History at the heart of medicine

With a focus on the challenges of today and tomorrow in the critical medical humanities the role of history is often overlooked. Yet history and medicine are closely intertwined. Right now, with the surfacing of knotty problems such as changing demographics, chronic pain, loneliness and Long Covid – and the consequent necessity to change directions and policies – history seems more urgent than ever. However, historians of medicine have sometimes been reticent to play a role in medicine and policymaking. The recent and welcome development of the critical medical humanities has intervened in medicine in important ways, but often without clear engagement with the history of medicine. In this letter, we make a renewed case for coherence and collaboration between history of medicine, medicine, and medical humanities, emphasising the continuity and links between all three. The skills and focus of the historian of medicine bring crucial historical context to the table, enabling better understanding of medical collecting, new imaginative futures, profound critiques of key medical concepts, and understandings of the body through time. By emphasising what historians can do for medicine and medical humanities, we call for building historical work into how medicine, illness and health are understood now and in the future. We suggest three potential roles for historians: keepers of memories, conversation partners, and futurist thinkers

A new study of an old sink of sulfur in hot molecular cores: the sulfur residue

Sulfur appears to be depleted by an order of magnitude or more from its elemental abundance in star-forming regions. In the last few years, numerous observations and experiments have been performed in order to to understand the reasons behind this depletion without providing a satisfactory explanation of the sulfur chemistry towards high-mass star-forming cores. Several sulfur-bearing molecules have been observed in these regions, and yet none are abundant enough to make up the gas-phase deficit. Where, then, does this hidden sulfur reside? This paper represents a step forward in our understanding of the interactions among the various S-bearing species. We have incorporated recent experimental and theoretical data into a chemical model of a hot molecular core in order to see whether they give any indication of the identity of the sulfur sink in these dense regions. Despite our model producing reasonable agreement with both solid-phase and gas-phase abundances of many sulfur-bearing species, we find that the sulfur residue detected in recent experiments takes up only ~6 per cent of the available sulfur in our simulations, rather than dominating the sulfur budget.Comment: 13 pages, 6 colourful figures, accepted by MNRA

The Long or the Post of It? Temporality, Suffering, and Uncertainty in Narratives Following COVID-19

Long COVID affects millions of individuals worldwide but remains poorly understood and contested. This article turns to accounts of patients' experiences to ask: What might narrative be doing both to long COVID and for those who live with the condition? What particular narrative strategies were present in 2020, as millions of people became ill, en masse, with a novel virus, which have prevailed three years after the first lockdowns? And what can this tell us about illness and narrative and about the importance of literary critical approaches to the topic in a digital, post-pandemic age? Through a close reading of journalist Lucy Adams's autobiographical accounts of long COVID, this article explores the interplay between individual illness narratives and the collective narrativizing (or making) of an illness. Our focus on temporality and suffering knits together the phenomenological and the social with the aim of opening up Adams's narrative and ascertaining a deeper understanding of what it means to live with the condition. Finally, we look to the stories currently circulating around long COVID and consider how illness narratives-and open, curious, patient-centered approaches to them-might shape medicine, patient involvement, and critical medical humanities research

Animal roles and traces in the history of medicine, c1880-1980

This paper argues for the need to create a more animal-centred history of medicine, in which animals are considered not simply as the backdrop for human history, but as medical subjects important in and of themselves. Drawing on the tools and approaches of animal and human–animal studies, it seeks to demonstrate, via four short historical vignettes, how investigations into the ways that animals shaped and were shaped by medicine enables us to reach new historical understandings of both animals and medicine, and of the relationships between them. This is achieved by turning away from the much-studied fields of experimental medicine and public health, to address four historically neglected contexts in which diseased animals played important roles: zoology/pathology, parasitology/epidemiology, ethology/ psychiatry, and wildlife/veterinary medicine. Focusing, in turn, on species that rarely feature in the history of medicine – big cats, tapeworms, marsupials and mustelids – which were studied, respectively, within the zoo, the psychiatric hospital, human–animal communities and the countryside, we reconstruct the histories of these animals using the traces that they left on the medical-historical record

Comorbidity and Quality of Life in Adults with Hair Pulling Disorder

Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and psychosocial functioning in a well-characterized sample of adults with HPD (N=85) who met DSM-IV criteria, had at least moderate hair pulling severity, and participated in a clinical trial. Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis. Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders. The relationships between certain comorbidity patterns, hair pulling severity, current mood and anxiety symptoms, and quality of life were also examined. Results showed that current depressive symptoms were the only predictor of quality of life deficits. Implications of these findings for the conceptualization and treatment of HPD are discussed

Factor Analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version

The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; Flessner et al., 2008) measures the degree to which hair pulling in Trichotillomania (TTM) can be described as “automatic” (i.e., done without awareness and unrelated to affective states) and/or “focused” (i.e., done with awareness and to regulate affective states). Despite preliminary evidence in support of the psychometric properties of the MIST-A, emerging research suggests the original factor structure may not optimally capture TTM phenomenology. Using data from a treatment-seeking TTM sample, the current study examined the factor structure of the MIST-A via exploratory factor analysis. The resulting two factor solution suggested the MIST-A consists of a 5-item “awareness of pulling” factor that measures the degree to which pulling is done with awareness and an 8-item “internal-regulated pulling” factor that measures the degree to which pulling is done to regulate internal stimuli (e.g., emotions, cognitions, and urges). Correlational analyses provided preliminary evidence for the validity of these derived factors. Findings from this study challenge the notions of “automatic” and “focused” pulling styles and suggest that researchers should continue to explore TTM subtypes

Clarifying the Relationship Between Trichotillomania and Anxiety

Although research has consistently linked unidimensional anxiety with Trichotillomania (TTM) severity, the relationships between TTM severity and anxiety dimensions (e.g., cognitive and somatic anxiety) are unknown. This knowledge gap limits current TTM conceptualization and treatment. The present study examined these relationships with data collected from ninety-one adults who participated in a randomized clinical trial for TTM treatment. Based on prior research, it was hypothesized that TTM severity would be related to the cognitive anxiety dimension and that psychological inflexibility would mediate the association. Hypotheses were not made regarding the relationship between TTM severity and somatic anxiety. Regression analyses indicated that only cognitive dimensions of anxiety predicted TTM severity and that psychological inflexibility mediated this relationship. Implications for the conceptualization and treatment of TTM are discussed