Analytic philosophy for biomedical research: the imperative of applying yesterday's timeless messages to today's impasses

The mantra that "the best way to predict the future is to invent it" (attributed to the computer scientist Alan Kay) exemplifies some of the expectations from the technical and innovative sides of biomedical research at present. However, for technical advancements to make real impacts both on patient health and genuine scientific understanding, quite a number of lingering challenges facing the entire spectrum from protein biology all the way to randomized controlled trials should start to be overcome. The proposal in this chapter is that philosophy is essential in this process. By reviewing select examples from the history of science and philosophy, disciplines which were indistinguishable until the mid-nineteenth century, I argue that progress toward the many impasses in biomedicine can be achieved by emphasizing theoretical work (in the true sense of the word 'theory') as a vital foundation for experimental biology. Furthermore, a philosophical biology program that could provide a framework for theoretical investigations is outlined

Negotiating roles and making claims as a patient in the psychiatric consultation: a frame analysis

My thesis develops an understanding of patient role and identity performances in psychiatric consultations. Recent increased attention to shared-decision making and patient-centred care in psychiatry is in large part influenced by changing ideas about the doctor-patient relationship, challenging power discrepancies and reconsidering notions of ‘expert’ and ‘lay’ contributions. Previous work surrounding this field has mostly focused on psychiatrists’ talk, asking ‘how can psychiatrists improve shared-decision making skills?’ While important, I argue that this focus is at odds with the principles behind shared-decision making by failing to consider patients’ own performances in their talk with psychiatrists. I re-analyse recorded interactions in 92 psychiatric consultations with patients prescribed anti-psychotic medication. Drawing on the work of Goffman, I identify frames which are negotiated throughout the consultations and explore how these shape the roles and ‘footing’ adopted by patients. I demonstrate techniques used by patients to maintain a balance between making credible and influential claims and maintaining an acceptable patient role. Finally I consider the impact of family members attending these consultations. I explore how they collaborate and compete with patients in making claims, and the impact of their presence on patients’ own performances. The thesis makes the case for considering patients as active participants in constructing the interaction in psychiatric consultations and the need to understand the work being undertaken by patients to construct their place in the immediate discourse and in their wider social connections. It moves towards developing this understanding by providing a detailed review of various techniques seen in this data set. In using a frame analysis it also provides a relatively new perspective on considering discourse and demonstrates how this kind of approach can be useful when analysing institutional talk

‘“Breathing for a while on our earth”: Re-reading S. T. Coleridge’s ‘Dejection: An Ode’ and ‘Letter To Asra’ in light of his severe rheumatic fever.’

Hitherto overlooked medical sources ascribing Coleridge’s ill health to a deadly strain of rheumatic fever should prompt us not only to reinterpret ‘Dejection: An Ode’ as an empirical narrative of respiratory distress as much as a lament for lost or lessened imaginative power, but also to reconsider its long-standing classification as a ‘conversation poem’ and to reassess the relation of the ode to the letter from which it derives. Whereas discussion of air and breathing in Romantic literature tends to be metaphysical, this thesis addresses the question of what happens when we place the physiology and pathology of respiration at the centre of an analysis of a major Romantic poem. Analysing Coleridge’s response to his rheumatic fever as a case study of respiratory writing, I trace the ways in which the poet’s facility for literary osmosis transforms daily management and mismanagement of his bodily ailments into poetic legacy. Coleridge’s rheumatic fever inextricably knots together his body and imagination, such that breathlessness figures in his writing as both a conventional poetic trope and a frightening lived experience. Coleridge’s acute awareness of sensation and relationship with pain led him to understand breathing within material and ethereal spaces. His rheumatic reflections in letters and notebooks play a large part in shaping his literary identity, and respiratory dysfunction, especially the sense of smothering oppression, is crucial to an understanding, his own as much as ours, of his deeply dejected state. This thesis examines papers published by physicians close to Coleridge, such as William Cullen, David Dundas, and William Charles Wells; records pertaining to Coleridge’s autopsy; and an editorial from the London Times reflecting on his death, in order to identify rheumatic fever as Coleridge’s primary ailment, against countervailing diagnoses of opioid addiction, scrofula and lassitude. The scientific investigation of breathing was familiar to Coleridge from his youth, during which the study of pneumatic chemistry and pneumatic medicine flourished. He immersed himself in a world of ‘new airs’ including Joseph Priestley’s Experiments and Observations on Different Kinds of Air. Engagement with a pneumatic zeitgeist that deconstructed elemental air saw him act on medical advice from Thomas Beddoes’ Pneumatic Institute. With his close friend, Humphry Davy, he experimentally inhaled nitrous oxide and to Davy confided his rheumatic grief. Yet the alarm Coleridge felt about the spiritual consequences of such novel scientific enquiries must inform any exegesis of ‘Dejection: An Ode’ even as we must also look beyond his nostalgia for an older vitalist response to breath to affirm the centrality of the physical body in his ode’s deeper poetic truth. I find all the ode’s motifs invite respiratory comment, from the lost screaming child and trampled men to the suffocating nightmares and crushing vipers. (499 words