Mental health, subjective experiences and environmental change

This article responds to Coope's call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare, with a focus on ecological mental health. The article emphasises the need to understand the cultural dimensions of mental health and proposes an interdisciplinary approach that integrates insights from the arts and humanities. It examines the impact of climate change on mental health, drawing on The Rockefeller Foundation - Lancet Commission on Planetary Health and recent studies. The discussion focuses on the intersection of mental health, subjective experience and environmental change. Focusing on emotional experiences as constructed from biological and cultural elements, the article proposes a holistic approach to mental health. It proposes two converging lines of research, in constant interaction: first, a historical and cultural research of those concepts, practices and symbols related to the environment, emphasising a cultural history of nature; and second, a synchronous research, drawing on anthropology, sociology and participatory art-based research, to understand how these aforementioned elements influence our current relations with nature. The article concludes by emphasising the urgency of developing narratives and histories that redirect temporal trajectories towards a better future, while respecting and acknowledging diverse narratives of individual experience. It calls for collaborative efforts from the medical humanities to contribute to a more comprehensive understanding of the complex relationship between mental health, nature and ecological crisis.

Linguistic and (micro)cultural differences in the global debate about re-naming 'schizophrenia': A mixed-methods survey from Switzerland

BACKGROUND AND HYPOTHESIS

This survey explores Swiss mental health professionals', users', and relatives' opinions on re-naming schizophrenia exploiting Switzerland's specific multilingualism to examine possible effects of linguistic and microcultural differences on the issue.

STUDY DESIGN

Opinions on 'schizophrenia' were collected using a self-rated online questionnaire incl. Freetext answers available in the three main Swiss languages, German, French and Italian. It was distributed to the main professional and self-help organizations in Switzerland between June and October 2021.

STUDY RESULTS

Overall, 449 persons completed the questionnaire, 263 in German, 172 in French and 14 in Italian. Of the total sample, 339 identified as mental health professionals, 81 as relatives and 29 as users. Considering the whole sample, almost half favored a name-change with a significant difference between stakeholder- and between language groups. Also, the name 'schizophrenia' was evaluated more critically than the diagnostic concept. Qualitative analysis of freetext answers showed a highly heterogenous argumentation, but no difference between language groups.

CONCLUSIONS

Our results suggest the attitude towards re-naming might itself be subject to (micro)cultural difference, and they highlight the nature of 'schizophrenia' as not only a scientific, but also a linguistic and cultural object. Such local factors ought to be taken into consideration in the global debate.

Interdisciplinary co-teaching as a sustainable model for health humanities pedagogy

Academics and students from marginalised identities encounter challenges and barriers at all levels of participation in the settler colonial university, in both practices of teaching and learning. While this observation holds true for courses in the health humanities, their unique interdisciplinary position and context creates space for challenging dominant norms in society and in academia. In this paper, we describe our experiences as two black and queer graduate students developing and co-teaching an online interdisciplinary course, 'Race and Medicine'. The idea for co-teaching originated as a means of ensuring continuity and sustainability in the course (AvB was expecting her first child and contending with the possibility of unplanned preterm birth) and emerged into what we suggest, in line with the transformative pedagogical theory of bell hooks, was a micro-scale transgressive learning community. We argue that our co-teaching partnership facilitated practices of revealing, mitigating and disrupting oppressive structures in the white heteropatriarchal academy, in addition to offering unique learning opportunities for students. The intersections of difference and similarity between our disciplinary, professional and social identities transformed and enhanced the types of conversations and learning activities we held with the class and were a feature of the course which was rated highly in evaluations. We conclude by suggesting co-teaching as a possible model of sustainable pedagogy for the health humanities, one that is especially valuable for racialised graduate students who are developing professional identities as instructors and exploring careers in the health humanities. In addition to facilitating interdisciplinary student learning, co-teaching and the subsequent formation of micro-scale transgressive learning communities challenges the dominant power structures of the academy by making space for teaching and learning in the contexts of solidarity, care and sustainability.

Maturity model for assessing the medical humanities: a Delphi study

BACKGROUND

Becoming a first-level discipline in China means access to more educational resources. The development of medical humanities in China has been going on for more than 40 years, and some medical schools have set up master's and doctoral programs in medical humanities. The demand for medical humanities-related knowledge in China is also growing after COVID-19. However, medical humanities is only a second-level discipline and receives limited resources to meet the needs of society. This study aims to establish a system of indicators that can assess whether the medical humanities has a first-level discipline and provide a basis for its upgrading to a first-level.

METHODS

A Delphi technique was used, with the panel of expert expressing their views in a series of two questionnaires. A coefficient of variation of less than 0.2 indicates expert agreement.

RESULT

A total of 25 experts participated in this Delphi study. Consensus was reached on 11 first-grade indices and 48 s-grade indices. The authoritative coefficient(Cr) of the experts was 0.804, which indicates that the experts have a high level of reliability.

CONCLUSION

This study provides a reliable foundation for the evaluation of medical humanities maturity.

The employment of art therapy to develop empathy and foster wellbeing for junior doctors in a palliative medicine rotation - a qualitative exploratory study on acceptability

BACKGROUND

The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being.

METHODS

A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants' experiences.

RESULTS

A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability.

CONCLUSIONS

The participants have mixed perceptions of the program's acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education.

Eugenics and genetic screening in television medical dramas

Medical dramas offer unique insights into the way popular media makes sense of genetic technology and the ethics of its applications. In this paper we evaluate the contrasting depictions in television medical dramas of reproductive genetic screening and eugenics-two medical themes that some commentators see as closely related. By conducting a content analysis of 32 episodes of doctor shows featuring eugenic and/or genetic screening themes, we put the medical drama landscape in conversation with bioethics scholarship and mark a significant divergence between the two. While the academic literature has been parsing the possible relationship between genetic screening and eugenics for over 50 years, doctor shows tend to champion genetic screening as a powerful tool for promoting individual reproductive choice and criticise eugenics as a socially unjust infringement of reproductive freedom. In doing so, medical dramas mark a subtle but important moral distinction between the population-level implications of eugenics and the highly personal, emotional impact of genetic screening.

Cultivating compassion in medicine: a toolkit for medical students to improve self-kindness and enhance clinical care

BACKGROUND

Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales.

METHODS

The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales.

RESULTS

17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points (p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points (p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points (p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales (p = 0.461, p = 0.144, p = 0.785, respectively).

CONCLUSIONS

Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program's existing compassion education, this customizable model allows for easy integration into a medical student's crowded curriculum. Furthermore, although teaching compassion early and often in a clinician's training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student's clinical years.

Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht

Bertolt Brecht's poem "A Worker's Speech to a Doctor" is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article, we show how "A Worker's Speech to a Doctor," with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Call to Arms trilogy: "Call to a Sick Communist," "The Sick Communist's Answer to the Comrades," and "Call to the Doctors and Nurses." We also show that, while "A Worker's Speech to a Doctor" has been applied in the training of health workers, its accusatorial tone towards health workers' complicity in the system the poem is critiquing risks alienating such workers. In contrast, the Call to Arms trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a "Communist" risks estranging these health workers, our analysis of the Call to Arms poems nevertheless indicates that their use can contribute to moving health workers' educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.

Through the looking glass: qualitative study of critical care clinicians engaging in humanities

PURPOSE

Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey.

METHODS

This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers.

RESULTS

Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues.

CONCLUSIONS

Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.

'Who Sanitizes the Sanitizer?': COVID Comics and Sanitisers

Much like face masks, hand sanitisers have become a household item and a prominent symbol since the COVID-19 pandemic. As sanitisers began to be widely used, contingent issues related to toxic ingredients in sanitising products, heightened pandemic-related anxiety, unscrupulous profiteering through inflated sanitiser prices, obsessive sanitisation, contamination fear, stockpiling, panic buying, and concerns regarding the overall effectiveness of hand sanitisers emerged. Building on these themes, the present article investigates the various issues related to sanitisers after a brief review of the history of sanitisers. To do so, the present article analyses sequential comics and single-panelled cartoons from comic artists such as Randall Munroe, Sarah Morrisette, Shivesh Shrivastava and Dan McConnell. This essay extends its inquiry beyond examining sanitisation practices during the COVID-19 pandemic and associated cultural implications. Drawing on insights from Object Oriented Ontology, this article brings to relief how sanitisers have evolved into objects that hold, govern and shape our modern existence. Furthermore, the present article highlights how the comic medium visually enunciates the lived experiences of the pandemic, rituals of sanitising and associated issues.

Hospital space interpreted according to Heidegger's concepts of care and dwelling

Modern hospitals have succeeded in saving humans from numerous diseases owing to the rapid development of medical technology. However, modern medical science, combined with advanced technology, has developed a strong tendency to view human beings as mere targets of restoration and repair, with modern hospitals characterised as spaces centred on technology-focused treatment. This results in a situation where human beings are reduced to objects and alienated. This study, integrating Heidegger's concepts of dwelling and care, contends that 'care' is a vital concept in terms of the fundamental spatiality of hospitals and needs to be restored as the key guiding principle affecting hospital space. The loss of the caring spirit in the development of modern hospitals affects how hospitals are conceived, built and managed, as well as how human experiences within hospitals are dealt with or allowed for appropriately. This study offers critical reflection on how future planning of hospital spaces can be better conducted to ensure that human experiences, and the care needed to appropriately value such experiences, are adequately expressed, and the complexity of human existence is suitably considered.

Illness and (hyper)masculinity in 'HIMM' comics from the USA

In this essay, I analyse HIMM comics from the USA, a specific textualisation of graphic medicine/pathography that deals with a variety of illness experiences by male cartoonists. It is my contention that, in the existing literature, the motif of masculinity in autobiographical health-related comics is an underdeveloped area of academic enquiry. As a result, my analysis focuses on how three North American men depict ill health in their work in relation to existing sociological understandings of male behaviour. The texts I discuss are John Porcellino's The Hospital Suite (2014), a story about his abdominal tumour; Matt Freedman's exploration of adenoid cystic carcinoma in Relatively Indolent but Relentless (2014); and Peter Dunlap-Shohl's My Degeneration (2015), which discusses the cartoonist's experience of Parkinson's disease. At the same time, I use the concept of hypermasculinity to explore the similar visual and verbal strategies through which these men respond to their physical and emotional suffering. It is my intention to illustrate how HIMM comics provide an important, non-medicalised lens through which clinical practitioners and lay readers alike can better see the subjectivised experience of male illness in the early 21st century. With a focus on the concept of bracketing, the representation of pain and vulnerability, men's loss of self-identity and hardiness, I explore how HIMM comics act as important counter-narratives to biomedical discourse by visualising the phenomenological aspects of men's ill health. In this way, the texts in my analytical corpus offer a valuable gender-oriented understanding of the connection between illnesses and (hyper)masculinity.

How and why to use 'vulnerability': an interdisciplinary analysis of disease risk, indeterminacy and normality

In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.

Adolescent idiopathic scoliosis: interdisciplinary creative art practice and nature connections

Scoliosis is an abnormal lateral curvature of the spine with the large majority of cases classed as idiopathic, meaning there is no known cause. Typically, most cases occur in children and young people affecting approximately three per cent of the adult populace with five out of six cases being female. The BackBone: Interdisciplinary Creative Practices and Body Positive Resilience pilot research study used arts and humanities methods to measure the impact of adolescent idiopathic scoliosis (AIS) on well-being and body perception. The research aimed to contribute to a better understanding of alternative treatments towards improving quality of life in young women diagnosed with AIS. In particular, concentrating on two highlighted priorities from the Scoliosis Priority Setting Partnership: (1) How is quality of life affected by scoliosis and its treatment? How can we measure this in ways that are meaningful to patients? (2) How are the psychological impacts (including on body image) of diagnosis and treatment best managed.Using established medical techniques, art-based workshops, and focus groups with postoperative participants with AIS and their families we gathered both quantitative and qualitative data. The workshops explored the aesthetics of imperfection through material investigations that focus on the body as both an object and how it is experienced using the metaphor of tree images. Drawing parallels between the growth patterns of trees that, for complex and often unknown reasons, have grown unexpectedly we explored questions around ideological notions of perfect growth through art-making in a non-clinical setting. Uniquely, the pilot project sought to draw on insights from four key disciplines (art, medicine, psychology and human geography), thinking across boundaries to evoke different ways of knowing and understanding the complexities of body perception through image-making.

Contention and collaboration: the tenuous encounter of modern Ayurveda and Western medicine in the twentieth and twenty-first centuries

Complementary medicine systems are ascending to rapid popularity as the twenty-first century progresses. Often adapted from ancient systems of healing such as Ayurveda, these modern alternative medical movements reappraise millennia-old health traditions that found their inception at the confluence of religious philosophy and herbal healing. Naturally, contemporary global economic forces and a desire to market traditional medicine products in an enticing fashion have characterised how historic traditional medicine systems are presented in the modern context. By establishing a vision of complementary medicine born from ancient traditions, it becomes clear how traditional methods of healing can contend with Western biomedicine-the prevailing standard of care around the globe. The claims made by both sides parry along a line of scientific validity, efficacy and regulatory purview. India, the birthplace of Ayurveda and an epicentre of contemporary medical education, is a prime arena to study the friction between biomedicine and traditional medicine. In this piece, I focus on the modernisation of Ayurveda and how it has found conflict with allopathic medicine. I posit that Ayurveda has re-emerged since the early twentieth century as a key tenet of Indian modernity: and in doing so has found contention with Western medicine. I furthermore argue that despite existing discord, the two medical traditions are not inherently antithetical. They can be synergistic, so long as healthcare delivery and education recognise the limits of each and focus on coaction rather than contradiction.

The 'Glasgow effect': the controversial cultural life of a public health term

The question of why more people in Glasgow were dying, and younger, compared with English cities with almost identical levels of deprivation, was a hot topic in Scottish public health debates in the early 21st century. Public health researchers, particularly the Glasgow Centre of Population Health (GCPH), used the terms 'Glasgow effect' and 'Scottish effect' as placeholders while identifying the unknown factors behind Scotland's excess mortality. Yet the terms took on a colourful life of their own in the press and larger culture and continue to circulate, despite GCPH's attempts to retire them. This paper is the first to analyse the cultural life of the 'Glasgow effect' and 'Scottish effect' terms. Looking primarily at the Scottish press 1998-2022, I analyse the politically charged and often controversial debates and lay recommendations around the concepts. I also trace the terms' parallel usage, and indeed origin, in contexts unrelated to health. I argue that the 'Glasgow effect' functions as a myth. This myth emphasises Scottish exceptionalism in public health and larger culture, at a time when devolution and the prospect of independence heightened optimism and anxiety about Scotland's future. It overlaps with a larger and longstanding myth of Scottish cultural pathology, or the pathological Scot. The flexibility of the 'Glasgow effect' and 'Scottish effect' terms is exploited by journalists, academics and artists to serve competing agendas, establish their own expertise and influence public opinion. While it may now be challenging to eradicate these terms, especially in lay contexts, researchers and policy makers should avoid using these unstable terms uncritically. The example of the 'Glasgow effect' shows how health concepts can become wrapped in larger national or political narratives and highlights the difficulties for public health communicators in introducing complex and emerging public health ideas into a dynamic landscape of lay beliefs.

Neurodiversity and disability: what is at stake?

Neurodiversity has come hugely to the fore in recent years in a variety of contexts, and is now subject to academic debate, activist discussion, and increasingly embedded in a range of institutional and corporate settings in the Global North, from workplaces to early years education, from psychotherapy to mainstream political discourses. The term has gained traction in Medical Humanities, as well as debate within bioethics, philosophy of psychology, and of law. Institutionally, it is now relied on in therapeutic practice, autism service provision, as well as in higher education, in particular. In this conceptual article we examine what is at stake in these usages and the implications in need of scrutiny. We resituate neurodiversity in relation to questions of disability by examining the deployment of neurology as the basis for identity, rights and benefits. The emergence of the term and the understandings to which it gives rise, we argue, leave out urgent questions of what is at stake for disabled people in a political climate of increasing harshness and ableism.

Patient-physician interaction education in Korea: a systematic review

Patient-physician interaction (PPI) is an important area in medical education, but in-depth discussions on the content of the outcome of patient-doctor education are rare. Therefore, in this study, we will systematically analyze the research on PPI education in Korea. In this study, papers searched with keywords related to PPI education from Korea's academic journal service were targeted according to a systematic literature analysis method. The scope of the study was to include papers published in academic journals that are candidates for Korea Citation Index registration, excluding dissertations, research reports, posters, conference presentations, books, and internet materials. The content included papers targeting medical education and medical school students was set as the range. As a result of the analysis, although communication between PPI has many positive effects in the PPI in medical education at medical schools, obstacles do occur, and various ways to overcome them were suggested. Therefore, although medical interview training between patients and doctors in medical schools is necessary, it was analyzed as being based on overseas research or lacking in specific content. The core of PPI education appears to be medical interviews, and it seems necessary to discuss whether empathy or patient-centered medical care are appropriate as the main principles of PPI education in Korea. Therefore, education on the patient-doctor relationship is an important element in medical humanities and medical humanities education, and it is expected that research and education on this will progress more actively.

Opacity, difference and not knowing: what can psychiatry learn from the work of Édouard Glissant?

Martinican poet, novelist and cultural theorist Édouard Glissant (1928-2011) rejected contemporary simplistic notions of creole hybridity popularised in the 1980s and 1990s in favour of a unique and explicitly antiessentialist construct of Caribbeanness-a form of being that embraces place while shunning any associated ideas of rootednesss. Throughout his work, there is a constant tension between the local and the global, the particular and the universal, the essentialist and the homogenising, a tension that is never resolved but used creatively to stake out an emergent third position against a backdrop of a metaphorical Caribbean seascape. The purpose of this article is to shed light on a central idea developed by Glissant: the importance of acknowledging opacity in the encounter with the Other, in contrast to idealised notions of transparency as inherently desirable. This 'right to opacity' has been embraced in poststructural theory, postcolonial activism and contemporary art. However, I argue that opacity is also a highly relevant notion in clinical contexts, as an essential resource for understanding concepts such as first-person, second-person and third-person perspectives in the phenomenology of mental health and illness. For illustration, I point to a number of clinical tools and approaches-such as the Cultural Formulation Interview, Therapeutic Assessment and the employment of a not-knowing stance in mentalisation-based treatment-that successfully incorporate a respect for opacity as a core value in the clinician-patient encounter. This article is not an attempt to offer a definitive how-to guide on how to make use of the ideas of Édouard Glissant in the clinic; instead, I hope to inspire further discussion about how various notions of opacity and transparency come into play for mental health practitioners and how acknowledging alterity and difference may contribute to more fruitful and respectful ways of engaging with the patient-as-Other.

Body integrity dysphoria and moral responsibility: an interpretation of the scepticism regarding on-demand amputations

A patient who requests an amputation deemed medically unnecessary by professionals is disqualified per se from being regarded as having medical decision-making capacity. This decision is based on the assumption that there is an option to pursue something other than amputation; such an assumption in many cases overflows into therapeutic obstinacy. This is the case for individuals who have ill or damaged body parts and who wish to avoid recurrent and painful medical treatment designed to save the limb, as well as for individuals affected by body integrity dysphoria (BID). BID is a condition that is recognised by the WHO and is included in the International Classification of Diseases, 11th edition. Individuals who are affected develop an intense feeling of overcompleteness of their body configuration, which leads to the development of a strong sense of dysphoria and consequently the desire to amputate in order to remove the source of such discomfort. In the few cases in which amputation has been carried out, the results have proved successful; the individual's quality of life has improved and they have had no new amputation desires. No medical therapy, including medical amputation, is available currently for individuals affected by the condition. This situation leads many with BID to mutilate themselves. Such events create a challenging ethical dilemma for the medical world.The present paper is focused on the capacity of the individual with BID to do other than request amputation and the implications that this carries regarding moral responsibility. It is proposed that the autonomy of the patient cannot be disqualified by default based on the amputation request, despite its oddity, and that any scepticism demonstrated by the physicians is based on a false preconception of ill will or ignorance, which results in a blaming attitude towards the requesting person.

Wait for Me: Chronic Mental Illness and Experiences of Time During the Pandemic

As someone diagnosed with severe chronic mental illness early in my adolescence, I have spent over half of my life feeling out of step with the rest of the world due to hospitalizations, treatment programs, and the disruptions caused by anxiety, anorexia, depression, and obsessive-compulsive disorder. The effect of my mental health conditions compounded by these treatment environments means I often feel that I experience time passing differently, which results in sensations of removal and isolation from those around me. The global shutdown caused by the COVID-19 pandemic seemed a way for normative bodies to experience the passing of time the way I always have. In this paper, I extend Dr. Sara Wasson's analysis of the ways in which chronic pain resists narrative coherence to my own temporal experience of chronic mental illness, specifically my embodied experience of the pandemic. I use that embodied experience as a case study for examining how the reciprocal nature of time and narrativity, as outlined by Dr. Paul Ricoeur, can create isolation for those struggling with their temporality due to chronic mental illness. To acknowledge and grapple with the ramifications of discursive and material privilege involved in such situations, I include an analysis of Robert Desjarlais's 1994 article "Struggling Along: The Possibilities for Experience among the Homeless Mentally Ill," in which he investigates a similar phenomenon of being outside of structured sequential narrative time in the residents of a Boston shelter for the mentally ill.

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.

UK media responses to HIV through the lens of COVID-19: a study of multidirectional memory

This article proposes correlations and parallels in UK newsprint media coverage of the COVID-19 and HIV/AIDS pandemics through engagement with Michael Rothberg's model of multidirectional memory. It achieves this via qualitative and quantitative analysis of newsprint media during selected timelines of the respective outbreaks. Although the COVID-19 outbreak, which originated in Wuhan, China in 2019 and spread globally, has prompted reference to a number of previous traumatic events, including 9/11 and the Holocaust, one might contend that it correlates most closely with HIV/AIDS given the latter's ongoing nature and worldwide reach. COVID-19, having infected 629 million people since December 2019 with 6.5 million deaths by November 2022, still presents a global threat through which we might read the trauma of HIV, a disease that has thus far seen 32.7 million deaths and has infected 75.7 million people worldwide. This relationship exists despite the fact that the two viruses and their effects differ markedly: HIV is a retrovirus, has a long incubation time, is transmitted via bodily fluids, has a low risk of infectivity via everyday contact and, to date, no fully effective vaccine has been developed. Contrastingly, COVID-19 is a coronavirus, has a short incubation time, is transmitted via contact and airborne respiratory aerosols, has a high risk of infectivity via everyday contact, and investment in vaccine development has been significant, with several vaccines now successfully developed. Nonetheless, while the two viruses and their prognoses are quite different and government strategies have followed highly divergent trajectories, certain parallels are apparent to the extent that one might read HIV/AIDS through the lens of COVID-19. It is therefore argued here that the connections between these two traumatic events constitute what Rothberg terms 'multidirectional memory' whereby we understand one traumatic event through another.

Prostheses of disability: Islamic fundamentalism and the disabled body in postcolonial Arab fiction

This essay focuses on the representational relationship between disability and Islamic fundamentalism in select contemporary postcolonial literary texts by Arab authors. The essay draws mainly on critical disability theory on the concept of prosthesis to argue that disability functions as a narrative and emotional prosthesis to narratives on Islamic fundamentalism at the same time as it lays bare this very process of instrumentalisation. To this end the essay asks: What are the privileged affects that attach themselves to representations of disability in fictions of Islamic fundamentalism? How do textual and affective prostheses emerge out of, or feed back into, Islamist contexts, worldviews and subjectivities? Finally, in what ways do the narratives under analysis uphold, lay bare or dismantle such prosthetic functions of the disabled body? In particular, this essay focuses on three specific prostheses of disability in the texts: conversion narratives, contemporary histories of Islamic fundamentalist violence and the figure of the disabled Islamist.

'I'm not hep C free': afterlives of hepatitis C in the era of cure

Since the advent of more effective, new-generation treatment for hepatitis C, immense resources have been devoted to delivering cure to as many people with the virus as possible. The scale-up of treatment aims to prevent liver disease, liver cancer and onward transmission of hepatitis C, but social research shows that people also approach treatment with its social promises in mind, including the hope that it might reduce or eradicate stigma from their lives. Such hopes reflect broader ideas about medical cure, which is seen as an end point to illness and its effects, and capable of restoring the self to a (previous) state of health and well-being. But what does cure mean among people for whom treatment does not produce an end to the social effects of a heavily stigmatised disease? While new treatments promise to eliminate hepatitis C, accounts of post-cure life suggest that hepatitis C can linger in various ways. This article draws on interviews with people who have undergone treatment with direct-acting antivirals (n=30) in Australia to explore the meanings they attach to cure and their experiences of post-cure life. We argue that dominant biomedical understandings of cure as an 'ending' and a 'restoration' can foreclose insight into the social and other effects of illness that linger after medical cure, and how individuals grapple with those afterlives. Drawing on recent conceptual re-framings of cure from medical anthropology and disability studies, we suggest that thinking at the limits of 'curative reason' helps to better address the afterlives of chronic illness. In the case of hepatitis C, reconceptualising cure could inform improved and less stigmatising ways of addressing people's post-cure needs. And in the era of hepatitis C elimination, such reconceptualisation is increasingly important as the cohort of people undergoing treatment and cure expands worldwide.

Creative forms: booklets by the hospital senses collective

This article details the creation of a series of booklets designed to explore sensory encounters with hospitals and healthcare environments. The booklets were devised as a series of prompts or provocations, created to attend to and examine embodied, sensory encounters with health/care settings rather than to present research findings. Bringing together an expansive range of backgrounds and skill sets the booklets were created to sit within and beyond language through their design, form and content. Within this article we share the ways in which the works are deliberately unfinished and exploratory as this necessitates that those interacting with them create their own meanings and explore how they think and feel about health/care environments. The form and design promote a certain attentiveness and embodied engagement. For example, users must engage with the works carefully, gently turning and unfurling the fragile pages. This is further illustrated through qualitative insights collected from users of the booklets. Throughout this paper we argue for multiplicity in the ways in which we explore and present sensory-focused research. Our attention to multiplicity is supported not only through the design, form and content of the physical booklets but through the creative audio description, text and images created to complement and support these works. These are available online to ensure that our provocations are widely accessible. Within this paper we critique how a reliance on narrative form can limit the ways in which we engage with spatial, sensory and emotional concepts. Such concepts are by their very nature challenging to articulate and arguably require more-than-text-based approaches. We propose that embracing creative, exploratory and seemingly risky routes to examining and presenting such concepts is critical in expanding research.

Gender, race and class at work: enlisting African health labour into the Gold Coast Medical Service, 1860-1957

From the mid-nineteenth century, the people of the Gold Coast formed an essential component of the missionary and early colonial medical services (CMS). The labour of the people was mainly confined to the category of medical auxiliaries. Enlisting these African auxiliaries into the medical service took place within gendered, racial and class boundaries. Yet, the historiography of the Gold Coast does not overtly address the interplay of gender, race and class in connection with the work of African health auxiliaries. This article examines the intersection of race, gender and class in the employment and training of African health labour in the Gold Coast. It argues that European and African gendered ideologies, racial discrimination and class difference influenced the recruitment of Africans into early colonial and missionary medical services. This article is largely based on qualitative research and critical reading and re-reading of textual records. The records include colonial medical reports obtained from the digital archives of the Wellcome Library in London, Manhyia Archives of Ghana, and Public Records and Archives Administration Department in Kumase of Ghana. Books and dissertations were critically re-examined for fragmented details about these auxiliary workers. This article reveals that men dominated the categories of African health labour, that is doctors, orderlies, dispensers, nurses and midwives until the 1940s when more women began to enter the CMS. The relationship between African and European medical staff, and colonial administrators within the Gold Coast Medical Department from the 1890s shows the existence of racial discrimination largely based on physical appearance and intellectualism. Recruiting Africans into the CMS was necessary to augment insufficient European staffing across many occupations, but not to the same rank and class. This research identifies the pathways into the formalised health professions in Ghana within the context of colonial and missionary medicine.

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.

(Post)confessional mode and psychological surveillance in The Crown and Fleabag

Contemporary television's portrayals of psychotherapy reveal anxieties surrounding surveillance and intimate self-disclosure in clinical and therapeutic settings. This paper analyses two twenty-first century television series featuring therapy sessions that observe and monitor mental states for prognostic purposes, engaging in what Alan Westin terms psychological surveillance: Peter Morgan's The Crown (2016-2023) and Phoebe Waller-Bridge's Fleabag (2016-2019). These shows feature contrasting modes of intimate self-disclosure-confessions and postconfessions-that emerge in psychotherapy. The confessional mode emphasises authenticity and a desire for healing. Postconfessions, on the other hand, are a parodical mode of revelation that refuse the authenticity and intimacy elicited by therapy and traditional confessional modes. Confessional discourses in The Crown reveal that state power, reinforced by genetic authentication, can benefit from psychological surveillance. In contrast, Fleabag uses postconfessional discourse to implicate the audience in the therapeutic encounter, capitalising on the increasingly decentralised self-care modalities sustained through social media, television and other audience-driven mediums.

Hanna Rion and The Weekly Dispatch's twilight sleep crusade

The story of twilight sleep is an important, yet neglected, episode in the history of obstetric pain relief in Britain. One reason for its neglect in historical writing is that most of the discussion of the therapy took place in newspapers, particularly the Weekly Dispatch Using digitised newspapers, as well as medical journals, this article reconstructs the largely overlooked story of twilight sleep in Britain. Twilight sleep was comprised of two drugs, scopolamine and morphine, which acted together to remove the pain of labour, as well as memory of it. Twilight sleep gained popularity in 1915 in Britain, a year after it became popular in America, on which most scholarship has focused. One of the main advocates for the use of twilight sleep in Britain was Hanna Rion, who wrote a series of weekly articles in 1916 campaigning for its use. Rion's articles, and the response to them, show how the rise in popularity of twilight sleep reflected concerns about a declining birth rate amidst the backdrop of World War I. Through studying twilight sleep we see how women began to see themselves as consumers and shape medical practice, before the natural childbirth movement, which it has traditionally been attributed to. Therefore, twilight sleep provides us with the missing link in the story of obstetric anaesthetics, between the discovery of chloroform in 1847 and the natural childbirth movement in the 1930s.

Authority and medical expertise: Arthur Conan Doyle in The Idler

Arthur Conan Doyle's medical and writing careers intertwined and his work has a history of being read in the light of his medical expertise. He wrote at a time when the professionalisation and specialisation of medicine had resulted in an increasing distance between the profession and the public, yet general practitioners relied financially on maintaining good relationships with their patients and popular medical journalism proliferated. A variety of contrasting voices often disseminated narratives of medical science. These conflicting developments raised questions of authority and expertise in relation to the construction of medicine in the popular imagination: how is knowledge constructed? Who should disseminate it? How and by whom is authority conferred? How can the general population judge experts in medical science? These are questions explored more widely in Conan Doyle's writing as he examines the relationship between expertise and authority. In the early 1890s, Conan Doyle wrote for the popular, mass-market periodical The Idler: An Illustrated Magazine His contributions to it address these questions of authority and expertise for a lay audience. First establishing the medical context of doctor/patient relationships in which these questions arose, this article undertakes a close reading of these mostly rarely studied single-issue stories and articles as a means of ascertaining how Conan Doyle and his illustrators identified the relationship between competing narratives, expertise and authority. It argues that rather than maintaining a distance between public and professional, Conan Doyle's illustrated work demonstrates to his readers that there are ways to successfully navigate the appearance of authority and recognise expertise as they confront entangled representations of advances in medical science.

Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis

BACKGROUND

Medical humanities education is an important part of medical education. The purpose of this study was to determine the effectiveness of medical humanities in improving empathy among medical students and healthcare professionals.

METHODS

PubMed, Embase, EBSCO-ERIC, Web of Science were searched systematically for studies in the English language. The last retrieval date is May 1, 2023. Best Evidence Medical Education (BEME) Global Rating Scale and Kirkpatrick-based results were used to evaluate the quality of literature. In this study, a meta-analysis of continuous data was conducted.

RESULTS

The pooled results by single-arm test meta-analysis showed a benefit with medical humanities programs in empathy (SMD 1.33; 95% CI 0.69-1.96). For single-arm trials of medical humanities program interventions of less than 4 months, 4 months to 12 months, and more than one year, the standardized mean differences(SMD) between post-test and pre-test were 1.74 (P < 0.05), 1.26 (P < 0.05), and 0.13 (P = 0.46), respectively. The results showed a significant difference in the effect of medical humanities programs on male and female empathy (SMD - 1.10; 95% CI -2.08 - -0.13). The SMDs for the study of course, the course combined reflective writing, and the course combined reflective writing and practice as intervention modalities for medical humanities programs were 1.15 (P < 0.05), 1.64 (P < 0.05), and 1.50 (P < 0.05), respectively.

CONCLUSION

Medical humanities programs as a whole can improve the empathy of medical students and health professionals. However, different intervention durations and different intervention methods produce different intervention effects.

Forming Physicians: Evaluating the Opportunities and Benefits of Structured Integration of Humanities and Ethics into Medical Education

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students' perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be "in" medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training.

A Narrative Medicine Pilot Curriculum for Internal Medicine Residents

Narrative medicine (NM) is the practice of reflecting on patient stories, which can improve physician empathy and has been linked to higher levels of well-being. We implemented a NM curriculum for a large internal medicine residency program and report the curriculum's positive effects.

Health Humanities: A Baseline Survey of Baccalaureate and Graduate Programs in North America

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and 20 institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities.

Assessing the competitiveness of medical humanities research on psychiatry, otolaryngology, and ophthalmology residency program applications

Medical humanities research is an increasing area of interest for students as medical schools become more aware of the benefits of humanities and the arts on patient care. However, medical students may feel dissuaded from pursuing medical humanities work for fear of how it will be perceived on their residency applications. In this study, residency program directors (PDs) in New York state in psychiatry, ophthalmology, and otolaryngology were surveyed about their opinions on the competitiveness of students doing medical humanities research applying to their programs. Of the 64 PDs contacted, twenty submitted responses (31.3%). When asked if a residency applicant who only had medical humanities research experience would be seriously considered for their program, 95% of PDs said yes. Furthermore, 65% of PDs said that having medical humanities research experience in addition to clinical research increased a student's chance of being accepted to their program. Thirty percent of PDs indicated that the medical humanities were an important selection criteria for their program. Qualitative responses emphasized that non-traditional projects, such as personal essays, were as valid as published journal articles when conducted with academic rigor. Many PDs also believed that the medical humanities increased compassion, empathy, and communication skills in their residents. Considering these results, medical students should feel empowered to pursue medical humanities research, even if they are applying into a competitive surgical specialty. It should not diminish their chances of being seriously considered for a program, and may even confer an advantage over their clinical research peers.

Expectations of Polish undergraduate medical students for medical humanities classes: a survey-based pilot study

BACKGROUND

Medical schools teach Medical Humanities (MH) to provide students with knowledge about the human experience related to health, illness, disease, medicine, and healthcare. Due to the previously observed negative opinions about MH courses, we examined the expectations of medical students in Poland toward humanities subjects.

METHODS

We conducted a voluntary, anonymous electronic survey in one medical school (single-center study) and collected data from 166 medical students. The results were analyzed by comparing continuous and categorical variables between groups (gender, year of study, previous participation in MH classes).

RESULTS

The students expected to learn how to communicate with patients and their families, especially about difficult topics. They also expected the classes to be active, stress-free, and without passing grades. The preferred MH teacher was a physician, although choosing a psychologist or other qualified person as an MH teacher was also popular. Previous participants in MH courses were more likely to expect such a course to be compulsory than those who had yet to attend it.

CONCLUSION

Considering the students' expectations when designing MH classes could increase students' satisfaction with MH courses.

Assessment of a medical student mentoring programme to improve attitudes related to grief and coping with death

Objectives

To evaluate the impact of a mentoring programme for medical students doing a palliative care rotation, aimed at improving coping with death and attitudes towards the suffering produced by illness.

Methods

A quasi-experimental study without a control group was carried out on second-year medical students. Five 1-h group sessions were conducted. Attitudes towards grief and coping with death were assessed before the mentoring programme began and afterwards, using the Brief Humanizar Scale and the Bugen's Coping with Death Scale, respectively.

Results

In terms of the sense of grieving as measured by the Brief Humanizar Scale, the mean score for the 'Burden' factor was 7 points and for the 'Change' factor it was 28.6, indicating that suffering makes more sense as a lever for positive change than as a burden. Regarding Bugen's Coping with Death Scale, the mean score was 127.8 points before the mentoring programme and 139.2 afterwards. Hence, the score after the mentoring programme increased by 11.4 points, improving strategies to cope with death.

Conclusion

Medical professionals must cope with death and end-of-life patients. In addition to scientific knowledge, students need to acquire competencies for better coping with the death of patients, with mentoring programmes helping to enhance this process of learning.

Narrative and its discontents

This review considers recent challenges to, and changes within, narrative medicine as a paradigm for humanities-based medical education. It suggests that, while narrative medicine has often been criticised for emphasising narrative at the expense of other dimensions of human experience, newer criticism has focused more on its relationship with other areas of medical knowledge. In different ways, recent work has shown greater interest in taking in humanities perspectives on their own terms, rather than (this is the charge against narrative medicine) instrumentalising them as diagnostic tools. The review concludes by considering how these criticisms might make their way into the institutional realities of medical education, as well as what they might learn from narrative medicine's success.

Cracking open the eristic rhetoric of contralateral prophylactic mastectomy research or why surgeons should not be so certain about this controversial breast cancer treatment

Contralateral prophylactic mastectomy (CPM) is a controversial breast cancer treatment in which both breasts are removed when only one is affected by cancer. Rates of CPM have been rising since the late 1990s, despite surgeons' strong agreement that the procedure should not be performed for average-risk women. This essay analyses that agreement as it is demonstrated in the surgical literature on CPM, arguing that it forms a 'rhetoric of certainty' built on the stark epistemological divide between objective and subjective forms of knowledge that operates in some areas of medicine. Further, the essay argues that this rhetoric of certainty has the potential to function as a kind of eristic rhetoric in which the right conclusion is known prior to any rhetorical exchange. As a way to 'crack open' this certainty, the essay compares the rhetoric of the surgical literature on CPM to the rhetoric of uncertainty in the radiological literature on breast cancer screening for women with a personal history of the disease. The goal of this comparison is not to suggest surgeons should support all choices for CPM. Rather, the aim is to demonstrate that choices against the procedure are not as straightforward as the surgical literature indicates and that the uncertainty affecting women's preferences for CPM is not solely the result of patient misunderstanding and/or emotional instability.

Medical specimens and the erasure of racial violence: the case of Harriet Cole

This article analyses the complex narrative of Harriet Cole, a 36-year-old African-American woman whose body was delivered to the anatomy department of Hahnemann Medical School in 1888. The anatomist Rufus B Weaver used her preserved remains to create a singular anatomical specimen, an intact extraction of the 'cerebro-spinal nervous system'. Initially anonymised, deracialised and unsexed, the central nervous system specimen endured for decades before her identity as a working-class woman of colour was reunited with her remains. In the 1930s, media accounts began to circulate that Harriet Cole had bequeathed her remains to the anatomist, a claim that continues to circulate uncritically in the biomedical literature today. Although we conclude that this is likely a confabulation that erased the history of violence to her autonomy and her dead body, the rhetorical possibility that Harriet Cole might have chosen to donate her body to the medical school reflects the racial, political and legal dimensions that influenced how and why the story of Harriet Cole's 'gift' served multiple purposes in the century and a half since her death.

Integrating person-centred care and social justice: a model for practice with larger-bodied patients

Person-centred care (PCC) has been touted as a promising paradigm for improving patients' experiences and outcomes, and the overall therapeutic environment for a range of health conditions, including obesity. While this approach represents an important shift away from a paternalistic and disease-focused paradigm, we argue that PCC must be explicitly informed by a social justice lens to achieve optimal conditions for health and well-being. We suggest that existing studies on PCC for obesity only go so far in achieving social justice goals as they operate within a biomedical model that by default pathologises excess weight and predetermines patients' goals as weight loss and/or management, regardless of patients' embodied experiences and desires. There remains a dearth of empirical research on what social justice-informed PCC looks like in practice with larger patients. This interview study fills a research gap by exploring the perspectives of 1) health practitioners (n=22) who take a critical, social justice-informed approach to weight and 2) larger patients (n=20) served by such practitioners. The research question that informed this paper was: What are the characteristics of social justice-informed PCC that play out in clinical interactions between healthcare practitioners and larger-bodied patients? We identified five themes, namely: 1) Integrating evidence-based practice with compassionate, narrative-based care; 2) Adopting a curious attitude about the patient's world; 3) Centring patients' own wisdom and expertise about their conditions; 4) Working within the constraints of the system to advocate for patients to receive equitable care; 5) Collaborating across professions and with community services to address the multifaceted nature of patient health. The findings illustrate that despite participants' diverse perspectives around weight and health, they shared a commitment to PCC by upholding patient self-determination and addressing weight stigma alongside other systemic factors that affect patient health outcomes.

The medical humanities at United States medical schools: a mixed method analysis of publicly assessable information on 31 schools

INTRODUCTION

There have been increasing efforts to integrate the arts and humanities into medical education, particularly during undergraduate medical education (UME). Previous studies, however, have focused on courses and curricular programming without rigorous characterization of the associated paracurricular environment or infrastructure enabling or facilitating these offerings.

METHODS

To assess opportunities for students to engage the arts and humanities during their medical education as well as the institutional resources to support those opportunities, we developed the Humanities and Arts Programming Scale (HARPS): an 18-point scale involving eight sub-domains (Infrastructure, Curricular Opportunities, Extracurricular Engagement, Opportunities for Immersion, Faculty Engagement, Staff Support, Student Groups, and Scholarship). This scale was used to evaluate the top-31 ranked United States medical schools as determined by US News and World Report's (USWNR) Medical School Research Rankings using information derived from public-facing, online information.

RESULTS

Mean cumulative HARPS score was 11.26, with a median score of 12, a standard deviation of 4.32 and a score range of 3-17. Neither USWNR ranking nor private/public institution status were associated with the cumulative score (p = 0.121, p = 0.739). 52% of institutions surveyed had a humanities-focused center/division with more than 70% of the schools having significant (> 5) faculty engaged in the medical humanities. 65% of schools offered 10 or more paracurricular medical humanities events annually, while 68% of the institutions had more than 5 medical humanities student organizations. While elective, non-credit courses are available, only 3 schools required instruction in the arts and humanities, and comprehensive immersive experiences in the medical humanities were present in only 29% of the schools.

CONCLUSIONS

Although there is a significant presence of the medical humanities in UME, there is a need for integration of the arts and humanities into required UME curricula and into immersive pathways for engaging the medical humanities.

Meeting up in broken word/times: communication, temporality and pace in neuromixed writing

The article investigates letter writing as a way to explore neurodiverse collectives, neuromixed communication and neurodiverse research collaboration. From the perspective of neurodiversity studies and translation practice/studies, the article negotiates new perspectives of inherited images of neurological selves and others, such as the non-autistic as the 'typical' in contrast to the 'atypical' autistic person. Experimenting with autistic time, allowing different sensory modalities and different approaches to time, detail and narrative, the article challenges deficit approaches to autism. Through a letter writing practice the possibilities and challenges of subjectivity, cultural translation and writing as method are examined. The article suggests that 'counter narratives' are important sources of knowledge as they reclaim personhood from dehumanising perspectives. By performing neuromixed conversation and dialogue with theoretical concepts, and pen paling as play as a fruitful form for responsible cross-neurotype translation, the article illuminates challenges and opportunities in neurodiverse collective writing.

Normality and Disability in H. G. Wells's "The Country of the Blind"

Describing someone as disabled means evaluating their relationship with their environment, body, and self. Such descriptions pivot on the person's perceived limitations due to their atypical embodiment. However, impairments are not inherently pathological, nor are disabilities necessarily deviations from biological normality, a discrepancy often articulated in science fiction via the presentation of radically altered environments. In such settings, non-impaired individuals can be shown to be unsuited to the world they find themselves in. One prime example of this comes courtesy of H. G. Wells's "The Country of the Blind." This paper demonstrates science fiction's capacity to decouple disability's normative quality from classical medical models stemming from the medical Enlightenment movement by challenging the idea of the biologically normal. It first provides a brief account of disability before exploring the concept of medical normality. It then problematizes the biologically consistent being, arguing that health is only understandable when environmentally situated. Next, the paper provides an overview of "The Country of the Blind" before analyzing how it challenges the idea of biological normality, framing it as a social product rather than a universal constant. Finally, the paper concludes that science fiction narratives effectively interrogate our world's seemingly consistent trends by envisioning (un)desirable alternatives.

Performing HeLa: theatrical bodies and living remains

As a biomedical entity that has been the subject of a plethora of artistic and cultural projects, HeLa, the first immortal human cell line, calls for investigations into the human. Extracted and cultured from the cervical tumour of African-American woman, Henrietta Lacks, at Johns Hopkins Hospital in 1950s' Baltimore, HeLa's robust capacity to grow has ensured its role in numerous medical advances. The first part of this essay synthesises scientific, sociocultural, familial and philosophical perspectives on HeLa, while the second half applies these perspectives to a reading of a theatrical production, HeLa (2013), written and performed internationally by black British artist Adura Onashile. The discussion considers ways in which prevailing cultural narratives that situate Lacks as a victim, dispossessed of bodily agency in life and after death, might delimit productive possibilities for thinking about Lacks as a contributor to biotechnological progress, and about HeLa as a living remain. Lacks' labour in the creation of HeLa may have been unwitting, but her role in biotechnological progress is profound in that it is constitutive. Onashile's solo performance-its deft choreography moving across the subjectivities of patient, physician and family-presents the political fact of black female corporeality as part of its exploration of scientific innovation. The theatrical registers of Onashile's HeLa open up and nuance imaginings of Lacks/HeLa, moving beyond monolithic conceptions of medical research by creatively investigating Lacks' scientific contribution in the midst (and in the wake) of medical exploitation.

'Freudism' and modernity: transcultural impact of psychoanalysis in the modern Turkish novel

The theory of psychoanalysis came to Turkey in the early 1900s, but it was dismissed as being unmedical in a psychiatric context shaped by the Kraepelinian model. Still, it rapidly entered the intellectual discourses of the period, and in literature, it became a contact zone to discuss broader issues concerning the modernisation of the country. Novelists in particular undertook a critique of its epistemology to explore what they deemed the conflictual relationship between the native values and the westernising attitudes as broadly conceived at the time. Two early examples of such novelistic engagements with psychoanalysis are Peyami Safa's Matmazel Noraliya'nın Koltuğu and Ahmet Hamdi Tanpınar's Saatleri Ayarlama Enstitüsü This article focuses on the novelists' engagement with psychoanalysis in their critique of the modernisation project adopted in Turkey through the theme of the 'self-in-crisis'. Both texts contribute to the broader discussions of their milieu in a way that presents psychoanalysis as being representative of that which is modern and portray it critically to underline the dissonances between the old, traditional values and the new, imported ones.