Improvisation and authority in illness meaning

Using the example of psychosomatic diagnosis, I argue that the clinical context has unique epistemological constraints that limit the certainty of diagnosis and so make meaning indeterminate for sufferer and healer. As a result, forms of clinical truth are borrowed from the therapeutic context to create and authorize meanings for ambiguous or ill-defined conditions and inchoate suffering. Diagnostic interpretation is concerned with classification and legitimation through the production of authoritative truth. In contrast, therapeutic interpretation is fundamentally concerned with the pragmatic problem of how to continue and hence, with the improvisation of meaning. These different ends give rise to tensions and contradictions in psychosomatic theory and practice. While authority is necessary to provide a structure on which variations of meaning can be improvised, authoritative meanings may also restrict the possibilities for invention by clinician and patient. The goal of patient and physician is to create enough certainty to diminish the threat of the inchoate while preserving enough ambiguity to allow for fresh improvisation. Accounts of illness meaning must recognize the interdependence of normative rigidity and metaphoric invention.A RUMBLING: truth itself has appeared among humankind in the very thick of their flurrying metaphors.     

Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: After diagnosis of a dementing illness patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine in an objective-oriented group intervention the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of care-givers. METHODS: During the years 2011-12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in for usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (10 participants/group) once a week for 8 weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. DISCUSSION: This is a "proof -of-concept" study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.     

Spirits and spiritist therapy in Southern Brazil: A case study of an innovative,syncretic healing group

This paper examines the treatment of patients by a group of Spiritist healers in southern Brazil. After describing and analyzing a healing session, the practices are shown to be deviant from conventional Spiritism in two directions: (1) they employ a technique, called apometry, that they claim makes possible the transportation of a part of the patient's body to the astral world where it is treated by disincarnate doctors who do past life regressions; and (2) although a conventional Spiritist disobsession is performed, the healers invoke rival Afro-Brazilian spirits who often are shown to have caused the patient's symptoms.Building on the work of Csordas (1983), 1 hypothesize that the discourse employed by the healers moves the patient to a new reality or phenomenological world in which s/he is healed not in the sense of being restored to the state in which s/he existed prior to the onset of illness, but in the sense of being rhetorically moved into a state dissimilar from both pre-illness and illness reality... (Csordas 1983:346). The new state, in this case, is the world of Spiritism. Unlike the Catholic Pentecostals Csordas studied who already were members of a primary group of believers, however, the patients treated by the Brazilian healers are mostly unaffiliated individuals who face the increasing uncertainty and insecurity of life in disorganized, anomic, urban Brazil. By encompassing modern science on the one hand, and aspects of the Afro-Brazilian traditions on the other, this healing group appeals to the often distraught white middle and lower-middle classes, providing them with therapeutic meaning that in many cases leads to healing, conversion, and the sense of security and safety that often accompanies identifying with and belonging to a religious group.     

The sociocultural context of nursing in Japan

Both by the standards of American nurses and in the eyes of the Japanese public, nurses in Japan appear subservient. In this paper I explore this situation from three perspectives. Most Japanese nurses lack a sense of professionalism which the nursing elite in Japan as well as sociological theory attributes to the low educational levels of the nurses. The second perspective investigates the nurses' functional role as intermediary between the medical world and the many patients who regard physicians as socially distant. Thirdly, Japanese nurses might be considered the housewives of the hospital in terms not only of their physical duties but also of their caretaking role. If the housewife analogy holds, the values, behavior, and attitudes that give Japanese housewives their satisfaction and their autonomy would considerably alter the role of the nurse in the delivery of cosmopolitan medical care.     

Health in exchange: teachers,doctors, and the strength of informal practices in Russia

This article explores teachers' and doctors' informal medical exchange practices in the context of the transforming health care system in post-Soviet Russia. Despite the advent of a medical marketplace, most Russians have low incomes and cannot buy the goods and services the market offers. Instead, they bypass the formal market mechanisms (such as obtaining cheaper medicine through personal connections) and official procedures (such as obtaining free or cheaper health care services despite the emergence of paid services) by using their social networks. This paper uses a network perspective to investigate how doctors' and teachers' mutual relations are formed and what resources form the basis of these informal exchange practices. Drawing on structured diary data and qualitative interviews with 20 teachers, in addition to interviews with eight doctors in St. Petersburg, the study goes beyond mere statistics on health care and attempts to depict from below the implications health and illness have for survival in contemporary Russia.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems     

The gene in search of an identity

Summary The concept of the difference between the potential for a trait and the trait proper, i.e., between the genotype and the phenotype, became clear only during the first decade of the century, mainly through the work of Johannsen. Although Johannsen insisted on that the terms he coined were only helpful devices to organize data about heredity, it is obvious that they were bound from the beginning to the hypothesis that there was something in the gametes that could be rendered to analysis as discrete units. These units were the genes.This reductionist yet materially non-committed attitude has been developed into what I called instrumental-reductionism: the genes were hypothetical constructs that were accepted as if they were real entities. The research program developed on such a concept was very successful, not least because this instrumental approach allowed maximum flexibility in the attachment of meaning of the genes. While most geneticists accepted one or another position of this flexible concept, others took more extreme positions. At the one extreme end of the conceptual continuum was the realist approach that argued that genes were discrete, measurable, material particles, and on the other end, the claim that the attempts to identify discrete units only led to hyperatomism of a holistic view appropriate to heredity.The acceptance of the gene as a material and discrete unit, in the beginning of 1950s, opened the way to a deeper level of conceptualizing both its structure (cistron-recon-muton) and function (one gene—one enzyme). The discovery of the structure of DNA finally offered a chemical-physical explanation to the geneticist's requirements of a material gene. Thus, within less than 20 years the gene has been established as a sharply limited segment of the linear structure that is involved in the structrue of a product or its regulation.However, with turning of much of the attention to the eucaryotic DNA, it was necessary to accommodate the gene to an increasing flood of findings that did not tally with its concept as a discrete material unit. Without much heart-seeking among geneticists, the gene regained its role as an instrumental unit, or even as just an intervening variable, a quantity obtained by specified manipulation of the values of empirical variables. Though this flexibility demonstrated again that the most fruitful concepts are those to which it is impossible to attach a well defined meaning, it brought us also into a situation in which the same term has a different meaning for each group of scientists. In order to avoid the danger to be scattered over the face of all the earth because of lack of communicable language, it might be advisable to halt a little and reflect on the meaning of our concepts and their function.     

T.H. Morgan,neither an epistemological empiricist nor a “Methodological” empiricist

T. H. Morgan (1866–1945), the founder of the Drosophila research group in genetics that established the chromosome theory of Mendelian inheritance, has been described as a radical empiricist in the historical literature. His empiricism, furthermore, is supposed to have prejudiced him against certain scientific conclusions. This paper aims to show two things: first, that the sense in which the term empiricism has been used by scholars is too weak to be illuminating. It is necessary to distinguish between empiricism as an epistemological position and the so-called methodological empiricism. I will argue that the way the latter has been presented cannot distinguish an empiricist methodology from a non-empiricist one. Second, I will show that T. H. Morgan was not an epistemological empiricist as this term is usually defined in philosophy. The reason is that he believed in the existence of genes as material entities when they were unobservable entities when they were unobservable entities introduced to account for the phenotypic ratios found in breeding experiments. These two points, of course, are interrelated. If we were to water down the meaning of empiricis, perhaps we could call Morgan an empiricist. But then we would also fail to distinguish empiricism from realism.     

Evaluación del efecto del sentido de coherencia en la carga percibida y en la adherencia a un programa psicoeducativo para cuidadores informales de personas dependientes

Introduction

The care of dependent persons is arduous, and requires time, energy, and physical effort on the part of caregivers. Personal characteristics, such as the sense of coherence (SOC), can influence the perceived burden and care giving.

The heart of what's the matter The semantics of illness in Iran

Our understanding of the psychosocial and cultural dimensions of disease and illness is limited not merely by a lack of empirical knowledge but also by an inadequate medical semantics. The empiricist theories of medical language commonly employed both by comparative ethnosemantic studies and by medical theory are unable to account for the integration of illness and the language of high medical traditions into distinctive social and symbolic contexts. A semantic network analysis conceives the meaning of illness categories to be constituted not primarily as an ostensive relationship between signs and natural disease entities but as a syndrome of symbols and experiences which typically run together for the members of a society. Such analysis dirests our attention to the patterns of associations which provide meaning to elements of a medical lexicon and to the constitution of that meaning through the use of medical discourse to articulate distinctive configurations of social stress and to negotiate relief for the sufferer. This paper provides a critical discussion of medical semantics and develops a semantic network analysis of heart distress, a folk illness in Iran.     

Constructing Alzheimer's: Narratives of Lost Identities,Confusion and Loneliness in Old Age

This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the Boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families.     

‘Mental’ in ‘southie’: Individual,family, and community responses to psychosis in South Boston

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of going mental and being mental in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual.     

The meaning of nervios: A sociocultural analysis of symptom presentation in San Jose,Costa Rica

The foundation of the symbolic tradition in medical anthropology is the examination of a patient's experience of a category of illness. The interpretation of folk explanations of etiology and nosology provides insight into the cultural definition of what constitutes an illness, how and why an illness is labeled, and how the afflicted individual should be treated. Further, the analysis of sociocultural meaning emerges as a critical theoretical contribution to our understanding of health and culture.Allen Young in his article Some Implications of Medical Beliefs and Practices for Social Anthropology suggests ... that if we want to learn the social meaning of sickness, we must understand that signs, whatever their genesis, become symptoms because they are expressed, elicited, and perceived in socially acquired ways (1976: 14). He further states that some categories of sickness are particularly interesting in that they enable people to organize the illness event into an episode that has form and meaning (1976: 19–20). Nervios is an example of a symptom that has acquired a special sociocultural pattern of expression, elicitation and perception in San José, Costa Rica. The empirical study of symptom presentation in general medicine and psychiatric outpatient clinics describes the patients who present the symptom and their associated attributes and explanations of the symptom's occurrence. The meaning of nervios is then discussed within a social interactional and symbolic framework.     

Pictures,Preparations, and Living Processes: The Production of Immediate Visual Perception (<Emphasis Type="Italic">Anschauung</Emphasis>) in late-19th-Century Physiology

This paper addresses the visual culture of late-19th-century experimental physiology. Taking the case of Johann Nepomuk Czermak (1828–1873) as a key example, it argues that images played a crucial role in acquiring experimental physiological skills. Czermak, Emil Du Bois-Reymond (1818–1896) and other late-19th-century physiologists sought to present the achievements and perspective of their discipline by way of immediate visual perception (unmittelbare Anschauung). However, the images they produced and presented for this purpose were strongly mediated. By means of specifically designed instruments, such as the cardioscope, the contraction telegraph, and the frog pistol, and of specifically constructed rooms, so-called spectatoriums, physiologists trained and controlled the perception of their students before allowing them to conduct experiments on their own. Studying the material culture of physiological image production reveals that technological resources such as telegraphy, photography, and even railways contributed to making physiological facts anschaulich. At the same time, it shows that the more traditional image techniques of anatomy played an important role in physiological lecture halls, especially when it came to displaying the details of vivisection experiments to the public. Thus, the images of late 19th century physiology stood half-way between machines and organisms, between books and instruments.This paper was written in the context of ten project, The Experimentalizaiton of Life: Configurations of Life Sciences, Art, and Technology (1830–1930). The project is based at the Max Planck Institute for the History of Science (Dept. III: Hans-Jörg Rheinberger), Berlin, and receives funding from the Volkswagen Stiftung, Hannover. A first draft of this paper was presented, accompanied by Sven Dierig on the Virtual Laboratory, at the Institute of Theater Sciences, Free university Berlin, in December 2000. I would like to thank Sven Dierig and the other members of the project as well as Nick Hopwood, Skúli Sigurdsson and the anonymous referees and the editors of this journal for their helpful comments on an earlier version of this paper. Thanks also to Laurie McLaughlin and Nancy Anderson for helping me with the English version of the text.     

Between folk concepts of illness and psychiatric diagnosis: Kitsune-tsuki (fox possession) in a mountain village of Western Japan

Two cases of kitsune-tsuki (fox possession) in a mountain village are examined from psychiatric and ethnographic viewpoints. Kitsune-tsuki, one of the most familiar expressions of madness in Japan, represents, as an interactive performance, religious and mythopoetic contexts metaphorically in time of crises. The atypical symptoms and the complicated clinical process of these cases reflect a multistratified cultural background and its transformation; communal religion, folk tales, kyôgen play, shared concepts of illness, and the post-war rise of one religious cult. The psychiatric diagnosis, trying to arrive at a single correct understanding, partially translates the entangled indigenous illness. Focusing on these issues; the dichotomy between form and content of mental illness, the atypicality of the symptoms and the restructive process of illness experiences, the author reconsiders the possibility of interpretation, diagnosis and treatment which respect the multiple realities.     

Polygonal inequalities as a key to neuronic equations

Neuronic or decision equations, first proposed as a mathematical model of neural activity, have shown, after their exact, compact solution was found, typical behaviours that make them natural tools for General Systems studies. It is shown here that their mathematical investigation is remarkably furthered by generalizing the triangular inequality to polygonal ones. These permit the immediate computation of the tensorial expansion of linearly separable boolean functions, and exhibit clearly the connection between their continuous and discontinuous aspects.     

Adjustment,the hands and healing

Chiropractic is the largest unorthodox health profession in the United States. It is licensed in all 50 states and its services covered by governmental and private health insurance. Yet chiropractic remains, in the opinion of medical commentators, an unscientific healing cult. Chiropractic holds that much illness is caused, directly or indirectly, by derangements in homeostasis that result from subtle vertebral malalignments called subluxations. Only a minority of straight chiropracters continue to provide spinal manipulation as their only treatment, while the majority mixers have embraced physical therapy, vitamin supplements and a wide variety of drugless symptomatic treaments Clinical trials suggest that spinal manipulation has short-term benefit in back pain, but the success of chiropractic is not fully explained by that effect. The clinical art, though, as manifested in the chiropractor-patient interaction contributes greatly to chiropractic healing. This process promotes patient acceptance and validation, fulfills expectations, provides explanations and engages the patient's commitment. The same process lies at the core of the art of medicine. Seeing the clinical art as it functions in chiropractic can help us to understand its independent power in medicine.     

The brachial plexus of a capuchin monkey (Cebus capucinus)

Brachial plexuses of an adult female capuchin monkey (Cebus capucinus) were observed macroscopically. The main characteristic features of the organization of the plexus were as follows:Substantially the same organization was observed in the plexuses on both sides. The plexuses were formed by the union of the 5th–8th cervical nerves and the 1st thoracic nerve. The component from C5 contributed only to the superior posterior division; consequently the superior trunk in the strict sense was lacking. The medial cord was a peripheral extension of the inferior anterior division and formed a common trunk with the lateral root of the median nerve. Therefore, the medial root of the median nerve in the strict sense was absent, and the median nerve arose from the common trunk with the ulnar nerve. In the plexus on the right side, a long aberrant branch was found, which arose as an extra anterior divison of the middle trunk and joined peripherally the medial cord at a point where the cord formed the common trunk with the lateral root of the median nerve.These findings were compared with previous data obtained from other primates.