Au mode subjonctif. La construction narrative des crises d'épilepsie en Turquie

Au mode subjonctifLa construction narrative des crises d'épilepsie en TurquieCet article présente une analyse culturelle des crises en Turquie, à l'aide d'entrevues individuelles et familiales auprès d'un échantillon constitué de personnes diagnostiquées comme souffrant d'épilepsie ou de crises psychogènes. L'article brosse une brève critique des stratégies d'analyse qui juxtaposent « croyances » culturelles et « connaissance » médicale à propos d'une condition biologique et développe une façon spécifique de comprendre la construction narrative de la maladie et de son expérience. L'article s'inspire plus particulièrement des theories de la narrativité et de la réponse du lecteur (Iser, Ricoeur, Bruner) pour analyser les « tactiques de subjonctivisation » présentes dans les récits de maladie.In the Subjunctive ModeThe Narrative Construction of Seizures in TurkeyThis paper provides a cultural analysis of seizures in Turkey, based on individual and family interviews with a community sample of persons diagnosed as suffering epilepsy or psy-chogenic seizures. It outlines a brief critique of analytic stratégies that juxtapose cultural « beliefs » to médical « knowledge » of a biological condition, and develops an alternative understanding of the narrative construction of illness and ils expérience. In particular, it draws on récent theories of narrativity and reader response (Iser, Ricoeur, Bruner) to analyze the « subjunctivizing tactics » présent in illness narratives

Temps narratif et incertitude en médecine clinique

Temps narratif et incertitude en médecine cliniqueLes stratégies narratives auxquelles recourent les médecins traitants pour esquiver les incertitudes qu'ils affrontent au moment de poser un diagnostic, d'établir un pronostic ou de se prononcer sur l'efficacité d'un traitement semblent varier selon la spécialité médicale, les qualités temporelles de la pratique clinique et les processus morbides en cause. Cet essai propose deux concepts issus de la theorie littéraire — temporalité et construction de l'intrigue — comme des perspectives permettant d'interpréter la pratique clinique. Il porte, plus précisément, sur les stratégies narratives développées par les oncologues. Plutôt que d'analyser l'incertitude reliée à la catégorie du diagnostic, je me penche ici sur le dilemme posé par l'incertitude qui entoure la temporalité et l'efficacité du traitement. Je pose l'hypothèse que les oncologues cherchent à créer, chez leurs patients, des expériences d'immédiateté plutôt que de chronologie, de manière à mettre à distance et à circonscrire les incertitudes qui entourent les résultats du traitement et à pallier les lacunes de la connaissance biomédicale. Ces stratégies narratives particulières créent une ambiguïté concernant les dénouements. Lorsque l'issue de la maladie — la mort — cesse désormais d'être incertaine, les « récits therapeutiques » se fragmentent tandis que les dénouements au niveau du travail clinique se révèlent souvent boiteux.Narrative, Time and Uncertainty in Clinical MedicineThe narrative stratégies clinicians create to distance uncertainties that arise regarding diagnosis, prognosis or efficacy of treatment appear to vary by médical specialty and by the temporal qualities of clinical practice and the disease processes encountered. In this essay, two concepts from narrative theory — temporality and emplotment — are introduced as interpretive perspectives on clinical work. The narrative stratégies of oncologists are analyzed. The dilemma posed by uncertainty associated with temporality and efficacy of treatment rather thah uncertainty of diagnostic category is explored. I propose that oncologists seek to create expériences of immediacy rather than of chronology, thus distancing and circumscribing uncertainties regarding treatment outcomes and the limits of biomédical knowledge. Thèse distinctive narrative stratégies produce ambiguity about endings. There-fore when endings — and death — are no longer uncertain, therapeutic narratives fragment and endings in clinical work are often ill-crafted

The British Fight against Cancer: Publicity and Education, 1900–1948

This article explores the early history of cancer education in Britain, focusing on the period between 1900, when discussions about a public ‘crusade’ against cancer began in Britain, and the foundation of the National Health Service (NHS) in 1948. Arising from debates around the development of invasive operations for cervical cancer, the campaign had a cautious start because of important uncertainties about the efficacy of available therapies, worries about the undesirable effects of partial knowledge, and anxieties about creating demands that could not be fulfilled. Against this background, anti-cancer activists attempted to produce a discourse which would not undermine people's faith in medical science, and which would encourage people to consult their doctors without putting excessive pressure on health services funded by public money. A ‘regime’ of hope came to the fore that served to draw patients, philanthropists, practitioners and researchers together into a joint market agenda

“Reaching Out to the People”: The Cultural Production of Mental Health Professionalism in the South Indian Public Sphere

Although a significant body of scholarship has examined medical discourse in clinical and other institutional settings, far less has been studied in regard to the discursive activity of health professionals in the public sphere. This line of inquiry is particularly relevant in Kerala, south India, where, for reasons including felt obligation, the political economy of allopathic mental health care, and desires for social prestige, many psychologists and psychiatrists actively engage the public as lecturers, authors, and guests of television and radio programs alongside their clinical work. Ethnographic attention to discursive activity in the public sphere reveals how these experts blur the boundaries between clinical and popular registers of speech and forge alternative ethical sensibilities and values that challenge institutionally prescribed ideas of clinical professionalism. They do so in ways that can attract reprobation and accusations of quackery among critical peers who hold competing ideas of where, how, and to whom mental health professionals “should” speak

Therapeutic journeys: the hopeful travails of stem cell tourists

The recent growth of so-called stem cell tourism reflects the high optimism that currently surrounds stem cell science. Stem cell treatments for various conditions are increasingly advertised over the Internet as being available at hospitals and clinics around the world. However, most are clinically unproven. Despite numerous warnings from scientists about the dangers posed by such treatments, many individuals are evidently prepared to take the risk, sometimes on more than one occasion. This article explores the dynamics of hope that underpin stem cell tourism. Drawing on ideas from the sociology of hope, as applied to biomedicine, the article explores how hope is constructed and shapes actions in relation to stem cell treatments. Making reference to the findings from an Australian study of patients and carers who travelled overseas to receive stem cell treatments, it is argued that hope has an ambiguous significance in the context of deregulated health care. As we explain, this has implications for patients' and carers' treatment decisions and experiences. The findings are discussed in light of current responses to stem cell tourism

Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It

RefereedMichael Crichton FundHarvard Medical SchoolNational Institute of Mental Health Training Grant on “Culture and Mental Health Services” (5T32MH018006-21

"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

Barriers to colorectal cancer screening in community health centers: A qualitative study

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer screening rates are low among disadvantaged patients; few studies have explored barriers to screening in community health centers. The purpose of this study was to describe barriers to/facilitators of colorectal cancer screening among diverse patients served by community health centers.</p> <p>Methods</p> <p>We identified twenty-three outpatients who were eligible for colorectal cancer screening and their 10 primary care physicians. Using in-depth semi-structured interviews, we asked patients to describe factors influencing their screening decisions. For each unscreened patient, we asked his or her physician to describe barriers to screening. We conducted patient interviews in English (n = 8), Spanish (n = 2), Portuguese (n = 5), Portuguese Creole (n = 1), and Haitian Creole (n = 7). We audiotaped and transcribed the interviews, and then identified major themes in the interviews.</p> <p>Results</p> <p>Four themes emerged: 1) Unscreened patients cited lack of trust in doctors as a barrier to screening whereas few physicians identified this barrier; 2) Unscreened patients identified lack of symptoms as the reason they had not been screened; 3) A doctor's recommendation, or lack thereof, significantly influenced patients' decisions to be screened; 4) Patients, but not their physicians, cited fatalistic views about cancer as a barrier. Conversely, physicians identified competing priorities, such as psychosocial stressors or comorbid medical illness, as barriers to screening. In this culturally diverse group of patients seen at community health centers, similar barriers to screening were reported by patients of different backgrounds, but physicians perceived other factors as more important.</p> <p>Conclusion</p> <p>Further study of these barriers is warranted.</p