• Narrative Medicine

  • Inaugurated by Rita Charon

  • Clinical practice fortified by the knowledge of what to do with stories

• Graphic Medicine

  • New field in the health humanities

  • Interdisciplinary

  • Practitioners come from all walks of life: people who have experienced illness, scholars in the humanities, medical sciences, clinicians, and artists

  • Examines the intersection between comics and health, illness, healthcare, and medical education

• Frontline stress

  • Approximately 20% prevalence of depression, anxiety, and PTSD seen in healthcare workers

  • Concerning outlook for health care workers

  • “Domestic combat”

  • Working under severe stress

• Moral injury

  • In traumatic circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations

  • Moral injury is the distressing psychological, behavioral, social and sometimes spiritual aftermath of these circumstances

  • It can be difficult for patients to share morally injurious events because of the feelings of guilt and shame associated with them

• Risks and benefits of social media for health care workers

• Ethical issues

  • In pandemic nursing

    • Fairness and justice in resource allocation

    • Duty to care

    • Personal safety vs professional integrity

    • Re-narrated job description

  • Online

    • Nursing staff fired after posting tik tok with newborn baby

    • Dancing and lip-syncing nurses during the pandemic waste of resources?

    • Nurse placed on leave after revealing on tik tok she does not wear a mask at work

  • What’s ok to share and what’s not?

• Platform affordances

  • What do social media platforms request, demand, allow, encourage and refuse for their users?

  • Markers of authority (lab coat, scrubs, books, setting)

  • Calibrated amateurism - filmed with smartphone, creator speakers directly to the audience

    • Effect: cultivate a sense of accessibility, authenticity, and closeness

• Icons

  • Pictures: images designed to actually resemble their subjects

• Closure

  • Observing the parts but perceiving the whole

• Gutters

  • The space between panels

  • The gutter represents time and action that the reader fills in, each in their own way

• The reader

• Emanata

  • Found close to the character’s head and represent feelings, or states of mind or thoughts

• Grawlixes

  • Typographical symbols like #$@! Used to represent profanity or curse words

• Motion lines

  • Show action, force, sound, speed or direction

• The rhetorical situation

  • Rhetorical discourse is called into existence by an exigent situation capable of being modified discursively by an audience with the potential to mediate change

  • Shaped by exigence, audience and constraints

• Exigence

  • An imperfection marked by urgency ( + capable of being modified discursively)

    • Chased by a hungry alligator

    • Touching a hot stove

    • Not enough people are voting

• Audience

  • With the potential to mediate change

    • The rhetorical audience is capable of being moved: in attitude, in action, in knowledge

• Constraints

  • Give shape to the message

  • Audiences can be moved, there are “heavy” and “light” audiences

  • Culture, language, expertise, timeliness - what else is going on?

• Confirmation bias

  • People favor information that confirms their beliefs and reject facts that contradict them

• Vaccine hesitancy

  • Vaccine hesitancy is complex

• Best practices for vaccine communication

  • Pro vaccine communication is often ineffective and some well-intentioned efforts may backfire

  • Know your audience and tailor your message accordingly

  • Anticipate cognitive shortcuts

    • Such as confirmation bias

  • Tell stories - use narratives to engage your audience

  • Build trust and use credible communicators

  • Connect with people’s values

  • Remind people why we vaccinate

  • Be careful when using fear and shame based appeals

• Fear of contamination

  • All true Americans must help to stop our governmental policy of poisoning the blood of babies are grownups with putrid blood

    • Arguments like this uses a strong sense of individual rights and links it to skepticism about the bacteriological approach to disease

• Distrust of medical profession

• Resistance to compulsory vaccination

• Local quality of vaccine skepticism

• Fear of the irreparable

  • An irreparable consequence operates as a limit or boundary… that, once crossed, cannot be recovered or undone, and therefore functions as a powerful source of fear

• Quantity based arguments

  • Strength by numbers

  • Durable

  • Represent consensus

  • Resist exceptions

  • Ex: the significant positive impact of COVID vaccines on severe illness or hospitalization

• Quality based arguments

  • Find uniqueness, exceptions, outliers, the rare, and the exceptional - and place value on them

  • Ex: the rare chance of hospitalization or death from disease AND the rare chance of side effects from vaccines. Not limited to pro or anti vaccine

• Bodily autonomy

  • Right to decide what happens to your own body

  • Fluoridation controversy

• Disability rights movement

  • Built on organizing and civil disobedience strategies from the civil rights, LGBTQ, and women’s rights movements

  • Focus on access: buildings, employment, education, opportunities

  • 1990: passage of the Americans with Disabilities Act

    • “Reasonable accommodations”

• Models of disability: moral, medical, social, identity

• Moral Model

  • Disability (and/or bodily difference) is a reflection of one’s character

    • Sign of character

    • Caused by character

  • Disability as a curse or punishment

  • Disability as a gift providing special compensatory abilities (eg the blind seer, the mad prophet)

• Medical model

  • Disability is located in an individual’s body

  • The “problem” of disability is solved by modifying that body

• Social model of disability

  • Disability is produced by environments, policies, and ways of thinking that assume and/or require typical bodies

  • The “problem” of disability is solved by modifying environments, policies and attitudes

  • Disability is not inherent embodies, but arises from the meeting of a body and an environment that assumes a typical body and/or mind

  • Ina deaf community, deafness is not disabling

  • Wheelchairs are not disablings until one encounters stairs, a curb, or a snowy sidewalk

  • In these examples, disability is produced

• Identity model

  • Deaf culture

  • Autistic communities

  • Shared stigma and exclusion creates shared political identity

• Supercrip/ heroic overcomer

  • Disabled person used as an inspirational example for nondisabled people

  • “Inspiration porn”

  • “Cultural script”

• Singer / johnson debate

  • Johnson is a disability rights activist

  • Singer is a philosopher and bioethicist

    • Personhood is the key to singer’s thinking

    • Person is no mere descriptive label, it carries with it a certain moral standing

    • Every person has a right to life, a newborn baby nor a fish is a person, the wrongness of killing such beings is not as great as the wrongness of killing a person

    • Personhood is defined by ability, not birth

  • Johnson challenged Singer’s belief of being able to eliminate a disabled baby while they are still in the womb

  • Singer was asked to write Johnson’s eulogy after her passing

• Quality of life

  • Usually measured through personal ratings of satisfaction in various life domains

  • Quality Adjusted Life Years (QALYs): a utilitarian approach to health economics

    • Inherently privileges people with good health and devalues the lives of people with disabilities “based on the beliefs of nondisabled outsiders”

• Triage Guidelines

  • Direct how medical resources are distributed under conditions of scarcity

  • QALYs are used in the process of these

• USPHS syphilis study at Tuskegee

  • 600 Black men with syphilis

  • Men told they were being treated for bad blood

  • Men were not deliberately infected

  • Consequences of untreated syphilis were known

  • Treatment was available but not given

• Aspects of scientific writing that contributed to dehumanization

  • Encouraging readers to dissociate themselves from the men (as subjects)

  • Reducing men to environments where disease takes place, as objects that are acted upon

• Performative speech

  • A sentence or speech that does something

• Guatemala syphilis study

  • Deliberately infected subjects by encouraging prisoners to have sex with sex workers who had been infected

  • Deliberately infected many of those sex workers

  • When that didn't work, researched attempted direct inoculations

• Features of official apologies: demonstrate recognition of the error, assumption of responsibility, moral distancing

• Hypochondria

  • Patients are persuaded they are sick based on faulty evidence

  • Patient tries to persuade the provider that they are sick, and fails

  • Provider tries to persuade the patient that they are not sick, and fails

  • The “absence of evidence of disease falls short persuasively of evidence of absence of disease, and the latter is almost impossible to secure”

• Medical student syndrome

• Placebos

The placebo: a rhetorical treatment?

The placebo effect

• The physical and/or psychological response of patients to inert treatments

  • Placebo is from latin and means I shall please

• Must be accounted for in randomized clinical trials

• The problem: confusing correlation for cause

  • All the control group patients had inert tablets, therefore the inert tablets caused their improvement; and similarly, in the experimental group, all the patients had active treatments, therefore the drug caused their improvement

• The meaning response

  • The physiological os psychological effects of meaning in the treatment of illness

  • Ex:

    • Pill color

    • Branding of pills: brands affected the efficacy of both active and inert medications

    • Number of pills

    • Meaning caries according to cultural factors

    • Meaning response is particularly strong for pain, sleep, psych. Conditions, immune and endocrine disorders

    • Not everyone experiences the meaning response (third to half)

• Harnessing the meaning response in a clinic

  • Speak positively (yet truthfully) about the therapy being prescribed

  • Provide encouragement and education to empower the individual to take positive action

  • Develop relationships of trust, compassion and empathy

  • Provide reassurance

  • Reinforce the importance of interpersonal relations

  • Learn about the individual’s unique outlook, values, past experience, and belif system

  • Help the patient explore their own health-related value system

  • Create ceremony and ritual that facilitate meaning and expectancy for the patient

• Enhancement

  • Improves human function or characteristics beyond what is necessary to sustain health of repair the body

• Ethical critiques of enhancement

  • Is it fair?

  • Enhancement becomes compulsory

  • “Gattaca” Critique: unequal access reproduces social inequalities

  • Symptom of a too-competitive society - steroids are a way of answering a competitive society’s demand to improve our performance and perfect our nature

  • “Free market eugenics” - enhancement, and especially int he form of genetic engineering reproduces dominant assumptions about what bodies/minds should be like

  • Lack of agency of autonomy - choosing characteristics of a future child, you make a choice they have no say over

• Sandel’s argument against enhancement

  • enhancement reflects “hyperagency”

• Is the real problem about genetic enhancement of a future child not a lack of agency but in fact too much agency? “... threatens to banish our appreciation of life as a gift and to leave us with nothing to affirm or behold outside our own will”