Rebecca Garden

Reflection in/and Writing: Pedagogy and Practice in Medical Education

During the past decade, “reflection” and “reflective writing” have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey’s thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.

Expanding Clinical Empathy: An Activist Perspective

ABTRACTBACKGROUNDDiscussions of empathy in health care offer important ways of enabling communication and interpersonal connection that are therapeutic for the patient and satisfying for the physician. While the best of these discussions offer valuable insights into the patient-physician relationship, many of them lack an action component for alleviating the patient’s suffering and emphasize the physician’s experience of empathy rather than the patient’s experience of illness.METHODSBy examining educational methods, such as reflective writing exercises and the study of literary texts, and by analyzing theoretical approaches to empathy and suggestions for clinical practice, this article considers how to mindfully keep the focus on what the patient is going through.CONCLUSIONClinical empathy can be improved by strategies that address (1) the patient’s authority in providing first-person accounts of illness and disability, (2) expanding the concept of empathy to include an action component geared toward relieving patients’ suffering, and (3) the potential value of extending empathy to include the social context of illness.

Who speaks for whom? Health humanities and the ethics of representation

The medical or health humanities are in essence a form of advocacy, a means of addressing a problem of underrepresentation. They focus on suffering, rather than pathology, and on sociocultural understandings of illness and disability, rather than a narrow biomedical perspective. The health humanities thus analyse and attempt to recalibrate the power imbalance in healthcare. This article reviews health humanities scholarship that addresses underrepresentation through the analysis of illness and disability narratives. It examines the ethics of representation by exploring how literary representation functions, its aesthetic as well as political dimensions, and how it operates as a relay mechanism for power. The mechanism of representation is further explored through a reading of Eli Clares narrative Exile and Pride. Donna Haraways notion of articulations is proposed as a tool for a more ethical approach to representation. The article suggests that transparency about the power health humanities scholars stand to gain through representation may contribute to a more ethical health humanities practice.

Disability and narrative: new directions for medicine and the medical humanities

People with disabilities are a large minority that disproportionately seeks medical care. However, disability is relatively neglected in medical education and practice, and disabled people experience troubling differences and even disparities in healthcare. Practitioners can help improve healthcare for disabled people through disability studies, a multi-disciplinary field of enquiry that draws on the experiences and perspectives of people with disabilities to address discrimination. This article outlines a disability studies perspective on healthcare, specifically the rejection of the medicalisation of disability and difference in favour of an understanding of disability that focuses on social factors that disable, such as stigmatisation and a lack of accommodation. The ‘social model’ of disability can be expanded to chronic illness and to the broader work of the medial humanities. The author argues that narrative, particularly first-person accounts, provide a critical resource by representing the point of view of people with disabilities and by offering a means of examining the social context and social determinants of disability. The author examines specific conventions of narrative, the dominant plotlines such as the triumph over adversity, that predetermine experiences of disability and illness. Through disability studies and critical examinations of narrative informed by disability studies, practitioners can provide better care for patients with disabilities and work as allies towards more equitable relations in the clinic.

Sympathy, Disability, and the Nurse: Female Power in Edith Wharton’s The Fruit of the Tree

The nursing profession’s emphasis on empathy as essential to nursing care may undermine nurses’ power as a collective and detract from perceptions of nurses’ analytical skills and expertise. The practice of empathy may also obscure and even compound patients’ suffering when it does not fully account for their subjectivity. This essay examines the relation of empathy to women’s agency and explores the role empathy plays in obscuring rather than empowering the suffering other, particularly people who are disabled, through a close reading of Edith Wharton’s 1907 novel, The Fruit of the Tree, and through discussions of empathy and sympathy from literary and disability studies.

Distance Learning: Empathy and Culture in Junot Diaz's "Wildwood"

This essay discusses critical approaches to culture, difference, and empathy in health care education through a reading of Junot Diaz’s “Wildwood” chapter from the 2007 novel The Brief Wondrous Life of Oscar Wao. I begin with an analysis of the way that Diaz’s narrative invites readers to imagine and explore the experiences of others with subtlety and complexity. My reading of “Wildwood” illuminates its double-edged injunction to try to imagine another’s perspective while recognizing the limits to—or even the impossibility of—that exercise. I draw on post-colonial theory and feminist science studies to illuminate a text that is created and interpreted in a post-colonial context—the Dominican diaspora in the United States. The essay offers a model of historical and critical analysis that health care educators can use to frame the concept of empathy in the classroom and the clinic.

Critical Healing: Queering Diagnosis and Public Health through the Health Humanities

This introduction provides an overview to a special issue on Critical Healing, which draws on queer theory, disability studies, postcolonial theory, and literary studies to theorize productive engagements between the clinical and cultural aspects of biomedical knowledge and practice. The essays in this issue historicize and theorize diagnosis, particularly diagnosis that impacts trans health and sexuality, homosexuality, and HIV/AIDS transmission. The essays also address racialization, disability, and colonialism through discussions of fiction, film, theoretical memoir, and comics, as well as biomedical discourse and knowledge.