HLTB50 Final Exam

What is Health Humanities?

Health humanities is an interdisciplinary field of study that akss and incorporates the arts with the field of health and illness. It looks into the human condition in its complexity, uncertainty and vulnerability.

What are 2 definitions of health covered?

1. A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

2. Health is seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.

What are the humanities?

The humanities are a cluster of disciplines that study how people process and document the human experience through creative and/or intellectual expression. Often distinguished from the empirical approaches typical of the natural (and some social) sciences• i.e., critical, speculative, creative, and historical methods.

Involves critical inquiry (analysis of judgement) and aesthetics (principles of beauty and artistic taste).

What is epistemology?

Principles and theories of knowledge.

What is the biomedical perspective of health and illness?

This perspective of health focuses on biological factors in the attempt to understand a medical illness or disorder. It excludes psychological and social factors.

What is the public health perspective of health and illness?

This perspective studies the patterns, causes and effects of health and disease conditions in defined populations, often by identifying risk factors for disease and targets for preventative healthcare.

What is the anthropological perspective of health and illness?

Systematic study of human social life, groups, and societies, often with an emphasis on the way in which groups of people act toward, respond to, and influence each other. Its definitions of health and perspective focus on social, political and cultural interests.

What do the arts and humanities add to our critical understandings of health?

A means of better understanding the individual experiences of health and illness through critical and creative texts, stories, and creative art works.

What is an example of arts and design in healthcare using health humanities?

Studies suggest aesthetically-deprived hospital rooms result in poorer patient recovery.

What is an example of art therapy and its usefulness?

Uses the creative process of making art to improve a person's physical, mental, and emotional well-being.

According to the health humanities reader, what's missing in vocational training?

It leaves out everything that makes us uniquely human. Where [in health professional education] do we train for understanding, suffering and joy? ... Where do we gain perspective on our own life, on others', and the relationships between them? These things don't just happen, however much we like to believe they do.

What is the importance of the "aesthetics" in the health humanities?

Reading for specific textual elements (POV, plot, imagery, setting, etc.) as well as subtlety, ambiguity, rich detail.

To encounter, sensitively, "words in their personal and social contexts and when several things are being said at once".

Poetics

- How a text's many elements synthesize to produce certain effects on the reader.

Rhetoric

- The use of language to produce a persuasive or impressive effect on its audience.

What is the difference between medical humanities versus health humanities?

Medical humanities focuses on education of health professionals to enhance their understanding of human condition, illness and patient care. It's primarily concerned with the physician-patient relationship.

Health humanities takes a broader approach to understanding health and wellness in society (SDOH, health inequalities) and is relevant to a wider audience.

What is moral reflection in the health humanities?

Moral reflection engages cultural perspectives on health and illness, social justice and the moral dimensions of patient encounters. It's a tool for imagining concrete ways in which people differ from one another.

What is empathy training?

The ability to understand and appreciate another person's feelings and experiences. The effect is to suspend the reader's own POV and enter the reality of another character or another world.

When teaching and learning health humanities, what are the 3 aspects to keep in mind?

1. Empathy Training.

2. Moral Reflection.

3. Aesthetics.

What is Arthur Frank's "Being a Good Story"? Why is it so influential to health humanities?

Frank's text proposed a conceptual framework of restitution, chaos and quest narratives of illness.

It opens with a personal anecdote to prompt critical thinking - an example of how to have sensitive, emotionally rich encounters while also being critical. It then describes the health humanities' purpose to prime ourselves to experience inevitable states of illness. Frank argues that storytelling can be therapeutic/healing.

What are the 3 key terms when it comes to creating a good story?

1. Event.

2. Story.

3. Narrative.

What is an "event" in storytelling?

This is a single occurrence in which something happens. There is no story until a second event is introduced.

What is a "story" in storytelling?

A story is when 2 or more meaningful events happen in a sequence.

What is a "narrative" in storytelling?

This is one particular rendering of a story. It can be organized by many thematic and/or formal sylistic categories (non-fiction or fiction) and isn't always written (can be visual too).

What is the difference between a story and a narrative?

Story

- Irreducible substance of a story.

- The factual sequence of events.

Narrative

- The way the story is related.

- How the story is framed or communicated.

- The form the story takes.

What are 4 key distinctions to be made in the health humanities?

1. Disease vs illness.

2. Patient vs ill person.

3. Medical history vs ill person's history.

4. Treatment vs care.

These 4 "Tensions" tend to biomedical vs humanistic perspectives of health. We make these distinctions to "enhance" - enchantment.

Describe disease versus illness.

Disease: condition of the body reducible to biochemistry.

Illness: an experience that involves a biography, a reflective consciousness, multiple relationships and institutions.

Describe patient versus ill person.

Patient: identity imposed a person by medical/health institutions.

Ill Person: a patient only some of the time, and remains many other things as well.

Describe medical history versus ill person's story.

Medical History: this is an understanding of the patient in terms of the nature of the disease, "set parameters" of relevant information that create "illusion" of knowing the ill person.

Ill Person's Story:

The medical patient becomes delimited by his or her history. If the storytelling is truly a relationship, the [ill person] storyteller is invited to reinvent his or her own character... what the storyteller needs the listener to know about him or herself, to appreciate that self.

Describe treatment versus care.

Treatment:

- "Service" with monetary value.

- Instrumental; requires technical expertise.

- Defined boundaries between bodies giving and recieving treatment.

- Untroubled by its use of power as a resource.

Care:

- "Gift"

- Involves emotion as well as cognition.

- Relational nature of giver and reciever.

- "Sensitive to assymetries of power"

The treatment provider uses his or her body as an instrument. The caregiver's embodiment is compassionate, feeling the suffering of the one who is cared for, while sustaining a boundary that enables the caregiver to act effectively rather than becoming engulfed - another danger of imagination.

What is enchantment?

To imbue with meaning.

What is disenchantment?

This is a characteristic of modernity post-industrial revolution. As we subject the world to rationalization, we lose the sense of mystical in the real world. A world without enchantment becomes illiterate to creativity and wonder.

Health humanities as an "antidote" to disenchanment of health vs. the biomedical paradigm. Disenchanted illness is the body grown unworthy of the spirit, sinking into its own senses, especially the imperialism of pain, and disenchanted treatment reduces lik eto mechanics.

How do we define illness narratices?

The "ill person's story" is an ancient narrative genre, often taking the form of written autobiography or memoir. There's 3 major types of patterns..

1. Restitution (Cure)

2. Chaos

3. Quest

What is the restitution (cure) narrative?

This narrative looks at illness as a temporary detour in which the body is restorable. The primary goal is permanent return to normal life and health; self is separate from illness experience. The only outcome of this narrative is getting well.

Example: "yesterday, I was healthy, today I am sick, but tomorrow I will be healthy again."

What is the chaos narrative?

In this narrative, illness is a permanent state of disaster, where it gets worse with no redeeming virtues. It's anxiety provoking and the ill person isn't control of the illness.

What is the quest narrative?

This narrative looks at illness as an opportunity to transform oneself or one's relationship to disease. It's characterised by 3 events.

1. Departure (the "call of the symptom").

2. Initiation (determining extent of illness, often through a road of trials).

Return (the ill person no longer in crisis but remains mared by illness.

It's fundamentally different from the restitution and chaos narrative. It can be therapeutic, and a new understanding of the illness emerges.

What is the difference between literal and figurative language?

Literal:

- Refers to the use of words in their primary and non-figurative sense.

- An exact rendering.

- What is actually written, as opposed to what's implied.

Figurative:

- Language with uses of figures of speech (metaphor, simile and alliteration).

- Distinguished from literal language.

Contemporary literary theory argues that all language is fundamentally figurative.

How do we define poetics?

1. Alliteration - the repetition of a consonant (ride the rocket).

2. Apostrophe - addressing something that's not a regular listener (be still, my heart! O, Canada).

3. Assonance: the repetition of a vowel sound (hot shot, lock rock).

4. Simile.

5. Metaphor.

What are similes and metaphors?

Simile

- Implied or qualified association between 2 things or ideas.

- "Life is like a journey".

Metaphor

- Strong association drawn between 2 disimilair things.

- "Life is a journey".

What is the composition of a metaphor?

Metaphors are composed of 2 parts.

1. Tenor: The subject to which attributes are ascribed or given.

2. Vehicle: The object whose attributes are borrowed to make the comparison.

"Life is a journey"

- Tenor: life

- Vehicle: journey

What are metaphors in relation to illness?

These describe disease and experience of illness in relation to one another. Military metaphors are especially prevalent in health care.

Example)

- Influenze attacks the body's immune system.

- White blood cells fight off disease.

Why are military metaphors used so often?

These metaphors are socio-culturally ubiquitous. They have a recognizable tenor (illness/disease) and vehicle (war). It connotes seriousness of the purpose, providing a strong counter-message to feelings of powerlessness/passivity associated with serious illness.

- There is an enemy (the illness or disease).

- There is a combatant/fighter (the patient).

- There are allies (the health care team).

- There is weaponry (technologies of treatment).

What are the 3 key features of military metaphors?

1. Metaphors provide effective, efficient language to help patients understand complex biomedical processes.

2. Metaphors impose order on a suddenly disordered world, helping the understand and (sybiolically) control of their illness.

3. Metaphor can serve as the basis of shared understandings of the clinical realities of treatment.

What is problematic about using war as a tenor/illness or a vehicle?

The use of cancer in political discourse encourages fatalism and justifies "severe" measures.

It overmobilizes, it overdescribes, and it powerfully contributes to the excommunicating and stigmatizing of the ill. "We aren't being invaded, the body is not a battlefield" - the military metaphors should be given back to the war-makers.

In summary, how are the poetics of health and illness useful?

1. Figurative language provides building blocks for larger narratives of health and illness.

2. The language we use provides a powerful frame for understanding relationships to disease and illness.

3. Figurative language has the power to make us more or less at home with illness, vulnerability and mortality.

What is the medical home?

A new primary care setting/model for treating disease and caring for ill people. It offers patient-centred practices. It uses the poetics of home to reframe (re-enchant) biomedical basis of health care relationship.

Remember the 4 important differences in health humanities, this is a new one: hospital versus medical home.

It shows how humanistic values can enhance healthcare for both patients and professionals.

What is (un) homelike in relation to health humanities?

Health/Homelikeness

- Indicates a "state of equilipbrium among all the various dimensions of personhood"

Illness/Unhomelikeness

- States of disruption or disequilipbrium.

The goal of professional health care is, therefore, the restoration of homelikeness.

What is Haddad's "Second Degree Block"?

This poem represents a narrative of the speaker's - recollection of a patient with second degree AV block which is a cardiac disease involving impairments in the heart's electrical conduction system.

It displays aspects of simile, metaphor and home/homelike/unhomelike.

What is depression through the biomedical lens and the humanistic lens? How do they differ?

According to WHO, this is a mental disorder characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness and poor concentration. Depression is often understood through a biomedical lens which impacts how depression is understood, experienced and treated.

Humanistic perspectives - especially narrative - provide invaluable tools for navigating and linking many models of depression. Art can both reflect and generate intense feeling in its viewer - provides an alternative model ofr expression such strong emotional states.

Describe Lewis and "Narrating Our Sadness".

This piece argues for the importance of narrative as a tool for "navigating the diversity" of depression. There's multiple models through which depression can be understood. The humanities are essential for "making sense of psychic difficulties and psychic differences".

There's 4 narrative elements to narrating sadness.

1. Metaphor.

2. Plot.

3. Character.

4. POV.

What are metaphors in relation to expressing depression?

Metaphors are critical for understanding many models of depression because a model, in short, is a metaphor developed over time.

To claim depression is a disease, "re-describes sadness and allows us to perceive something new about it".

Consider...

1. Depression is a disease.

How are a plot and a story closely related?

A story focuses on a sequence of events (x leads to y).

A plot gives a sense of causality (x leads to y because of z).

The same story can allow for multiple plots.

Restitution narratives involve 2 events.

Chaos narratives involves 1 event.

Quest narratives involve 3 events.

What is a "character" in health narratives?

Characters are representations of human identity and helps us understand human identity by drawing a comparison between identity in life and character in fiction. Characters guide readers through stories, helping us understand plots and broader themes. The type of character stands as a representative of a particular class or group of people (the depressed person).

What is "point of view" in health narratives?

POV refers to both the way in whihch the story is narrated and POV is either or both the perspective of the character of the problem portrayed in the text.

POV can look both inward and outward, affecting how a story is told. This allows us insight to the text.

What is a depression memoir?

Depression memoir is a therapeutic (recovery) tool. Each memoir engages different models of depression to tell a story of sadness.

- Biomedical model: depression as a disease.

- Psychoanalytic model: depression based in childhood traumas.

- Spritual/creative model: depression as a spur to poetry.

Writers of depression memoirs use a combination of approaches and models as recovery tools.

Describe the Gilman Reading, on "Seeing Bodies in Pain".

This reading is a complex but useful overview of how western medicine has attempted to represent human body in visual form in pain.

According to Gilman, images of the body are never simply unmediated - medical images of the body are generated, shaped, even distorted by cultural influences and assumptions. Artifacts of technology generates images of the body.

The takeaway is that any act of imagining bodies, especially when those bodies are in pain, always involves an imaginative leap.

What is "representation"?

Mitchell describes representation as the use of signs that stand in for or take the place of something else. Representation refers to the use of (x) to...

1. Look like or resemble something or someone.

2. Stand in for something or someone.

3. Present a second time; to re-present.

The means of literary representation is language, the means of visual representation is the image or icon.

What is representation in health and medicine?

Medical sciences "claim to represent the body objectively through brain imaging and the neurosciences or evolutionary biology or psychology, approaches that offer a single, unambiguous pathway without much attention to who sees and what is claimed to be seen".

Medical images generally assumed to be mimetic - content directly represented, shown; fixed meaning.

Rather than diagetic (told, recounted and interpreted).

There is a debate concerning representations of body vs seeing the body.

What is human anatomy in relation to representation?

Technological innocations have allowed us to "see" the inside of the human body. The piece "On the fabric of the human body" shows a packed crowd, an open body and fingers pointing in which instructions are given regarding the body. It represents the cartesian split between subject (seer) and object (what is seen).

What is the clinical or medical gaze?

This is a concept that argues that the "birth of the clinic" and clinical gaze, is a reorganization of depth - penetrates surface to discover or reveal hidden truth.

It denotes the dehumanizing medical separation of the patient's body from the patient's person (identity).

What is pain? How do we understand it in terms of health?

Pain is inherently subjective meaning there's no way to comprensively measure or see objective reality of pain, therefore the communication of pain is reliant on the patient's narrative.

What is The McGill Pain Index?

This is a clinical tool developed at McGill University to evaluate a person experiencing significant pain.

1. What does your pain feel like?

2. How does your pain change with time?

3. How strong is your pain?

It provides a list of Gerunds (nouny ending with -ing) as a way of articulating pain - after completing the questionnaire, users will have selected 7 words that best describe their pain.

What is "Facing Pain"?

Pain scales attempt to capture "the face of pain" as objective reality - "whatever the motivation of the sufferer and, perhaps, whatever his or her cultural location".

Drive to universality to important, certain groups of people throughout history have been understoof to have different thresholds of pain - women, POC, the disabled and animals.

What is "photographing pain"?

GIlman discusses Charles Darwin's Expression of Emotion in Man and Animals. Darwin argued that emotions are mimetic (unmediated) physical expressions of experience.

Use of photographs to prove continuity of pain expression across species.

What is body mapping?

In 2002, South African art therapy methods developed for women living wiht HIV/AIDS. It's a therapeutic process of creating life-sized body images to visually represent aspects of people's lives. Body mapping makes biological, emotional and social body vivid in participant's narratives. It's a visualization of problems faces and sources of strength.

What is the graphic narrative?

Graphic medicine was a term coined by physician/comic illustrator Ian Williams. It's the use of comics in context of medicine, patient care, stories of health, disability and illness. It's a form of visual storytelling that combines image/text, research/experience, time/space and language/line.

How do we understand comics in health humanities?

Reading visual texts asks us to develop skills in visual literacy, using poetics (the study of linguistics techniques in written arts) also shapes visual texts. Visual images possess their own visual vocabulary and grammar.

Why would anyone ... respond to a cartoon as much or more than a realistic image?

"Amplification through simplification"

Abstracting an image doesn't so much eliminate details as focuses it on specific details, the cartoon thus focuses on our attention to an idea.

What is "culpability" in graphics of health?

This is a comic of therapeutic relationships - mental illness (depression), the ill person's story (involves both health practitioner and client/patient). It presents a case study of visual vs literary means of communicating pain and mental illness.

What are the features of a comic?

Gutter: the space between 2 panels in a comic.

Panel: individual frame in a comic's image sequence.

Closure: observing the parts but perceiving the whole.

Occasional words are used in comics, but for the most part black boxes and punctuation symptoms provide narration.

What are bioethics?

Bioethics is a specific kind of ethical study which focuses on values, moral dilemmas in clinical practice, healthcare and health policy.

What are the 4 principles of bioethics?

1. Autonomy: free will or agency.

2. Beneficence: to do good.

3. Justice: social distribution of benefits and burdens.

4. Nonmaleficence: to not harm.

What is the role of ritual action?

This focuses on one bioethical problem. The role of ritual action or performances in health with reference to the hippocratic oath and broader notion of informed consent.

Chambers argues that each is a public delcaration of a physician's dedication to the humanitarian goals of medicine.

What is the hippocratic oath?

Ancient Greek physician Hippocrates is credited with being the first person to believe that diseases were caused naturally (not superstition, gods) - disease was not a publishment but a product of environment, diet and living habits.

Aligned medicine with philosophy, rather than religion.

Life is short, and the Art is long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must...be prepared to do what is right...

How is medical ethics a ritual performance?

Clinical practices should be considered through "ritual and performative dimensions". Performance of medical (bio)ethics forms a conceptual parallel with dramatic performances relying on gestures, words, staged expression of certain rites, beliefs and behaviors.

How is medical school initiation a ritual performance?

Versions of the oath are recited at white coat ceremony, announcing healthcare professionals' adoption of moral values - autonomy, beneficence, nonmaleficence and justice. It promises solemnly, freely and upon their honor.

Why and how has the ritualistic aspects of medicine become emptied of meaning?

Where physician's oath once transformed and altered the reality of the person uttering it, the performative power of the oath has lost its meaning.

How has the culture of western medicine resulted in the devaluation of ritual aspects of informed consent?

Informed consent is the process for obtaining a patient's permission prior to conducting a healthcare intervention. The patient must have adequate reasoning faculties and be in possession of all relevant facts.

Failure of informed consent as a ritual practice reinforces paternalism or legalism.

- Omission: failure to perform ritual act, refusal to accept morality or patient's right to self-determination.

- Misapplication: inapproproate person or circumstances of the performance of ritual act.

- Opacity: ritual doesn't function because rite is meaningless, unrecognizable or uninterpretable - medical information is not presented adequately.

What are the most serious forms of ritual failure?

Breaches

- Ritual failures that are "abrogation of ceremonially made promises"

- Disregarding patient autonomy.

Insincerities

- When things are said and done without requisite feelings, thoughts or intentions.

- Consent performance carried out as if merely a legal requirement.

How has the culture of western medicine resulted in the devaluation of ritual aspects of informed consent?

Pt.2

Informed consent isn't just the signing of a legal document, but a set of actions.

We need to reconcieve informed consent as a ritual act.

1. Symbolic dramatization of social values.

2. Re-enchant ritual of informed consent.

Reframing in this way means thinking of interactions between social actors (doctor and patient) kind of theatre.

Deliberately looks to theatre rather than legal tradition to reframe/reenchant consent relationship.