Bradley Lewis

Narrative Medicine and Healthcare Reform

Narrative medicine is one of medicine’s most important internal reforms, and it should be a critical dimension of healthcare debate. Healthcare reform must eventually ask not only how do we pay for healthcare and how do we distribute it, but more fundamentally, what kind of healthcare do we want? It must ask, in short, what are the goals of medicine? Yet, even though narrative medicine is crucial to answering these pivotal and inescapable questions, it is not easy to describe. Many of its core claims go against the grain of common sense thinking about medicine. This article argues that the best way to understand narrative medicine is to tell a story that puts its emergence in historical context.

Prozac and the Post-human Politics of Cyborgs

Working through the lens of Donna Haraways cyborg theory and directed at the example of Prozac, I address the dramatic rise of new technoscience in medicine and psychiatry. Haraways cyborg theory insists on a conceptualization and a politics of technoscience that does not rely on universal “Truths” or universal “Goods” and does not attempt to return to the “pure” or the “natural.” Instead, Haraway helps us mix politics, ethics, and aesthetics with science and scientific recommendations, and she helps us understand that (without recourse to universal truth or universal good) questions of legitimacy in science come down to local questions of effect and inclusion. What, in the case of my example, are the effects of Prozac? And for whom? Who is included and empowered to create legitimate psychiatric knowledge? Who is excluded and why? And, what political strategies will increase the democratic health of psychiatric science and practice?

High Theory/Mass Markets: Newsweek magazine and the circuits of medical culture

Medicine is driven by much more than science and reason (ethics); it is also driven by the circuits of culture within which it operates. This article examines how postmodern theory deconstructs standard ideals of science and reason and allows medical humanities scholars to better contextualize the world of medicine. As such, postmodern theory provides an invaluable tool for understanding the circuits of popular culture and medicines place within these circuits. Using a recent issue of Newsweek magazine devoted to health and technology to illustrate the main points, this essay argues that contemporary popular influences on medicine are deeply problematic, and that through an appreciation of the dynamics of culture, medical humanities scholars can join the struggle over medical culture. This perspective allows medical humanities to make important contributions toward alternative circuits of medical representation, consumption, and identification.

Authoring Autism: On Rhetoric and Neurological Queerness

Melanie Yergeau begins Authoring Autism in a Bshit stained bedroom,^ and she ends in a field that is Bfilled with pinwheels.^ The shitty beginning is her mother’s story of Yergeau in her childhood crib Bwith poop up to [her] neck.^ BUp to your neck.^ Her mother’s story forms part of the prehistory of Yergeau’s eventual placement in the diagnostic category crib of autism. BI wet myself at school, I didn’t have friends, I spent hours in my room memorizing road maps^ (1). But, by the conclusion of the book, Yergeau has flown the category crib to place herself in an open field of present possible futures and re-membered pasts where she is much less constrained and isolated. What does Yergeau plan to do in the open field? BI will stim in this field, hands wrenching, full and swaying body movements, words that are cool and crisp, like pulchritudinous, all echo-localized. Parallelism is repetition but repetition isn’t always parallel, pinwheels, pinwheels, pinwheels^ (207). The middle of Authoring Autism is the journey Yergeau took from a crib of categories to an open field of pinwheels. I do not mean to imply that Authoring Autism is primarily an autobiography. It’s not. Rather it is a closely argued, elegantly performed, and even joyfully humorous work of critical emancipatory scholarship. Yergeau carefully intertwines lived experience, autistic memoir, clinical discourse, and humanities theory (particularly rhetorical studies, narrative theory, disability studies, and queer theory) to achieve a highly insightful hybrid discourse. In the process, she breaks down binaries and opens new possibilities of form for scholarly invention and cultural creation. Yergeau’s deconstructive sections are devoted to the Bgod theories^—reminiscent of Donna Haraway’s Bgod trick^—of normative, hegemonic, ableist clinical models. She focuses this part of the work on Applied Behavioral Analysis (ABA) and Theory of Mind (ToM) to highlight the rhetoric of lack, failure, and deficit at the core of these clinical discourses. These Bmedicalized stories of lack^ not only rank, label, and exclude, they also challenge the very J Med Humanit https://doi.org/10.1007/s10912-018-9520-6

A Medical Sublime

Inspired by a passage from Kate Chopin’s The Awakening , this article considers the possibility of a “medical sublime.” It works through a history of the sublime in theory and in the arts, from ancient times to the present. It articulates therapeutic dimensions of the sublime and gives contemporary examples of its medical relevance. In addition, it develops the concept of sublime-based stress-reduction workshops and programs. These workshops bring the sublime out of the library and the museum into the lives of the healthcare community—patients, families, clinicians, staff, concerned others—in the service of better navigating human vulnerability and finitude. Opening the cannon of aesthetic theory and the arts as resources for the human condition is at the heart of health humanities. The sublime can be an invaluable tool in this task.

Narrative Medicine and Contemplative Care at the End of Life.

Two important movements leading the way toward a new approach to healthcare are narrative medicine and contemplative care. Despite considerable common ground between these two movements, they have existed largely parallel to each other, with different literatures, different histories, different sub-communities, and different practitioners. This article works toward integration of narrative medicine and contemplative care through a philosophical exploration of key similarities and differences between them. I start with an overview of their similar diagnosis of healthcare’s problems and then consider their related, but different, responses to these problems. Finally, I use the example of Margaret Edson’s Pulitzer Prize winning drama W;t to highlight how these issues can play out at the end of life.

The Isolation of Illness

Reading the illness narratives of my professional collogues was a moving experience, which reminded me of my own vulnerability and made clear the wisdom of connecting the dots between lived experience and scholarship. Though this wisdom is compelling, it is far from clear how it might be done. Including lived–sexperience in medical humanities scholarship exposes researchers to the vulnerability and isolation that goes with illness. Disability studies analysis offers powerful tools for understanding this vulnerability and isolation. The next step is to take that analysis into applied medical scholarship. These articles provide a valuable start in that direction.

Response to David DeGrazia

As David mentions, he and I are good friends. Our friendship is based on many things, but certainly part of it is our similar concerns for the future of psychiatry (and health care more broadly). David outlines these similarities well, so, like him, I will concentrate on our differences. We have had extended conversations about these differences, but we usually end up not much closer than the two papers would suggest. This indicates to me that there is more than a “misunderstanding” between us. We understand each other. David understands me and I do him, but we have different perspectives. It is important to note however that our personal differences are part of a larger social context. Indeed, we are bit players in a larger discursive theater, and the deadlock between us is also the battle scene of the “science wars” drama currently raging in academe. These theatrical academic wars have been, like the real wars they simulate, very destructive and very crude. Fine distinctions and nuances are lost on a battlefield. Thus, I am grateful to David for articulating his perspectives so eloquently and for providing such a good humored opportunity for continued dialogue on this topic—without either of us having to go to war. In my response, let me make the somewhat arbitrary, but to me useful, distinction between theprocessand contentof David’s and my differences. The processaspects of our differences largely come from our cross-disciplinary interactions. David’s disciplinary background is analytic philosophy, particularly bioethics. Mine is a post-disciplinary mix of psychiatry and cultural studies. However, even though I consider myself “post-disciplinary,” it is important to realize I am as bound by that discourse (which David points out) as David is by his (which David does not point out). Post-“disciplinary” is still “disciplinary” despite many efforts to go beyond it. David’s and my different disciplinary boundedness creates a cross-disciplinary divide that effectively functions like a cross-cultural divide. After all, disciplines (including most “post-disciplines”) resemble cultures in that each has its own histories, parent (usually Father) figures, core texts,