This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with natural balance. It (...) is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (shrink)

Connectionist models aiming to reveal the mechanisms of atypical development must in their undamaged form constitute plausible models of normal development and follow a developmental trajectory that matches empirical data. Constructivist models that adapt their structure to the learning task satisfy this demand. They are therefore more informative in the study of atypical development than the static models employed by Thomas & Karmiloff-Smith (T&K-S).

Comics has always had a critical engagement with socio-political and cultural issues and hence evolved into a medium with a subversive power to challenge the status quo. Staying true to the criticality of the medium, graphic medicine critiques the exploitative and unethical practices in the field of healthcare, thereby creating a critical consciousness in the reader. In close reading select graphic pathographies such as Gabby Schulz's Sick, Emily Steinberg's Broken Eggs, Ellen Forney's Marbles: Mania, Depression, Michelangelo & Me and Marisa (...) Marchetto's Cancer Vixen, the present article delineates how graphic medicine interrogates the larger than life forces in the field of healthcare. Drawing specific instances from the aforementioned graphic texts, the essay demonstrates that graphic medicine scrutinizes the political economy of health under capitalism. In so doing, the article illustrates how the pharmaceutical corporations, insurance companies, medical technology, and healthcare corporations marketize and commoditize health in the neoliberal era. Finally, the article attempts to theorize how graphic pathographies, mediating subjective experiences, generate a new critical literacy through the conflation of the personal and the political in the verbovisual medium of comics. (shrink)

It is often assumed that similar domain-specific behavioural impairments found in cases of adult brain damage and developmental disorders correspond to similar underlying causes, and can serve as convergent evidence for the modular structure of the normal adult cognitive system. We argue that this correspondence is contingent on an unsupported assumption that atypical development can produce selective deficits while the rest of the system develops normally (Residual Normality), and that this assumption tends to bias data collection in the field. Based (...) on a review of connectionist models of acquired and developmental disorders in the domains of reading and past tense, as well as on new simulations, we explore the computational viability of Residual Normality and the potential role of development in producing behavioural deficits. Simulations demonstrate that damage to a developmental model can produce very different effects depending on whether it occurs prior to or following the training process. Because developmental disorders typically involve damage prior to learning, we conclude that the developmental process is a key component of the explanation of endstate impairments in such disorders. Further simulations demonstrate that in simple connectionist learning systems, the assumption of Residual Normality is undermined by processes of compensation or alteration elsewhere in the system. We outline the precise computational conditions required for Residual Normality to hold in development, and suggest that in many cases it is an unlikely hypothesis. We conclude that in developmental disorders, inferences from behavioural deficits to underlying structure crucially depend on developmental conditions, and that the process of ontogenetic development cannot be ignored in constructing models of developmental disorders. Key Words: Acquired and developmental disorders; connectionist models; modularity; past tense; reading. (shrink)

In relationships ‘I’ and ‘you’ become ‘we’; despite individual differences, couples obtain an interdependent identity due to their shared interactions. During a serious illness, biological and biographical disruptions can put any reciprocal relationship under strain. Through intermedial analysis of Judith Fox’s photographic project, I Still Do: Loving and Living with Alzheimer’s, I will explore ways the couple make sense of illness, how illness is communicated through text and image and also to identify the limits of representation. Here the photographs, I (...) argue, solidify their relationship and echo the stuck-in-the-present state of mind brought on by Alzheimer’s. (shrink)

Until quite recently bioethicists have had little of depth and probity to say about the duty of healthcare professionals in general and physicians in particular to relieve pain and suffering associated with disease and/or its treatment.

Max Weber is noted for his analysis of the `specific and peculiar rationalism' of western culture. However, his diagnosis of a life disenchanted by reason draws attention to his lesser known formulations of the problem of theodicy - the problem of reconciling pain and misfortune with moral expectations of the world. Weber suggests that cultural responses to this problem change with the increasingly secular rationalization of life. The present paper traces this development from the cultural representation of pain as the (...) embodiment of moral strife in the early modern novel to contemporary images of pain and suffering in medicine, the mass media and film. The comparison suggests that late modernity is confronted by an `inverse' problem of theodicy, in which representations of pain and suffering are disassociated from ethical and political contexts and the quest for meaning within a human frame. (shrink)

Most health professionals are unaware of the extent to which aspects of language, such as metaphor, influence their practice. Sensitivity to metaphor can deepen our understanding of healthcare and, arguably, improve its quality. This is because metaphors, and the linguisticality of which they are a part, shape medical practice in important ways. Examples are the metaphors used in pain management. By exploring the dialogical tension between such metaphors, we can better understand the ways in which they influence medical practice.

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and (...) mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy. (shrink)

Background For a variety of sociological reasons, different types of centredness have become important in health and social care. In trying to characterize one type of centredness, we were led to consider, at a conceptual level, the importance of the notion of centredness in general and the reasons for there being different types of centeredness. Method We searched the literature for papers on client-, family-, patient-, person- and relationship- centred care. We identified reviews or papers that defined or discussed the (...) notions at a conceptual level. The reviews and papers were analyzed as text transcripts. Results We identified 10 themes that were common to all the types of centredness. At a conceptual level we could not identify thematic differences between the types of centredness. These findings were subjected to a philosophical critique using ideas derived from Wittgenstein. Conclusion Different types of centredness are required in different contexts. The differences are justified by their practical utility. The unifying themes of centredness, however, reflect a movement in favour of increasing the social, psychological, cultural and ethical sensitivity of our human encounters. (shrink)

Neuroscience, together with a broadened concept of “mind” has instigated pragmatic and ethical concerns about the experience and treatment of pain. If pain medicine is to be authentic, it requires knowledge of the brain-mind, pain, and the relative and appropriate “goodness” of potential interventions that can and/or should be provided. This speaks to the need for an ethics that reflects and is relevant to the contemporary neuroscience of pain, acknowledgment and appreciation of the sentient being in pain, effects of environment (...) and value(s), and the nature of healing. It may be that neuroethics provides this viable meta-ethic for pain care. This essay describes how an integrative neuroethics of pain care allows, if not obligates, alignment of facts, values, and moral attitudes as a continuing process of re-investigation, analysis, and revision of what we know (and don’t know) about brains, minds, selves, and how we regard and treat the painient. (shrink)

This article explores illness as an assemblage of bodies, discourses, and practices by tracing a genealogy of the condition hystero-epilepsy in order to show the precarity of dominant bio-psychiatric ideology in the present. I read Siri Hustvedt’s case study of her own nervous condition with and against other histories of nerves, including Charcot’s treatment of hystero-epilepsy in the 1870s, Foucault’s treatment of hysteria, simulation, and the ‘neurological body’ presented in his lectures in 1974, and Elizabeth Wilson’s recent treatment of the (...) Freudian concept of ‘somatic compliance.’ I assemble this eclectic hystero-epileptic archive not in order to present a definitive history of hystero-epilepsy, but rather to think about how illness is made, unmade, and remade in the clinic and narrative. (shrink)

Since the nineteenth century the theory and practice of mainstream Western medicine has been grounded in the biomedical model. In the later years of the twentieth century, however, it has faced a range of serious problems, which when viewed collectively, remain unresolved despite a variety of responses. The question we now face is whether these problems can be dealt with by modifying and extending the principles underlying the biomedical model, or whether a more radical solution is required. Recent critiques of (...) Western medicine have focused mainly on the biopsychosocial model in relation to the former approach, but it will be contended that this cannot deal adequately with the challenges that medicine currently faces, because although it addresses both the scientific and humanistic aspects of medicine it fails to harmonise them. I shall therefore argue for the necessity of a more radical approach, and suggest that what is required to accomplish this is the development of a new medical cosmology, rooted in an older and more global framework. Such a fundamental change would inevitably involve a long term process which it is not yet possible to fully comprehend let alone specify in detail. Some of the necessary features of such a new medical cosmology can, however, already be distinguished and the outline of these is described. (shrink)

The Tuskegee Syphilis Experiment (TSE) has shaped African Americans’ views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton’s attempt to restore African Americans’ trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by (...) noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies. (shrink)

Between 1917 and 1935, William Carlos Williams’ poetic style shifted from a focus on color to a verbal grayscale of photorealism. Considering this shift alongside of the historical connection between photography and eugenics raises questions about Williams’ status as a physician during an era when medical discourse was dominated by theories of scientific racism. While one might conclude that Williams move from color to grayscale represents a capitulation to public health anxieties regarding the pathologized bodies of the immigrant poor, I (...) argue that it is precisely through his adoption of black-and-white photorealism that Williams overturns hereditary notions of degeneracy. (shrink)

Creations of many contemporary artists indicate the emergence of technoculture. Although artistic manifestations of technoculture may appear to be a provocation, they encourage fundamental ontological questions, such as whether a person has unchanging nature; what was and is our relationship to the Other, and what it should be; to what extent can body and mind be altered before they stop being “human”; what is the future of our species. To properly understand the works of technoculture artists, it appears necessary to (...) have a thorough grasp post- and transhumanism as their key sources of inspiration. As a result, the developed tools will be employed to indicate which aspects of technoculture are a manifestation of post- and transhumanist ideas. This analysis is based primarily on the works of Stelarc and Orlan – two widely commented artists of technoculture. (shrink)