Jenny Slatman

Hand Transplants and Bodily Integrity

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness requires a process of re-identification. Medical interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has.

Multiple dimensions of embodiment in medical practices

In this paper I explore the various meanings of embodiment from a patient’s perspective. Resorting to phenomenology of health and medicine, I take the idea of ‘lived experience’ as starting point. On the basis of an analysis of phenomenology’s call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature ‘lived experience’ is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of ‘lived experience’ should be revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body’s subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person’s embodied agency, or a person’s ‘I can’.

Being Whole After Amputation

Assessing various studies on Body Integrity Identity Disorder (BIID), Müller (2009) claims that while psychology and psychiatry may have provided accurate descriptions of this rare disorder so far, they fail to actually explain it. According to her, only neurology can convincingly explain it: it is most likely that this disorder involves a congenital malformation in the brain. This claim about the cause of BIID is crucial for her answer to the question whether elective amputation is ethically justified or not. Taking for granted the neurological explanation of this disorder, she argues that elective amputation is not justified; if the problem can be located in the brain, it is the brain that should be treated, instead of amputating a healthy limb. Referring to the so-called four principles of medical ethics, she also maintains that elective amputation can also not be justified by a patient’s autonomous decision, since it is not clear how autonomous such a person actually is. In this review we would like to comment on two issues in Müller’s target article: 1) her emphasis on a neurological explanation and treatment, and 2) her principlist ethical approach. As an alternative we would like to provide an existential clarification of BIID, and a phenomenologicalnarrative ethical approach which leaves the possibility for interpreting a person’s autonomy against the background of the person’s embodied experience and his or her life world. Although it might be true that psychology and psychiatry research on BIID leaves us with unresolved questions of classification, we doubt whether resorting to neurology will resolve this problem. At least four objections can be raised here: 1) The suggestion that a neurological disturbance should be seen as the cause of a distorted embodied self-experience entails a crucial fallacy: every experience correlates with a certain neuronal activity, but this does not mean that neuronal activity causes experiences. Correlation does not necessarily imply a causal relation. 2) The neurological “explanation” is in fact no more than a hypothesis (Ramachandran and McGeoch 2007). 3) The idea that it may be better to adapt one’s neuronal body image to one’s body than to adapt one’s body to one’s neuronal body image does not take into account that manipulation of the brain is very risky and that an exact manipulation is in fact not (yet) possible. Neuroscientists who have established that transsexualism also correlates with a deviation in the brain, consider sex reassignment surgery as an adequate therapy (Cf. Swaab 2007) and do not even mention the possibility of a “causal therapy” which would influence the brain. 4) It is

The meaning of body experience evaluation in oncology.

Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily wholeness or bodily integrity. Since this experience is contextualized by a person’s life story, evaluation should also focus on narrative aspects. I finally suggest that the interpretation of body experience is not only valuable to assess a person’s quality of life after treatment, but that it can also be useful in counseling prior to interventions, since it can support patients in making decisions about interventions that will change their bodies. To apply this type of evaluation to oncology practice, a rich and tailored vocabulary of body experiences has to be developed.

Responding to Scars After Breast Surgery

This article represents a phenomenological study on how women endow meaning to their scarred bodies after breast cancer treatment. Data collection consisted of multiple interviews with 10 women who had mastectomy, and 9 women who had breast-saving surgery. Against the background of the phenomenological premise that one’s body can appear to oneself in various ways, we identified meaningful differences between experiences that go together with one’s body “at a distance” and experiences that go together with one’s body’s “closeness.” The diversity in body experiences we have revealed in our study calls for reconsidering the prejudiced critique of the “body as object” in mainstream phenomenology of health care, and invites medical professionals to develop the ability to recognize different perspectives on embodiment.

Can you restore my 'own' body? : a phenomenological analysis of relational autonomy

Can You Restore My “Own” Body? A Phenomenological Analysis of Relational Autonomy Jenny Slatman, Kristin Zeiler & Ignaas Devisch To cite this article: Jenny Slatman, Kristin Zeiler & Ignaas Devisch (2016) Can You Restore My “Own” Body? A Phenomenological Analysis of Relational Autonomy, The American Journal of Bioethics, 16:8, 18-20, DOI: 10.1080/15265161.2016.1187219 To link to this article: http://dx.doi.org/10.1080/15265161.2016.1187219

A virtual rehabilitation program after amputation: a phenomenological exploration

Abstract Purpose: This study provides an analysis of bodily experiences of a man with a lower leg amputation who used a virtual rehabilitation program. Method: The study reports data from semi-structured interviews with a 32-year veteran who used a virtual environment during rehabilitation. The interviews were analyzed using interpretative phenomenological analysis (IPA). Results: During this rehabilitation program, he initially experienced his body as an object, which he had to handle carefully. As he went along with the training sessions, however, he was more stimulated to react directly without being aware of the body’s position. In order to allow himself to react spontaneously, he needed to gain trust in the device. This was fostered by his narrative, in which he stressed how the device mechanically interacts with his movements. Conclusion: The use of a virtual environment facilitated the process of re-inserting one’s body into the flow of one’s experience in two opposite, but complementary ways: (1) it invited this person to move automatically without taking into account his body; (2) it invited him to take an instrumental or rational view on his body. Both processes fostered his trust in the device, and ultimately in his body. Implications for Rehabilitation Providing (more) technological explanation of the technological device (i.e. the virtual environment), may facilitate a rehabilitation process. Providing (more) explicit technological feedback, during training sessions in a virtual environment, may facilitate a rehabilitation process.

What does a breast feel like? A qualitative study among healthy women

BackgroundRestoring the body as normal as possible increases quality of life. Aesthetically, almost perfect breast reconstructions can be created. However, these reconstructed breasts have almost no sensation. Our hypothesis is that if we succeed in restoring sensation, this will increase quality of life. So far, little is written about the phenomenon of breast sensation, which makes it difficult to evaluate whether the quality of life increases after restored sensation. Therefore, the primary goal of this study is to determine what the importance and meaning is of breast sensation among healthy women.MethodsA qualitative, descriptive phenomenological study was performed in an academic hospital between October 2016 and March 2017. A total of 10 semi-structured in-depth interviews were conducted in healthy women who did not undergo prior breast surgery. The sample size was based upon ‘saturation’. The interviews were tape-recorded, transcribed verbatim, coded and analysed according to phenomenology keeping in mind the research question ‘what is the importance and meaning of sensation of the breast?’ResultsSeven interrelated themes on how sensation of the breast is experienced were found: the absent breast (1), the present breast (2), the well-functioning breast (2a), the feminine breast (2b), the sensual breast (2c), the alien breast (2d), the safe breast (2d).ConclusionsThe seven interrelated themes can form the basis to develop a quantitative research tool to evaluate quality of life after innervated breast reconstruction and can be implemented in counselling before breast reconstructive surgery in the form of shared treatment decisions.

Can we "Remedy" Neurohype, and Should we?: Using Neurohype for Ethical Deliberation

In her article, Grubbs (2016) presents a rhetorical dismantlement of a neuroscientific and a cognitive psychology study on literariness. Following Rose and Abi-Rached’s (2013) plea for a more constructive commitment with the neurosciences, Grubbs aims to give practical examples of how humanities scholars could contribute to the neurosciences, and prevent neurohype. To this purpose, she analyzes two recent studies on the impact of reading literary fiction on the mind and brain. We think the article is a laudable example of how humanities scholars could productively engage with the neurosciences without falling into defensive boundary disputes. Especially, the author’s meticulous analysis of the conceptual poorness of the scientists’ research shows convincingly how scholars in the humanities could contribute to better theoretical models, research questions, and methodologies. However, her analysis of the translational work of the two science studies urges some further reflection on the phenomenon of neurohype. Based on a body of work in the field of ethics of emerging technologies, we want to question the feasibility of reducing neurohype. Neurohype is to a great extent inevitable. However, fortunately, it is not all bad. We propose an alternative strategy for scholars in the humanities to engage with neurohype: as source for upstream ethical deliberation. Throughout the article, Grubbs characterizes neurohype as oversimplified science, incorporating shallow, decontextualized information, with overstated social implications, appealing to reductionist explanations, and portraying (false) credibility and scientific validity. Grubbs calls attention to systemic, institutional pressures (such as publication and grant writing) that would demand neuroscientists to justify their work and make promissory claims. Grubbs echoes Rose and Abi-Rached’s proposal that scholars in the humanities should help “defend” the neuroscientists from this “translational imperative.” Humanities scholars could do this by providing “possibilities for more ethical scientific rhetoric.” She compares the rhetorical changes of the two scientific studies when presented in press releases and popular media, scrutinizing how their conditional phrases and qualifications got lost. In this way, Grubbs aims to make “science communication more accurate—and hence ethical.” A “more ethical rhetoric” seems to imply careful and balanced language (i.e., conditional statements and qualifications), credible representations, and avoiding the urge for premature translation and promising relevance. While we fully agree with Grubbs’s exemplary and concrete analysis of the rhetorical journey of brain claims, we are a bit wary of her framing of the humanities in the role of “reducing” and “remedying” neurohype. Her strategy of combating neurohype seems to rest on a clear-cut distinction between a stable factual core and an “inflated” or subjective valuation. We think that facts and values cannot be distinguished so easily in our times of “post-normal science” (Ravetz 1999), which is characterized by political and public pressures for valorization. Valuation pervades the whole process of scientific knowledge construction, from funding decisions and setting research priorities, to the theories of mind and statistical models used. In all such decisions value judgments play a role, roles that are based on assessments on the likelihood of certain consequences to occur. Of course, this is likely to be contested, so the concept of “neurohype” is hardly a neutral, descriptive one. Rather, the label itself is highly valueladen and by definition contested, as expectations with regard to the future tend to diverge. That scientists calibrate their expectations and promises depending on the context—a discussion with peers during a conference, an article for a peer-reviewed journal, a contribution to a debate in the journals, a funding proposal—is by now a well-established sociological fact. It is hard to see how this can be different in a world where society is no longer willing to write a blank check for scientists but instead demands some justification of spending scarce resources on scientific research. As a consequence, what counts as valuable knowledge (for addressing specific problems) is from the outset intertwined with political and public pressures for possible valorizations. In our times, there is no longer a strict demarcation between science and society,

Duurzaam meer bewegen

Het promoten van een actievere leefstijl is sinds jaar en dag een van de belangrijkste pijlers van gezondheidsbevordering. Inzicht in de gunstige effecten van beweging voor de gezondheid stapelen zich op, maar al deze kennis zet mensen die te weinig bewegen – volgens de huidige bewegingsnorm – niet zomaar aan tot meer bewegen. Duurzaam meer bewegen is geen sinecure.