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The acts of Stanton.
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A reminiscence from the Editor.
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Is a case report an anecdote? In defense of personal observations in medicine.
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Swelling in the left fronto-temporal region.
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Rendezvous in Rhamu. Teaching and learning with traditional birth attendants in rural Kenya.
When Carol Steele came to Rhamu, Kenya, in 1983 as a Quaker, Peace, and Service volunteer, there was little or no contact or cooperation between the Government Health Center personnel and the traditional birth attendants of the surrounding villages. The two groups were worlds apart in thinking, attitudes, and practices. The government center was viewed as alien by the people, with nothing to offer them except emergency care. The health center personnel viewed the traditional birth attendants as uneducated, unskilled women, who jealously kept clients away from the professional obstetric care the clinic provided. It was Carol Steele's plan to bring these diverse groups together in a professional, trusting relationship. Her success in accomplishing this task is the theme of this article.
The innocent research worker.
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The Swedish pimple. Or, thoughts on specialization.
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Archie Cochrane in his own words. Selections arranged from his 1972 introduction to "Effectiveness and Efficiency: Random Reflections on the Health Services" 1972.
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Varied acceptance of clinical trial results.
The subject of varied acceptance of clinical trial results is discussed in the context of review of trials with which I have been involved and my subjective evaluation of their impact on the practice of clinical medicine. My experience goes back to 1949 and a World Health Organization trial of hyperimmune gamma globulin against rabies. This was followed by a large trial of secondary prevention of poliomyelitis. I participated in the planning and initiation of the first chronic disease trial, the University Group Diabetes Program (UGDP). The latter lasted for 15 years and its ramifications continue to this day. My next trial was the Coronary Drug Project (CDP), a complex trial with more than 8,000 patients. The trials of aspirin and aspirin combined with persantine (the CDPA, AMIS, PARIS I, and PARIS II) followed. My last three trials were a trial of photocoagulation in diabetic retinopathy (DRS), a six-country trial of the antiarrhythmic drug mexiletine (IMPACT), and a study involving two diagnostic procedures for pulmonary embolism (PIOPED). When one considers, in retrospect, the plethora of trials one is struck by the uniform absence of a priori considerations of the impact on medical practice, or likely lack thereof, of possible outcomes.
Founders of hand surgery. L.D. Howard.
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Damaged goods: oral narratives of the experience of disability in American culture.
In a field project on oral narratives, I documented personal experience stories from 33 persons with visible, physical disabilities. These stories reveal informants' perceptions of how popular American notions about disability frame social interactions between disabled and nondisabled individuals, how such interactions affect the self-images of disabled persons, and how the predictability of such interactions constitutes a disabled experience that may be uniform across American culture.
Medical students' first-person narratives of a patients story of AIDS.
Fourth year U.S. medical students' first-person narratives of a patient's experience of AIDS are analyzed using a conceptual framework that builds on the interactive model of narrative critique. Relational and affective convergence and, conversely, relational and affective dissonance, reveal imaginative reconstructions of emotional and interactional themes depicted in the patient's original story. Attention is focused on representations of isolation, contamination, shame and fear. Elements of indeterminacy and openness in the patient's description of his experience with AIDS provided students with opportunities to create an imagined response to HIV infection in their own narratives. The narratives describe social interaction that is tainted and constrained by the presence of infection and its associated stigma. The emotional content of the student narratives portrays an affective landscape that resonates. elaborates and, in some cases, distorts the feelings expressed in the patient's story. The narratives call attention to the way in which individual meanings are externalized, objectified and projected onto a socially and morally salient 'other'. Using the first-person narrative approach in the seminar on AIDS proved to be an effective method of sensitizing students to the experience of living with HIV infection. The challenge for medical educators lies in creating opportunities for students to develop increased empathy toward individuals with AIDS.
Narrative representations of illness and healing. Introduction.
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Narrative representations of chronic illness experience: cultural models of illness, mind, and body in stories concerning the temporomandibular joint (TMJ).
The narratives individuals told about their experiences with an illness they have come to understand as TMJ, a problem linked to the temporomandibular joints of the jaw, are complex. Each is embedded within a unique set of life circumstances and guided by individual schemas and explanatory models. Each recounts how persons have come to make sense of perplexing symptoms that are not easily categorized and treated within the North American health care system. Yet, in spite of their distinctiveness, the reconstructed narratives are not independent of shared cultural schemas, such as those relating to mind and body, and other shared models, such as the model for TMJ, which individuals come to adopt as a consequence of treatment and interaction with others. The consistent emergence of themes concerning the mind and body within and across narratives attest to their salience for understanding the narratives related here. While describing the effect of illness on individual lives, narratives also illuminate how shared understanding shape the interpretation and construction of individual experience.
Coming to terms with advanced breast cancer: black women's narratives from eastern North Carolina.
This paper analyzes in-depth interviews with 26 black women who entered the medical system in rural North Carolina with advanced breast disease. In these narratives, women draw on multiple sources of knowledge in order to come to terms with the diagnosis of breast cancer--a biomedically-defined disease that they often refuse to acknowledge or accept. The analysis demonstrates how women relate the meaning of their individual episodes of illness to one or more of the following sources of knowledge: an indigenous model of health emphasizing balance in the blood, popular American notions about cancer, and particular biomedical conceptions about breast disease and its treatment. These narratives provide an important window into the processes involved when individuals attempt to adapt personal experience to pre-existing cultural models, modify such models in the light of new information, and confront conflicts in their own interpretations of the meaning of a single episode of illness.
AIDS-talk and the constitution of cultural models.
In a village in rural Haiti, a cohort of 20 adults was interviewed annually in order to trace the development of a cultural model of AIDS. It was possible to document the initial lack of a cultural model of AIDS followed by the elaboration over time of a widely shared representation of the new disorder. A number of steps important to this process were identified: exposure to illness or rumor of it; a high ranking in a hierarchy of perceived stress leading to sustained attention; and the generation of illness stories. It is argued that these stories provide the matrix within which nascent representations were anchored. The significance of intercurrent 'large-scale' political changes in the process of narratization is also underlined.