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.

They are not all wolves: menstruation, young adult fiction and nuancing the teenage boy

Before the 2020 publication of Elana K. Arnold's Red Hood and Sarah Cuthew's Blood Moon, Judy Blume's 1970 novel Are You There God? It's Me, Margaret, which ends with the heroine praising God for blessing her with menarche, was one of the only young adult novels to feature menstruation as a central theme. This paper opens with a brief overview of recent English and American menstrual activism and a discussion of scholarly considerations of the menstrual cycle in literature. Then, through a close comparative reading of works by Arnold and Cuthew, I argue that both novels fulfil their feminist agendas by representing the stigmatised experience of the physicality of menses, and by depicting young women negotiating instances of the kinds of misogyny that punctuate contemporary Western culture. At the same time, the novels share an overly simplistic, binarised attitude towards male adolescents. That aspect highlights the need for the development of affirmative feminist boys studies. Such progress would foster more nuanced literary depictions of young males-and address the challenges of building a more equitable world, thereby responding to some of the motivating concerns of Red Hood and Blood Moon.

Intrusion of the other: identity, ethics and transplantation in Sui Ishida's Tokyo Ghoul

This essay examines the profound themes and complex narratives presented in Sui Ishida's Tokyo Ghoul, focusing on the illegal xenotransplantation and the transformation of the protagonist, Ken Kaneki, as he undergoes ghoulification. It delves into concerns surrounding patient autonomy and the integrity of medical procedures within organ transplantation, raising thought-provoking questions about identity and the process of reconciling one's sense of incompleteness in the context of xenograft research aimed at surpassing the transplantation. Through his transformation into a ghoul, Kaneki embodies the challenges faced by individuals undergoing organ transplantation and the profound impact it has on their sense of self, relationships and societal acceptance. The essay offers an insightful analysis of the stages of Kaneki's ghoulification, shedding light on the interplay between medical technology, power dynamics, oppression and personal agency. It draws connections to philosophical and literary works, such as Jean-Luc Nancy's reflections on organ transplantation and Kafka's The Metamorphosis, to enhance the exploration of themes within Tokyo GhoulIn this essay, a comprehensive examination of the intricate dynamics of power, control and oppression within medical technology takes place. It underscores the challenges Kaneki faces as he navigates his transformed body and grapples with societal prejudices and discrimination. The essay critically reflects on the complex interplay of power, identity and ethics within the context of Tokyo Ghoul, prompting contemplation of the multifaceted dimensions of human existence and the societal structures that shape our understanding of identity, autonomy and acceptance. Kaneki's transformation serves as a lens through which readers can examine the nuanced complexities and challenges associated with organ transplantation, medical ethics and the social implications of difference. By exploring the multifaceted themes and intricate narratives of Tokyo Ghoul, this essay considers the profound implications of xenotransplantation and the ethical considerations that arise in medical practice.

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.

Bubbles and lockdown in Aotearoa New Zealand: the language of self-isolation in #Covid19NZ tweets

In March 2020, as cases of COVID-19 were found in Aotearoa New Zealand, the government moved to eliminate community transmission of the virus through self-isolation. During this month, as the population discussed if, when and how households would be asked to stay at home, terms such as lockdown-the state of (national) closure-and bubble-the household isolating together-became common parts of everyday conversation.In this article, we blend quantitative and qualitative research methodologies from corpus linguistics, literary studies and the medical humanities to compare the affective range of the terms lockdown and bubble as they were used in tweets containing the hashtag #Covid19NZ. Both lockdown and bubble are metaphors of containment that provided different ways of understanding and engaging with government stay-at-home measures by highlighting and minimising different aspects of the event. We found that while the strong, prison connotations of lockdown were reflected in discussions of the measure as a tough form of control exercised from above, the lighter associations of the term bubble led to the perception of this measure as more malleable and conducive to exertion of individual control. Yet, although the seemingly restrictive range of lockdown made it a useful term for the expression of negative affect, the term was actually more frequently used with neutral or unclear affect to share information. Conversely, while bubble tweets expressed more positive sentiment, humour and support towards government stay-at-home measures, this rendered the term surprisingly restrictive in its potential uses: its lightness makes it an effective way to limit the expression of antilockdown sentiment. As Kiwi Twitter users faced the uncertainty of the first COVID-19 lockdown, the pre-existing connotations of the metaphors used to frame stay-at-home measures also helped frame their own experiences of these measures.

Understanding mixed and ambiguous emotions - integrating neurophenomenology and literary studies

This commentary makes three suggestions on Willems' neurocognitive model for understanding mixed and ambiguous emotions and morality. First, it proposes that his atheoretical approach risks unwittingly adopting theoretical and conceptual limitations implicit in reigning paradigms and overlooking the need for theoretical impetus and constraints in the development of valid constructs of targeted emotions. Second, it suggests that a dynamical systems approach to emotions provides a fruitful theory and neuro-phenomenology as a corresponding methodology. Lastly, it proposes that Willems' objective would benefit from a more systematic integration of insights from the humanities into the nature and nuances of literary (moral) emotions.

Fatherlessness, sperm donors and 'so what?' parentage: arguing against the immorality of donor conception through 'world literature'

Is biology and knowing biological ancestral information essential to the construction of identity? Bioethicist James David Velleman believes this is the case and argues that donor gamete conception is immoral because a portion of genetic heritage will be unknown. Velleman is critical of sperm donation and the absence of a biological father in donor-assisted families. His bioethical work, specifically the 2005 article 'Family History', is oft-cited in articles debating the ethics surrounding gamete donations and diverse family formations. However, I wonder to what extent Velleman's ethical stance is exhibited in contemporary culture? Velleman suggests that innate knowledge of bio-superiority helps readers and audiences appreciate the importance of biological family structures in literature and film; he says, 'When people deny the importance of biological ties, I wonder how they can read world literature with any comprehension' (2005, 369). Velleman understands the stories of Oedipus, Moses, Telemachus and Luke Skywalker as demonstrating a universal cultural comprehension that genetics are essential to identity construction. I adopt Velleman's list of stories and ask if they really can support an antidonation sentiment and suggest that most of the stories actually support diverse family structures. By exploring the significance of story-telling in cultural understandings of family and identity, it is possible to identify the ways in which story-telling can impact how society negotiates complex issues such as assisted reproduction, donor conception and donor industry regulation.

Digital hermeneutics: scaled readings of online depression discourses

When it comes to understanding experiences of illness, humanities and social sciences research have traditionally reserved a prominent role for narrative. Yet, depression has characteristics that withstand the form of traditional narratives, such as a lack of desire and an impotence to act. How can a 'datafied' approach to online forms of depression writing pose a valuable addition to existing narrative approaches in health humanities? In this article, we analyse lay people's depression discourses online. Our approach, 'digital hermeneutics', is inspired by Gadamer's dialogical hermeneutics. It consists of a 'scaled reading' on five different scales: platform hermeneutics; contextual reading with term frequency-inverse document frequency (TF-IDF); distant reading with natural language processing topic modelling; hyper-reading with concordance views and close reading. Our corpus consisted of three data sets, from the blogs and message boards of, respectively, time-to-change.org.uk, a UK-based social organisation and movement that aims to counter mental health discrimination and alleviate social isolation by spreading awareness; Sane.org.uk, a leading UK mental health charity that seeks to help people in facing the challenges of mental illness and to improve quality of life; and the subreddit 'r/depression' on web discussion platform reddit. We found that the manner in which people express experiences of illness online is very much dependent on the specific affordances of platforms. We found degrees of 'narrativity' to be correlated to authorship and identity markers: the less 'anonymous' the writing, generally speaking, the more conventionally 'narrative' it was. Pseudonimity was related to more intimate and singular forms, with less pressure to conform to socially accepted and positive narratives of the 'restitution' type. We also found that interactive affordances of the platforms were used to a limited extent, nuancing assumptions about the polyvocality of online depression writing. We conclude by making a claim for increased cooperation between digital and medical humanities that might lead to a field of 'Digital Medical Humanities'.

'Creative Ferment': abortion and reproductive agency in Bessie Head's Personal Choices trilogy

Using original archival research from Amazwi South African Museum of Literature, this article examines representations of abortion in three novels by Bessie Head: When Rain Clouds Gather (1968), Maru (1971) and A Question of Power (1973). I argue that Bessie Head documents both changing attitudes to terminations of pregnancy and dramatic environmental, medical, and sociopolitical developments during southern Africa's liberation struggles. Furthermore, her fictional writing queers materialism and its traditionally gender-dichotomous origins, presenting an understanding of development which exceeds temporal or national boundaries. Her treatment of human reproduction in both tangible and figurative terms disrupts teleological definitions of exile: separation and loss, rendered through literal and metaphorical abortions, are seen as inherently vital processes for gaining agency in post/colonial southern Africa. Instead of using discourse from contemporary debates about freedom and choice, which are often polarised, I use the term 'reproductive agency' to refer to a continuum of ethical presentness, rooted in considering women's desires. My literary analysis explicitly concentrates on Head's biological imagery of growth and separation and how this ruptures repronormative discourse underpinning colonial expansion in southern Africa. I refer to Head's ethical outlook as a critical form of humanism. My understanding of critical humanism differs from humanism proper in that it relies on queer associations: both queerness as strangeness, and queerness as resistance to categorisation (much like Head's critiques of essentialist national identities). Adapting new materialist theories with postcolonial scholarship, I coin the term 'queer vitality' to argue that abortion involves both tragedy and desire, and that southern African feminist fiction functions as postcolonial theory when the concept of reproductive agency is understood to encompass both individual and collective desires. In Head's words, in her creative worlds, abortion does not signal the ending of a life, but rather a plethora of new possibilities.

A logical development: biomedicine's fingerprints are on the instrument of close reading in Charonian Narrative Medicine

Narrative Medicine as originated by Rita Charon began as an attempt to redress the unopposed biomedicalisation of the medical profession. Although the movement has been self-positioned as a corrective to deliver an ideal of care, it began within the rhetorical framework of biomedicine and not outside of it. Thus, Narrative Medicine justifies itself in biomedical terms, invoking instrumental rationales for its use. This seeming 'scientification' of narrative is only half of the biomedicine-indebted Narrative Medicine story. An equally important but as-yet unmentioned debt is the quasi-scientific origin story of Narrative Medicine's signature method of close reading. Thus, there is an inherent paradox at the heart of the Narrative Medicine movement: designed to resist a reductive biomedicine, it exists in a dependent relationship on biomedicine at the level of justification and at the level of praxis. Thus, it is an open question if the Narrative Medicine movement is the proper vehicle for a rebalancing of humanities and biomedicine.

Science fiction in bioethics: a role for feminist narratology

This article explores the various reasons science-fictional references feature so prominently in bioethical debate, particularly regarding emerging reproductive biotechnologies. It will reflect on how science-fictional references are often co-opted in bioethics scholarship to promote technoconservatism, before considering how bioethicists can engage more appropriately with this genre in practice. This will include a discussion of which kinds of texts might be best suited to stimulate meaningful debate, and how using tools of literary analysis, such as narratology, can maximise the potential benefits of uniting these fields.

Vivisection through the eyes of Wilkie Collins, HG Wells and John Galsworthy

The article argues that, unlike Collins' adamantly negative view towards vivisection in the latter half of the nineteenth century and approaching the end of his writing career and life, Wells and Galsworthy's changing opinions responded to medical advances, reflected the dynamics of public opinion, and their own knowledge and experience at their time of writing. With its primary focus on Galsworthy, the study also explores the reactions of contemporary critics, readers, scientists and medical practitioners to these depictions of vivisection. Above all, the article argues that popular writers, particularly before modern multimedia, greatly influenced public attitudes towards changes in society, including medical research by vivisection. The ultimate change of heart towards vivisection by Nobel Prize winner Galsworthy, an indirect and eminent beneficiary of vivisection, the article concludes, would have boosted public acceptance and the cause of modern medicine.

Making emergency responders visible: working-class responses to industrial disaster in 19th-century journalism and poetry

Hidden beneath the ground in coalmines, or behind the walls of factories, injured bodies of workers have too often been overlooked. Using the 1842 Hartley Colliery disaster as a case study, this paper contrasts journalistic neglect with the ways in which working-class poets illuminated responses to large-scale injury. Often the greatest difficulty in industrial disaster was in securing access to trapped victims. Arriving late on the scene, neither journalists nor doctors were able to influence the outcome of events: in most cases emergency treatment was provided by workers themselves. While journalists struggled to portray these men's stories, working-class poets such as Joseph Skipsey brought attention to their collaborative actions even in the face of injury or death. The actions of these colliers as first responders had a lasting significance, foreshadowing working-class involvement in the wider cultural shift towards collective responsibility for healthcare.

Be still, my beating heart: reading pulselessness from Shakespeare to the artificial heart

Today, patients with heart failure can be kept alive by an artificial heart while they await a heart transplant. These modern artificial hearts, or left ventricular assist devices (LVADs), remove the patient's discernible pulse while still maintaining life. This technology contradicts physiological, historical and sociocultural understandings of the pulse as central to human life. In this essay, we consider the ramifications of this contrast between the historical and cultural importance placed on the pulse (especially in relation to our sense of self) and living with a pulseless LVAD. We argue that the pulse's relationship to individual identity can be rescripted by examining its representation in formative cultural texts like the works of William Shakespeare. Through an integration of historical, literary and biomedical engineering perspectives on the pulse, this paper expands interpretations of pulselessness and advocates for the importance of cultural-as well as biomedical-knowledge to support patients with LVADs and those around them. In reconsidering figurative and literal representations of the heartbeat in the context of technology which removes the need for a pulse, this essay argues that narrative and metaphor can be used to reconceptualise the relationship between the heartbeat and identity.

Out of date: genetics, history and the British novel of the 1990s

This article examines the representation of human genomics in the British historical novel of the 1990s. A form which meditates on the past and its relationship to the present, the historical novel readily lends itself to the exploration of genealogy, heredity and inheritance. Forwarding an understanding of human history, and particularly of family history, as a direct and causal function of the genes, the neo-Darwinian explanation of the genome popular in the 1990s similarly advanced its own teleological relationship between past and present. Reading Jenny Diski's Monkey's Uncle (1994), A S Byatt's Babel Tower (1996) and Zadie Smith's White Teeth (2000), this essay argues that the historical novel provides a unique form with which to critique the deterministic view of heredity promoted by neo-Darwinism. Focusing on moments of textual anachronism, asynchronicity and repetition in these family sagas, it shows how-at its most transgressive-the historical novel imagines temporal disruptions that bring the present into contact with the past in ways that defamiliarise conventions of linearity, order and progress. Refusing the idea of human history as a single, legible line that underpins neo-Darwinian ideas of genetic inheritance, Diski, Byatt and Smith's novels are able to interrogate both the temporal logics and cultural capital of 1990s genetic science. While the decade was shaped and defined by popular science speculation and large-scale genetic research projects, such as the Human Genome Project (1990-2003), the novels addressed in this essay ultimately suggest the lively and seductive genocentrism of the 1990s to be inadequate to the task of explaining the complexity and meaning of the lived genome. As Diski, Byatt and Smith's novels anticipate, the question of the uses, meanings and value of the human genome sequence continue to be of relevance within our current, postgenomic era.

Counterdiagnosis and the critical medical humanities: reading Susanna Kaysen's Girl, Interrupted and Lauren Slater's Lying: A Metaphorical Memoir

This article is about the complicated intersections of mental illness, diagnosis and narrative in life writing. It analyses challenges posed to the authority of diagnosis-both as medical label and mode of reading-within two memoirs about mental illness and celebrates the ensuing literary innovation in each text. As such, this article is situated as part of the continuing move within the critical medical humanities to develop more sophisticated readings of illness narratives and emphasises the importance of the role of literary studies to achieve this aim. Borrowing from and expanding Margaret Price's concept of the counterdiagnostic as a tool that challenges a reader's urge to explain, clarify and contain a narrator with mental disabilities, I will read Susanna Kaysen's Girl, Interrupted (1993) and Lauren Slater's Lying: A Metaphorical Memoir (2001) as two texts that challenge the organising structures of medical authority as they are manifested in diagnostic processes. In so doing I will reflect on the work of illness narratives and the force of the diagnostic moment, understood as a violent misreading of the expressions of mental illness in texts. My readings of these memoirs demonstrate how the material locations and political aesthetics of counterdiagnosis undermine the limited figuration of narrative offered by much work in narrative medicine, and deconstruct diagnosis, both in a medical and literary capacity. Counterdiagnosis is, then, posited as a crucial means of further opening up the analysis of illness narratives, specifically those of mental distress.

Reading heredity in racist environments: epigenetic imaginaries in Bessie Head's The Cardinals

The field of epigenetics research shows us how we are constructed by what is without-materially, socially and environmentally-while also taking us beyond narrow genetic determinants of heredity. If misappropriated, epigenetics research risks pathologising particular social or ethnic groups as biologically damaged. However, epigenetics may also allow us to better conceptualise the biopsychosocially constitutive nature of racist environments. In this article, I argue that epigenetic understandings of embodiment allow us to follow Achille Mbembe's recommendation: that to account for postcolonial relations of power-their effectiveness and psychology-we need to go beyond the binary categories (like passivity vs resistance) so frequently deployed in the analysis of domination. To demonstrate this, I offer a literary example from apartheid South Africa. In Bessie Head's The Cardinals, embodiment is imagined as the hereditary effect of segregated environmental space. The Cardinals thus offers something like a literary imagining of the epigenetic (as a material change that is heritable), before contemporary advances in epigenetics research made the connection between environment and embodiment more sensible in molecular terms. Head radically calls into question the certainty of biological identity: characters are 'marked' deterministically by their environments but ultimately the mutability of such 'epigenetic' markers is revealed when the individual transcends apartheid's spatial and racial demarcations. Writing in the context of apartheid, Head's engagement with non-genetic understandings of identity is a motivated attempt to evade the stigmatising categories and 'genetic' assumptions of scientific racism, which constructed races as biologically distinct (modern genetic science shows us that there is no genetic basis for 'race'). Instead, Head positions environmental spaces, including the Indian Ocean (a conduit for South Asian arrivals and for new philosophies and the potential political affiliations that arrive with them) as points of genealogical origin and as constitutive of identity in non-deterministic ways.

Neurological disorders, affective bioethics, and the nervous system: reconsidering the Schiavo case from a materialist perspective

This article proposes a novel approach to bioethics, referred to as "affective bioethics", which draws on traditions in anthropology, science and technology studies, disability studies, and Spinozist materialism. By focusing on the case of Michael and Terri Schiavo, in which Terri's personhood and subjectivity are challenged by dominant forms of neurological reductivism in the USA, this article suggests that approaching her condition as a set of relations with the people in her life and her socio-technical environment may have helped to develop new ways to conceptualise personhood and subjectivity moving beyond the view of her as a non-person. Drawing on Michael Schiavo's memoir of his legal battles, and Terri's diagnosis and care, this article shows how Terri's connections to the world disrupt American ideas about the isolatable individual as the basis for personhood and subjectivity. Attending to these interpersonal and socio-technical connections focuses bioethical attention on the worlds that individuals inhabit, and how those worlds might be designed to make more kinds of life livable and new forms of personhood and subjectivity possible.

Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research

Compared with self-help bibliotherapy, little is known about the efficacy of creative bibliotherapy or the mechanisms of its possible efficacy for eating disorders or any other mental health condition. It is clear, however, that fiction is widely used informally as a therapeutic or antitherapeutic tool and that it has considerable potential in both directions, with a possibly significant distinction between the effects of reading fiction about eating disorders (which may-contrary to theoretical predictions-be broadly negative in effect) or one's preferred genre of other fiction (which may be broadly positive). Research on creative bibliotherapy, especially systematic experimental research, is lacking and requires a medical humanities approach, drawing on knowledge and methods from psychology and cognitive literary studies as well as clinical disciplines to expand our understanding of how the dynamic processes of interpretation mediate between textual structures and characteristics of mental health and illness.

'Geraniums (red) and Delphiniums (blue)': Trauma, Ethics, and Medical Communications

More official complaints about medical treatment in the UK relate to poor communications than to wrong diagnoses. This article, in considering the importance of communications training for clinicians, is structured into three sections. From use of a story that introduces the idea of miscommunication and trauma in the first section, the article moves, in the second, to a theorisation of trauma as a concept, addressing issues of intersubjectivity, the relationship between embodied and psychological being, and ethics. From this, the third section engages directly with medical communications training, exemplifying a particular literary-studies approach to matters of communication.

Hopeless Cases: Queer Chronicities and Gertrude Stein's "Melanctha"

For this contribution to the special issue on "Mapping Queer Bioethics," the author offers a reflection on the nature of the literary, written word as the ethically fraught site of queer bioethics. By invoking the historical tendencies and tropes of the clinical case history alongside a seminal text by Gertrude Stein, the author at once asks if we should liberate a queer bioethics from biomedical discourse via mainstream narrative; or if we should see this strategy as unavoidably housed in narrative forms of storytelling because it echoes the tropes and stakes of the clinical, pathologized case history as regards queer sensibilities.