hltb50 final exam ch 10, 11, 12, 13

Empathy training and its limits

• dominant rationale for arts-based
  approaches in health education and practice

• Overemphasizing empathy risks romanticizing patients’ suffering or appropriating marginalized perspectives, while leaving structural inequities intact

  
  

Narrative training for nurses

a method where nurses engage in reflective practices (like writing stories or drawing comics) to enhance their emotional understanding of their work. The aim is to build empathy and a sense of purpose in the nurses' roles, especially in emotionally challenging fields like pediatric rehabilitation.

Examples of narrative training for nurses

eflective Writing: A nurse might write about a challenging patient experience, reflecting on how it made them feel and how it affected the patient.

Comics: Nurses might use comics or illustrations to represent their experiences and emotions.

Neoliberal Context in Health Care

health care environment where policies are shaped by neoliberal principles, health care becomes something that’s bought and sold, rather than a universal right or service.

The “Applied” Turn and the Value Debate of arts and humanities

refers to the growing debate about whether the arts should be used for practical, clinical purposes (like improving empathy in doctors) or whether they should challenge the current health care system, which often focuses more on science and efficiency.

Rejecting the Choice Between Theory and Application

Charise rejects the idea that health humanities should choose between focusing on theory (ideas) or practical application (real-world use). She suggests we think of arts-based work as entangled praxis, where theory and practice are linked.This work can critique, build empathy, and advocate for change all at once.

what is austerity?

when the government cuts public spending, often leading to worse health care and fewer resources)

Arts-Based Research Should Not Be Emotional Band-Aids

Charise argues that arts-based research (like using art in health care to explore emotions or improve empathy) should not just be a temporary fix or quick solution.Emotional band-aids mean something that temporarily makes people feel better without fixing the deeper problem. Charise says we shouldn’t use art just to help people feel okay in a broken system. It should be more than that.

What is arts-based research (ABR)?

treats art (like visual art, music, writing, performance) as both a method of research and a form of data. Uses the act of creating art to investigate and understand human experiences, emotions, and perspectives, art becomes a tool for discovery

Key take aways for arts-based research

Art is both method and critique
• It generates knowledge and challenges structures
• Empathy is not enough
• Focus on conditions that make care possible

what are some strengths of arts based research?

makes research more accessible by presenting findings through performances, art exhibitions, or visual media. This means that people who may not have access to academic journals or research papers (like community members or the general public) can still engage with the research. It doesn’t just focus on logic or rational thought (which are often privileged in traditional research); it also embraces emotional, sensory, and embodied ways of knowing.

• For example, how people feel in their bodies during an experience, or the sensory reactions (sight, sound, touch) that provide insight into a particular situation.

examples of ABR

Visual arts and drawing
• Music-based research

what is photovoice?

Allows participants to take photographs reflecting their lived
experience

What is Forum theatre (participatory theatre)?

type of participatory theatre where the audience gets to actively participate in the performance, not just watch it. “spect-actors” the audience become a part of the action and they can stop the performance at any point and suggest changes to the story.

Visual arts and drawing

• helps participants express emotions, identity, or pain when verbalization may be difficult
  • Often used with children

Music-based research

Music-based activities (like group singing, songwriting, or musical performances) are used throughout the research process to help explore people’s experiences of health, illness, and care. Allows people to express emotions, stories, and experiences related to health and well-being in a creative, accessible way. ex. Group singing, songwriting, musical performance.

what are the three measures that were used to determine impact of participating mothers?

• Edinburgh Postnatal depression score (EPDS)

• the Multidimensional scale of perceived social support (MSPSS)

• The WHO-5 Well-being index

Visual arts

has powerful effects on both patients and providers in healthcare

• for patients it allows patients to express emotions that might be difficult to verbalize, like fear, sadness, or frustration. This release can help reduce feelings of anxiety and provide an emotional outlet. It can be a distraction from the stresses of illness or medical procedures.

• for providers it can help them understand the emotional and human side of patient care. For instance, seeing a piece of art made by a patient can give a provider insight into the patient’s emotional world, fostering empathy and compassion.

Transdiscipinarity

Commitment to working across disciplines. Commitment to working across disciplines

Drawing

Oldest form of visual arts
• Predates writing by at least 25,000 years

Ardeche valley caves in Southern France

Estimated at 17,000 to
22,000 years

Blombos Cave, South Africa

Estimated to be
73,000 years old

Drawing and everyday life

Children make meaning of their world visually
• Self-directed drawing dwindles around 8-12 years old

Subjective drawings

Expressive, unconcerned with accuracy, captures a “sense” of situation, Open-ended, intuitive, provisional, expansive, evocative, experimental

Comics

Not a genre but a medium, simplifies complex issues while still conveying the depth and ambiguity of those issues. Pedagogical Use: Comics are becoming recognized as useful teaching tools. Because they combine text and images, they can communicate ideas in a way that is both engaging and memorable.

When was the Crusade against comics?

• In 1948, there was a symposium (a meeting or discussion) called "The Psychopathology of Comic Books" held by the American Association of Psychotherapy

• People believed that action packed comic books encouraged violent behavior, especially in young readers.

The Comics Code (1954)

US comic publishers came together to create the Comics Code Authority, Comics could no longer show criminals in a positive light or make them appear heroic. The idea was to prevent kids from seeing crime as something cool or acceptable.

comics as “third space”

Comics can combine things that don’t usually go together—for example, mixing fantasy with real-world issues—in a way that sparks new connections and insights.

Hegemony

• Term popularized by Antonio Gramsci, the dominant influence or control that a particular group, ideology, or social system has over others, accepted as “common sense” or the norm by society

• Dominance is achieved through institutions like media, education, and religion

Hegemony examples

• Historical - British empire in 18th & 19th century, dominated quarter of world’s landmass

• Cultural - Hollywood/ American movies and pop culture dominate global entertainment

• Education - Western-centric curriculum

Community

• medium of social connection, Comics use images as a universal language, making them accessible to people across different languages, cultures, and education levels.

• Illness isolates, but “comics are a potent antidote for both social and
  physical isolation”

Graphic medicine

• term by Ian Williams in 2008

• Use of comics in context of medicine, patient
  care, stories of health, disability, illness...

Poetics

the study of linguistic techniques in
written arts)

loiterature”

refers to a specific kind of movement or structure in comics, created by how the panels in a comic are arranged. It's a concept that describes how the reader's eye moves back and forth through time, space, and narrative not in a straightforward linear way

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

“Amplification through simplification” (McCloud)
• Abstracting an image does not so much
eliminate details as focuses it on specific details

Williams, “Culpability”

Presents a case study of visual means of communicating pain and
mental illness, the ill person’s story (involves both health practitioner
and client/ patient)

Jo spence (1934-1992)

British photographer and community-based activist known for using photography as both a tool for cultural critique and a means of personal therapy

The skeleton

• used to address the physical toll cancer/leukaemia was taking on her body, used toy skulls to create modern day momento mori

Naked chest imprinted with patterns of a gravestone

• Her naked body was featured heavily in earlier works, addressing gender politics, here it’s tied up with her mortality (or death)

Jo spence standing in front of a freshly dug grave

• addresses her imminent death with the same sardonic attitude that permeates earlier work

Art

Puts power of representation in our hands

Rites of bioethics

Example of the ways in which philosophical thought informs critical

study of health and illness

Ethics

Branch of moral philosophy, focuses on determine what a person should do - or “ought” to do

Bioethics

Focuses on values and moral dilemmas in clinical practice, healthcare, and health policy, making ethical moral decisions about biological and medical issues.

Examples: organ donation (who should get a donated organ first?)

What are the principles of bioethics

Autonomy, justice, beneficence, nonmaleficence

Autonomy

• Having the freedom and right to make your own decisions about your own life and body

• ex. Doctor must ask your permission before giving you treatment

Beneficence

• to do good

Nonmalifcence

• to do no harm

• ex. Doctor avoids giving treatment if they know it could harm the patient / the side effects are more harmful then helpful

Justice

• social distribution of benefits and burdens, giving people equal access to care

• Ex. Making sure all patients get equal access to treatment

Hippocratic oath

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…

Medical school invitation

Versions of the oath are recited at white

coat ceremony

• Announces healthcare professionals’

adoption of moral values

Informed consent - Omission

Failure to perform ritual act

Informed consent - Misapplication

inappropriate person or circumstances of the performance of ritual act

Informed consent - Opacity

ritual does not function because rite is meaningless, unrecognizable or uninterpretable

Most serious forms of ritual failure

Breaches, Insincerities

Informed consent - breaches

• Ritual failures that are abrogation of ceremonially made promises

• Disregarding patient autonomy

Theatre

• language of theatre is not accidental, surgical theatres were built at nearly the same time as modern arts theatres, both places are designed for people to watch something happen.

Etymology of theatre

• greek: theatron - a show, a spectacle, a place for viewing

• Greek: theasthai - to behold

Rehearsal

simplify basic components of performance for maximum

clarity of all actors/ performers in a social space. One of the strengths of the drama analogy for understanding social

interaction, including medicine, is that it underscores the seriousness

of play

Biographical disruption

A health event (like illness or injury) can suddenly disrupt a person’s life story.

It makes them rethink who they are, what they can do, and the roles they play (student, worker, friend).

Defining Personhood - Early Modern Period (1500–1700 CE) & Enlightenment (1600–1800 CE)

• Philosophers began thinking about what makes someone a “person” beyond just being human.

Defining Personhood - Rene Descartes (early 1600s)

famous for Cogito ergo sum → “I think, therefore I am.” Meaning: even if you doubt everything, the fact that you are thinking proves you exist

Embodied Person hood - Maurice Merleau-Ponty, French philosopher (mid 20th)

Key idea: personhood isn’t just about thinking or memory, our body itself expresses who we are, often before we consciously think, being a person through your body, not just your mind.

rational man and dementia

• Western culture often celebrates the “Rational Man” — a person defined by thinking, reasoning, and self-awareness (Descartes: “I think, therefore I am”).

• People with dementia don’t fit the “Rational Man” ideal, even though they are still fully human because their memory, reasoning, and cognitive abilities are affected.

• Dementia shows that personhood is not only about being rational or cognitively “perfect”

Creativity is therapeutic and relational

Creative activities (like knitting, quilting, cooking, or art) are more than hobbies. They help people connect, share stories, and care for each other.

Therapeutic: Helps people cope with stress, illness, or emotional challenges.

Objects hold stories and memories

Clothes, quilts, recipes, handmade objects become carriers of personal history, cultural meaning, loss, resilience, self-expression

Practices bridge personal and public health

• Everyday creative activities can connect personal well-being with larger social issue's health isn’t just medical care but community and justice.

• Cooking: Highlights food justice—who has access to healthy food.

• Quilting: Can be used for advocacy, sharing stories, or raising awareness.

• Clothing: Supports dignity for patients in hospitals or care settings.

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Clothing

Not just about covering the body, it connects identity, and feelings, extension of self - clothes touch the body and become a part of how we move and feel

Enclothed Cognition

What we wear affects how we think, feel and act - clothes carry symbolic meaning, it shapes psychological processes

Clothing and dignity in care

Clothes do more than cover the body—they help people feel like themselves. In hospitals or long-term care, losing personal clothing can affect identity, autonomy, and comfort.

Importance of Knitting

Can support physical and mental well being, rhythmic and repetitive movements can calm the mind and body

Craftivisn

Knitting and quilting can be used for social change and political action, creates safe spaces for women to gather and support each other

example: 1960s Freedom Quilting Bee: Black women used quilting to gain economic independence, community, and cultural resistance.

Quilting - memory and narrative

quilts are commemorative - made from clothing of loved ones, marking milestones or memorializing loss

Importance of cooking

more than preparing food—it connects to culture, memory, community, and health, it’s a sensory and social practice that bring people together

Food justice

• Cooking highlights issues of access and inequality:

  • Who can afford healthy food?

  • Who lives in food deserts?

Food as medicine

Culinary medicine: Cooking teaches trainees to learn:

• Humility

• Communication skills

• Awareness of patients’ real-life experiences

Ancient traditions - cooking

• hippocratic medicine saw diet as central to preventing and treating illness

Medieval continuities - foods were known as hot/cold and moist/dry

Material companions in illness

• Objects can provide comfort and stability when a person’s body or environment feels uncertain. They help people remember who they are and maintain their sense of self, even during illness.

• cooking, or continuing a knitting project gives patients an active role in their own well-being. This reinforces autonomy, dignity, and identity.

• Examples: clothing, quilts, knitting projects, familiar foods.

Health humanities as ethical engagement

Health humanities isn’t just about medicine or biology—it emphasizes justice, witnessing, and ethical responsibility.

The Gaza health crisis: Establishing facts

• Israeli government blocked food and medical supplies which creates humanitarian and medical emergencies

• In march 2025 WHO recorded 670 attacks on healthcare facilities by Jan 2 over 1000 healthcare workers

• Health system collapses, fewer then 10 functioning hospitals

Defining genocide (Canada Criminal Code, 1985)

• happens when someone intentionally tries to destroy, in whole or in part, a specific group of people. Examples include destroying water, sanitation, housing, schools, cultural sites, or archives.

  1. Killing members of the group

  2. Deliberately creating living conditions that lead to the group’s physical destruction

What international body issued arrest warrants for Netanyahu and Gallant for acts in Gaza?

International Criminal Court

What did the UN Commission cite as evidence of genocidal intent?

Destruction of cultural heritage, Direct statements by officials, Forced displacement

What did the Human rights watch do?

Found evidence of acts of genocide and intent to destroy

What did the UN independent international commission of inquiry do?

Found evidence of genocidal intent based on: mass killings; serious bodily/ mental harm; forced displacement; destruction of infrastructure essential for life

Medical neutrality and obligations

Medicine has always been linked to war, neutrality, ethics and state violence. 1949 Geneva convention - was created after ww2 to prevent genocide, core principles: protect civilians, protect medical units

What is Can,EDS?

A framework used in Canada to describe what makes a good doctor. Developed by the Royal College of Physicians and Surgeons of Canada.

What are canMEDS roles/ competencies

Medical expert, communicator, collaborator, leader, health advocate, scholar, professional

What has The Canadian Medical Association (CMA) done?

Condemned attacks on medical facilities and called for unrestricted humanitarian access

The Royal College of Physicians and Surgeons of Canada primarily focuses on

Standards for medical education and practice

The College of Physicians and Surgeons of Ontario will take a position on international conflict

doesn’t take positions on international conflict unless it affects medical practice in Ontario

What is grassroots advocacy?

• bottom up Cole,Clive action led by communities, not institutions, often relies on shared stories, creative expression and mutual aid

Indigenous health humanities: Foundations

for art as activism

• Art can show injustice and structural violence in ways that facts alone may not. Indigenous health humanities teaches that stories, art, memory, and respect for community voices are powerful ways to resist oppression, raise awareness, and promote justice

• Example: A mural depicting missing and murdered Indigenous women raises awareness about systemic violence.

Arts based activism for gaza

Makes suffering visible, bridges emotion and information, builds collective identity and solidarity