Programação
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O GENAM-USP, a Medicina Narrativa e as Humanidades Médicas (2011-2019)
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Nesta sessão, discutiremos como a prática médica constituiu-se epistemologicamente ao longo do tempo, como chegou ao que hoje conhecemos pelo nome de Medicina Baseada em Evidências (Evidence-Based Medicine ou EBM) e de que modo a "Medicina Baseada em Narrativa" (Narrative-Based Medicine) e as Humanidades Médicas podem (ou não) constituir-se como crítica ao predomínio da tecnobiomedicina em saúde.
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O campo de estudos da Narrative Medicine, ou da Narrative-Based Medicine, consolidou-se especialmente a partir dos anos 2000 em meios acadêmicos anglossaxões (Inglaterra e Estados Unidos) como reação à onda avassaladora da Medicina Baseada em Evidência, ou Evidence-Based Medicine, que se tornou paradigma das práticas de saúde nos anos 1980 e 90.
Entenda o que é a Narrative Medicine e conheça seus principais teóricos.
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4. WHAT ARE THE MEDICAL HUMANITIES AND WHY DO THEY MATTER - BH e RR (Instituto de Estudos Avançados)
1. Conferência Brian Hurwitz:
What are the Medical Humanities and Why Do They Matter?
Medical Humanities today spans a variety of discourse communities that deploy the lenses and analytical tools of the arts and humanities to investigate problems of health, disease and responses to illness. The field emerged in the second half of the twentieth-century from criss-crossing interactions that sought to illuminate medical practices across a wider terrain of enquiry than established bimodal disciplines, such as medical ethics, medical history and medical sociology, by employing a fuller range of methods, analyses and perspectives, and by exploring whether all aspects of medical practice can fall under the umbrella of medicine as a science. I will trace the origins of what’s now also become known as the Health Humanities, and discuss its potential to link-up with user movements and disabilities studies.
2. Conferência Ruth Richardson:Gray’s Anatomy (1858), the Creation of an International Textbook
This textbook has carried the name of its author - Henry Gray - around the world. But in fact it was created by two young medical men in mid-Victorian London. The dissections on which the book was based were shared between Gray and a younger doctor, Henry Vandyke Carter, who created all the extraordinary illustrations which underpin its fame. This lecture maps out the story of the textbook's creation: why it was needed, why it was created, how the work was done. It looks at Gray's relationship with Carter, at their publishers, engravers, printers and those others who graduated from the mortuary to the dissecting room slab.
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History is a huge field, and so is medicine. This seminar will look at the capacity of history to make sense of past and present, and help anyone considering working in the cross-disciplinary field of Health Humanities to think about how to do it. We shall discuss primary and secondary sources, how to decide whether to trust a historical text, how to decide upon a subject to focus upon, how to gather material, and how to start writing. The session focuses on thinking historically, on reading and writing history, and on the place of patient and doctor in the history of medicine.
Required reading
John Harley Warner. The Aesthetic Grounding of Modern Medicine. Bulletin of the History of Medicine. 2013: 88(1): 1-47.
Nicholas Jewson. The Disappearance of the Sick-Man from Medical Cosmology. Sociology 10:2 (1976), pp. 225 – 244. http://soc.sagepub.com/content/10/2/225.full.pdf+html
Further reading
Carlo Cipolla. Cristofano and the Plague. Berkeley, University of California Press, 1973.
Irvine Loudon. Death in Childbirth. Oxford, Clarendon, 1992.
Roy Porter. Disease, Medicine and Society in England, 1550-1860 Second Edition (New Studies in Economic and Social History), Cambridge University Press 1995.
Eric Lax. The Mould in Dr Florey’s Coat. Little Brown and Abacus 2004/5
Rebecca Skloot. The Immortal Life of Henrietta Lacks. Random House and Macmillan 2010. -
This seminar considers a question close to the hearts of some medical humanities scholars and their affirmative answer to it, which has formed an important rationale for the medical humanities field. We will consider how well established an answer there is to the question, and examine a cluster of terms, such as human, humane, humanism and humanity. The postcolonial view of 'Humanism' is that it is a loaded term and an ideological battleground, yet we still tend to speak of 'humanity' as an ideal that solicits sympathy and generosity towards others, and of humanist education in medical training - past and current - as beneficial. But was it (and is it)?
Required reading
I. C. McManus. Humanity and the Medical Humanities. Lancet 346 (October 1995) 1143-45.
John Harley Warner. The Humanizing Power of Medical History: Responses to Biomedicine in the 20th-Century United States. Procedia - Social and Behavioral Sciences 77 (2013) 322 – 329.
Stanley Fish. The Uses of the Humanities, Part Two. NYTimes Jan 13, 2008 9:30 PM
Salvatore Mangione, Chayan Chakraborti, Jiuseppe Staltari, Rebecca Harrison, et al. Medical. Students’ Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey. J Gen Intern Med 33(5):628–34 DOI: 10.1007/s11606-017-4275-8
Liu EY, Batten J, Merrell SB, Shafer A. The long-term impact of a comprehensive scholarly concentration program in Biomedical Ethics and Medical Humanities. BMC Medical Education 18:2014, 2018 https://rdcu.be/5oRp
Further reading
Edmund Pellegrino. Educating the Humanist Physician: An Ancient Ideal Reconsidered (1974). In Brian Dolan (ed) Humanitas University of California Medical Humanities Press 2015.
D. W. Fraser and L. J. Smith, Unmet Needs and Unused Skills: Physicians' Reflections on Their Liberal Arts Education, Academic Medicine 64 (1989) 532-37.
Joanna Bourke. What it means to be Human. London: Virago Press 2011.
Tony Davies, Humanism, (The New Critical Idiom). London, New York: Routledge 1997.
Roger Smith. Being Human. New York: Columbia University Press 2007. -
The clinical case operates in the different zones of culture and nature, human experience and biology. Initially formulated in Hippocratic observations of external bodily appearances within a teleology of crisis, recovery or death, in the modern era, disease definition and diagnosis are the dominant themes worked out in cases, the sick person’s vicissitudes ‘merely variations on them’ (Pearcy 1992). In seeking to reformulate phenomena of illness in disease categories and diagnostic terms, the case mediates what is subjectively experienced in local and cultural terms as problems to be understood in terms of natural categories and medical science. In contemporary case reporting, two sorts of histories thereby come into play: ‘a superficial, overt, story presented by the patient […] and a deep, covert, and “true” history revealed by […] the physician’. (Gillis 2006) We will examine the decline and rise in the status of clinical case reports across the durée of the twentieth-century and the continuing epistemic dependence of medicine on cases in which the patient voice remains muted.
Required reading
Gianna Pomata. The Medical Case Narrative: Distant Reading of an Epistemic Genre. Literature and Medicine, 2014: 32:1, 1-23.
Julia Epstein. Historiography, Diagnosis and Poetics, Literature & Medicine 1992; 11(1): pp. 23e44 at 33.
Jonathan Gillis, The History of the Patient History since 1850’, Bull Hist Med 2006; 80(3):490e512 at 512
Hurwitz B. Form and Representation in Clinical Case Reports. Literature & Medicine 2006; 25: 216-40.
Hurwitz B. The Narrative Constructs of Modern Clinical Case Reports. Studies in History and Philosophy of Science Part A 2017; 62: 65-73. http://www.sciencedirect.com/science/article/pii/S0039368117300717
Samir Guglani. Medicine’s human voices. www.thelancet.com Vol 384 September 6, 2014.
Further reading
J Lee T Pearcy. Diagnosis as Narrative in Ancient Literature, Am J Philology 1992 113(4) 595-616.
Hurwitz B. What Archie Cochrane Learnt from a single case. Lancet 2017: 389: 594-5.
an P. Vandenbroucke. In Defense of Case Reports and Case Series. Ann Intern Med. 2001;134:330-334.
Joerg Albrechta, Alexander Mevesb, Michael Bigby. Case reports and case series from Lancet had significant impact on medical literature. Journal of Clinical Epidemiology 58 (2005) 1227–1232. -
Forty years ago Susan Sontag introduced the notion of illness as a form of citizenship ‘in the Kingdom of the Sick’. Her thesis was that the sick take up residence in another country: a metaphor for changed social identity and rights and taking on a type of alterity. Medical metaphors have since become a major area of interest and study. Lakoff and Johnson in 1980 showed how pervasive metaphors are in everyday language and thought: ‘most of our normal conceptual systems are metaphorically structured’ they concluded. Since then the frequency and type of metaphors used in many different discourses and in speech have been charted by psycho- and cognitive linguists. The ubiquity of metaphors in how illness is conceptualised is apparent in key figures of speech such as ‘illness journey’, ‘healthcare pathway’ and ‘battling with a disease’.
Required reading
Susan Sontag. Illness as Metaphor (many editions).
George Lakoff, M Johnson. Metaphors We Live By (Chicago: Univ Chicago Press 1980 and 2003).
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Stevenson’s extraordinary short story will serve as the basis for an examination of how creative writing can transform and preserve cultural memory of real events, throwing new light on the past, and leaving ambiguity and deeper understanding on past issues in its wake. Stevenson wrote the story in the 1880s, but it concerned events of fifty years earlier, and appears to record private knowledge which had been suppressed at the time. The serial murders committed by the famous villains Burke and Hare, who were discovered in 1828 to have sold the corpses of their victims to an Edinburgh anatomy school, provide the backdrop for the story.
Required reading
THE BODY-SNATCHER https://web.archive.org/web/20050310050214/http://gaslight.mtroyal.ca/body.htm
or
https://ebooks.adelaide.edu.au/s/stevenson/robert_louis/s848bs/complete.html
Further reading
Ruth Richardson. Death, Dissection and the Destitute. Various editions: Routledge 1987, then Penguin, University of Chicago and Phoenix Press. -
Conferência Brian Hurwitz:
How an Essay Transformed a Disease in 1817
James Parkinson’s Essay on the Shaking Palsy (1817) re-formulated an array of human dysmobilities as a single species of disease. Drawing on clinical and outdoor observations the Essay characterized a hitherto unrecognized set of disorders of shaking, posture and gait, by fusing together case-descriptions to create an affecting account of the disease. This talk will examine the textual machinery Parkinson deployed to create a new narrative of a disorder, by drawing upon sentimental writing, his political pamphleteering and indoor and outdoor observations in the context of earlier accounts of disorders of shaking.
Conferência Ruth Richardson:
AJ Cronin’s The Citadel: The 1937 Novel That Helped To Create the UK’s National Health Service
When it was published in July 1937, A J Cronin’s novel The Citadel attracted heated criticism from other doctors. That a doctor should expose other doctors even in fiction was considered professional treachery. Yet this revealing and romantic novel turned out to have a significant role in the creation of the consensus which led to the founding of the UK National Health Service. -
De modo sucinto, esta sessão e a seguinte pretendem apresentar três visões de análise narrativa: a partir do narrador/ponto de vista; a partir das tipologias de texto e personagem envolvidos nas narrativas; a partir da noção de dialogismo/polifonia narrativa, propondo-os como possíveis modelos metodológicos/técnicas analíticas.
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Apesar da preponderância absoluta, a partir da Idade Moderna, dos modelos científicos empiricistas como modos de conhecimento do mundo, este módulo pretende defender a Literatura como uma forma de acesso às "coisas" da vida e, portanto, de atribuição de sentido à existência, sob um ponto de vista hermenêutico.
Serão discutidos nessa aula textos teóricos e literários sobre doentes e doenças, na tentativa de explanação desse ponto de vista.
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Neste tópico, serão analisados 3 casos clínicos e discutida a necessidade, a adequabilidade e os possíveis fundamentos de uma teoria de comunicação em saúde.
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Proposta de trabalho final:
Apresentar um artigo sobre os temas/tópicos do curso, em língua inglesa ou em português, para ser submetido para publicação em uma das seguintes publicações online:
1. Literature and Medicine (JHU): texto em inglês, escopo de 5.000 a 9.000 palavras. Incluir resumo de 100 a 150 palavras e de 3 a 6 palavras-chave.
Normas para autores em:
https://www.press.jhu.edu/journals/literature-and-medicine/author-guidelines
2. Interface (Botucatu): Comunicação, Saúde, Educação: escolher uma das seções da Revista, entre Artigos (6000 palavras) ou Espaço Aberto (5000 palavras).
Normas para autores em:
http://www.scielo.br/revistas/icse/pinstruc.htm
Data-limite de entrega via Moodle: 15 de julho de 2019.