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

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

Bodies of emotion: rethinking culture and emotion through Southeast Asia

Feelings are not substances to be discovered in our blood but social practices organized by stories that we both enact and tell. michelle rosaldo 1984:14

American medicine: the quest for competence

What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care?These and many other crucial questions are examined in this book, the first to fully explore the meaning and politics of competence in modern American medicine. Based on Mary-Jo DelVecchio Good's recent ethnographic studies of three distinct medical communities - physicians in rural California, academics and students involved in Harvard Medical School's innovative "New Pathway" curriculum, and oncologists working on breast cancer treatment - the book demonstrates the centrality of the issue of competence throughout the medical world. Competence, it shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training.Timely and provocative, this study is essential reading for medical professionals, academics, anthropologists, and sociologists, as well as health-care policymakers

Cultural studies of biomedicine: An agenda for research

This paper outlines a 'cultural studies' approach to investigations of the transnational world of contemporary biomedicine. Although biomedicine is fostered by an international political economy and global community of medical educators and bioscientists, it is taught, practiced, organized and consumed in local contexts. This essay argues that cultural studies of contemporary biomedicine should focus on the dynamic relationship between local and international worlds of knowledge, technology and practice. Three issues illustrate this approach: (1) an exploration of the tensions inherent in the local and cosmopolitan shaping of 'clinical narratives', with examples drawn from comparative studies of oncology; (2) an exploration of the influence of biomedical research findings and international clinical trials on the production of clinical narratives, with examples drawn from current research on breast cancer; and (3) an exploration of the local or national and 'international' or 'transnational' dimensions of the production of biotechnologies and pharmaceutical therapeutics. The essay concludes with a discussion of the limits that privilege either universal or local perspectives and claims to knowledge and the ethical challenges that become apparent from this perspective.cultural studies oncology biotechnology clinical narratives comparative biomedicines

Haunting

Page range: 91-98This essay is one of more than a dozen in this volume to honor the late Mary Margaret Steedly. The paper’s theme is “haunting.” Steedly’s writings are filled with stories of spirits—in Karoland during the New Order’s core years, as well as in Indonesian horror films in the post-Suharto Reformasi years. There are the keramat of Mount Sibayak and the spirits of the dead. Steedly views spirit figures as part of the everyday world—her interest is not whether they exist, but rather what Indonesians do about them. She takes up analysis in terms of visibility and invisibility, or, more specifically, transparency and apparition. It is in the context of a suppressed national history that the ghosts of the New Order find a presence in popular Indonesian horror films—possibly, an association of revenge with the unexplained and unmourned dead remains present until today in talk about the dangers of revisiting Indonesia’s violent history. It is this association that begins to point back to Steedly’s experiences of ghosts and questions of vengefulness decades earlier in her Karo work. She did not engage theories of haunting explicitly, but her writings suggest important directions for placing her work in conversation with recent writings on hauntology.2025-04-0