Introduction to the issue on "Rhetoric and Health"

UIDB/00183/2020 UIDP/00183/2020publishersversionpublishe

Communication Skills, Expertise and Ethics in Healthcare Education and Practice

UIDB/00183/2020 UIDP/00183/2020publishersversionpublishe

Gender differences in diagnostic procedures

This review examines the contribution of the literature to the controversial issue of diagnostic procedures in women affected by coronary artery disease (CAD), on which a large number of papers have been published. It has been reported that cerebro- and cardiovascular diseases represent the first cause of death in the New as well as in the Old World, Italy included. Some studies are conditioned by bias; one of these is the Framingham study, in which angina was reported and defined only clinically and for a relatively young age range, as a benign condition in women. Angiographic studies, such as the CASS, considered a super elected group of women referred to the hemodynamic laboratory for chest pain, which in the female gender often has atypical characteristics. In our opinion, it is mandatory to take into account: 1) what chest pain really means in women; 2) the fact that there are gender differences: women have a different biological and hormonal status, lifestyle, and perception of the disease; 3) that there is a different approach of the physicians to a woman with possible or suspected CAD. We suggest, therefore, a more peculiar and individualized diagnostic approach to women suspected as having CAD. This approach should also take the pre-test probability of disease into consideration. The first investigational step we recommend is the exercise ECG test; should this be unfeasible or not interpretable, an imaging and/or pharmacological stress test is advisable. In case of positive first test results, coronary angiography should be performed. © 2003 CEPI Srl

Endothelial dysfunction in postmenopausal women and hypertension

‘Menopause is a cardiovascular risk factor for endothelial dysfunction … It also represents a unique opportunity to study the effect of endothelial dysfunction in healthy women and predicts the development of atherosclerosis and atherosclerosis-related diseas

Metaphors and Emotions as Framing Strategies in Argumentation

The paper focuses on the role of both emotional and metaphorical processes in reasoning. The aim of the paper is to present an extension of the argumentative theory of reasoning proposed by Mercier and Sperber (2011). In order to advance an integrated model of the roles of metaphors and emotions in argumentation, the paper argues that it is possible to ascribe not only a negative role to emotions and metaphors, but also a positive one. Far from being just a source of fallacies in reasoning, indeed, both emotions and metaphors – considered as framing and reframing strategies – can play a constructive role in argumentation, by enhancing their creative power

Argomenti metaforici: come integrare persuasione e argomentazione

The persuasive power of metaphor is often seen in opposition to rational procedures in argumentation, which should guarantee deliberative democracy in the public sphere. Against this view, referable to the classic theory of argumentation, we adopt the argumentative theory of reasoning (MERCIER, SPERBER 2011) and present the results of an experimental study on the role of metaphors in a specific argumentative fallacy, the quaternio terminorum (ERVAS, LEDDA 2014; ERVAS, GOLA, LEDDA, SERGIOLI 2015). In light of the experimental evidence, we argue that (1) it is no longer possible to evaluate the role of metaphors in argumentation without distinguishing different kinds of metaphors (in the experimental study the distinction between dead and live metaphors is analysed); (2) it is possible to identify different argumentative styles (i.e. argumentative persuasion and reflective argumentation). Connecting different kinds of metaphors with different argumentative styles, we propose an interpretative framework able to integrate persuasion and argumentation

Argumentation as a Bridge Between Metaphor and Reasoning

UID/FIL/00183/2013 SFRH/BPD/115073/2016 WoS - record outside the portuguese subscription range.The aim of this chapter is to explore the relationship between metaphor and reasoning, by claiming that argumentation might act as a bridge between metaphor and reasoning. Firstly, the chapter introduces metaphor as a framing strategy through which some relevant properties of a (generally more concrete and known) source domain are selected to understand a (generally less concrete and known) target domain. The mapping of properties from the source to the target domain implicitly forces the interpreter to consider the target from a specific perspective. Secondly, the chapter presents metaphor as an implicit argument where some inferences can be drawn from the comparison between the source and the target domain. In particular, this chapter aims to understand whether and to what extent such an argument might be linked to analogical reasoning. The chapter argues that, in case of faulty analogy, this kind of argument might have the form of a quaternio terminorum, where metaphor is the middle term. Finally, the chapter presents the results of an experimental study, aiming to test the effect of the linguistic nature of the middle term on the detection of such faulty analogy. The chapter concludes that a wider context is needed to make sense of an analogical argument with novel metaphors, whilst in a narrow context, a lexicalised metaphor might be extended and the overall argument might be interpreted as metaphoric.authorsversionpublishe

A Qualitative Comparison of First and Follow-Up Visits

UIDB/00183/2020 UIDP/00183/2020 SFRH/BPD/115073/2016 PTDC/FER-FIL/28278/2017Background: Misunderstandings in medical interactions can compromise the quality of communication and affect self-management, especially in complex interactions like those in the assisted reproductive technology (ART) field. This study aimed to detect and describe misunderstandings in ART triadic visits. We compared first and follow-up visits for frequency, type, speakers, and topics leading to misunderstandings. Methods: We purposively sampled 20 triadic interactions from a corpus of 85 visits. We used a previously developed coding scheme to detect different types of misunderstandings (i.e., with strong, acceptable, and weak evidence). We analyzed also the different topics leading to strong misunderstandings (direct expressions of lack of understanding, pragmatic alternative understandings, semantic alternative understandings) to provide insights about the contents of the consultation that may need particular attention and care. Findings: We detected an overall number of 1078 misunderstandings in the 20 selected visits. First visits contained almost two-third of the misunderstandings (n = 680, 63%). First visits were particularly rich in misunderstandings with acceptable evidence (e.g., clarifications and checks for understanding), compared to follow-up visits. In first visits, doctors’ turns more frequently than couples’ turns contained misunderstandings, while in follow-up visits it was the other way around. Looking at the couple, the majority of the misunderstandings were expressed by the woman (n = 241, 22%) rather than by the man (n = 194, 18%). However, when weighting for their number of turns, 9% of the men’s turns included an expression of misunderstanding, compared to the 7% of the women’s turns. Finally, more than half of the misunderstandings with strong evidence were about history-taking and treatment-related topics, and while the history-taking ones were particularly frequent in first visits the treatment-related ones were more present in follow-up visits. Discussion: Findings indicate that first visits may deserve particular attention to avoid misunderstandings, as they are the moment where a shared understanding can be harder to reach. In particular, misunderstandings happening in first visits seem mostly related to physicians having to reconstruct the clinical history of patients, while those in the follow-up visits seem to reflect residual and unsolved doubts from the couple, especially concerning treatments.publishersversionpublishe

The double framing effect of emotive metaphors in argumentation

In argumentation, metaphors are often considered as ambiguous or deceptive uses of language leading to fallacies of reasoning. However, they can also provide useful insights into creative argumentation, leading to genuinely new knowledge. Metaphors entail a framing effect that implicitly provides a specific perspective to interpret the world, guiding reasoning and evaluation of arguments. In the same vein, emotions could be in sharp contrast with proper reasoning, but they can also be cognitive processes of affective framing, influencing our reasoning and behavior in different meaningful ways. Thus, a double (metaphorical and affective) framing effect might influence argumentation in the case of emotive metaphors, such as "Poverty is a disease" or "Your boss is a dictator," where specific "emotive words" (disease, dictator) are used as vehicles. We present and discuss the results of two experimental studies designed to explore the role of emotive metaphors in argumentation. The studies investigated whether and to what extent the detection of a fallacious argument is influenced by the presence of a conventional vs. novel emotive metaphor. Participants evaluated a series of verbal arguments containing either "non-emotive" or "emotive" (positive or negative) metaphors as middle terms that "bridge" the premises of the argument. The results show that the affective coherence of the metaphor’s vehicle and topic plays a crucial role in participants’ reasoning style, leading to global heuristic vs. local analytical interpretive processes in the interplay of the metaphorical and the affective framing effects

The Communicative Functions of Metaphors Between Explanation and Persuasion

In the literature, the pragmatic dimension of metaphors has been clearly acknowledged. Metaphors are regarded as having different possible uses, especially pursuing persuasion. However, an analysis of the specific conversational purposes that they can be aimed at achieving in a dialogue and their adequacy thereto is still missing. In this chapter, we will address this issue focusing on the classical distinction between the explanatory and persuasive uses of metaphors, which is, however, complex to draw at an analytical level and often blurred and controversial also from a theoretical point of view. Building on the analysis of explanation in different theories and fields of study, we show how it can be conceived as characterized by a cognitive and a pragmatic dimension, where the transference of understanding is used pragmatically for different dialogical goals - such as informing, making a joint decision, and most importantly persuading. In this sense, the cognitive effects of understanding are not incompatible with a persuasive dialogical purpose. This theoretical proposal will be applied to examples drawn from the medical context, to show how a pragmatic approach to explanation can account for the complexity of the cases that can be found in actual dialogical contexts