with happiness and hedonic well-being, while personal fulfilment, self-esteem and goal achievement emerged as highly significant for children. In sum, the findings suggest that this school psycho-educative intervention based on narrative strategies provided useful information on children’s well-being and yielded positive feedback, the implications and possible further applications of which are discussed. (shrink)

Even though it is not a methodology on the level of principlism or casuistry, narrative bioethics nonetheless contributes to and guides decision-making in the field of biomedical ethics. However, unlike other methodologies, the narrative approach lacks a set of specific patterns and formal rules for doing so. This deficiency leaves this approach more vulnerable to the influence of historical factors; in fact, the vital history of a person is made up of thousands of scenes, which one (...) must select and group under different norms. Yet the historicity of narrative does not destroy its normative value; rather, it gives rise to a confluence of stories that contradict one another on the basis of their practical consequences. This problem is less severe in traditional cultures, where some stories take precedence over others according to the normative value conferred through the supposed authority of their sources. But it manifests in an intense manner within current multicultural societies. It is imperative to find the thread that leads outside the labyrinth of subjectivity. This paper shows that the end of this thread lies, paradoxically, not in actions but in the subject-actors that perform them—specifically when such subjects are conceived as dramaturgical characters in narrative. (shrink)

Many authors have described the ethical issues associated with international adoption for all members of the adoption triad, including adoptive parents, birth parents and the adopted child, and for both sending and receiving countries. This paper explores how political variants of care ethics, combined with a narrative approach to practice, can be used as a conceptual framework for ethically informed practice with families formed via international adoption. Political variants of care ethics foreground the particularized needs of the individual, (...) but also take into account the broader social, political, economic and cultural dynamics in which the experience of individuals occurs. This framework is particularly applicable to collaborative work with individuals or groups, such as families formed via international adoption, whose experience is both highly individualized and shaped by broader contexts and issues of social justice. This paper describes how changes in the social construction of international adoption have meaning for applied ethics and practice. Political variants of care ethics are then explored as a framework for ethical decision making. Finally, the relevance of a narrative, approach to practice is considered. This approach focuses on understanding the needs and experiences of families from their own points of view and within the social, economic, cultural and political contexts in which they have lived; linking a relationship-based, narrative approach to practice to important assumptions in many models of care ethics. (shrink)

Experimental studies have developed, conducted, and evaluated classroom interventions for foreign language anxiety reduction. However, various characteristics of those classroom interventions make it difficult to synthesize the findings and apply them to practice. We conducted what is, to the best of our knowledge, the first systematic review on educational interventions for FLA. Six criteria were established for inclusion of studies. Using English keywords, we identified 854 potentially eligible studies through ProQuest and Scopus, 40 of which were finally included. All included (...) studies were published from 2007 to 2020. The studies differed in type of intervention, duration of intervention, and scale to measure FLA. Our systematic review resulted in seven features of classroom interventions, categorized as student–student interactions, student-teacher interactions, self-management, and mood boosters; we also categorized interventions as either individual or interactional. (shrink)

Within the last fifty years as philosophy, psychology, and cognitive science have moved towards increasingly more embodied theoretical frameworks, there has been growing interest in Dance Movement Therapy. DMT has been shown to be effective in mitigating negative symptoms in several psychopathologies including PTSD, autism, and schizophrenia. Further, DMT generally helps participants gain a stronger sense of agency and connection with their body. However, it has been argued that it is not always clear what constitutes these changes in DMT participants. (...) I argue that we can better understand the empirical and phenomenological results of DMT across psychopathologies if we adapt an enactive embodied approach to cognition. I use the framework of embodied enactive cognition and narrative theories of the self to develop an account of DMT as a form of narrative change. I claim that through the acquisition of new bodily skill and bodily awareness, DMT can cause changes to the participant’s narrative self-understanding. (shrink)

Many senior doctors have had little in the way of formal ethics training, but express considerable interest in extending their education in this area. This paper is the report of an initiative in continuing medical education in which doctors were introduced to narrative ethics. We review the theoretical basis of narrative ethics, and the structure of and response to the two-day workshop.

Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives , it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised.Ulysses (...) contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition. (shrink)

The successful delivery of patient-centered care hinges on clinical affiliation for patients' personal needs and experiences. Narrative competence is a mode of thinking and set of actions that widens the clinical gaze beyond logico-scientific cognition. In this article, we investigate a tool that enables clinicians to rehearse their skills in narrative competence. We apply the narrative competence framework developed by the founding practitioners of narrative medicine to personal accounts of illness and patienthood published on the Internet. (...) We describe our use of the five-point framework in the close reading of 214 accounts by people with the life-threatening skin cancer melanoma. (shrink)