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    ABSTRACT: The idea of the smoking person portrayed in public health has been criticised as being based on too narrow a view of human nature. This article discusses that view: that of a person with a stable core and epiphenomenal 'behaviours' that can be removed by rational persuasion or Pavlovian manipulation, and examines social scientific critiques of it. The social sciences explore the meanings smoking has for individuals and portray human identity as malleable, the result of ongoing interactions with human and non-human others. Aspects of smokers' experience revealed in qualitative research - descriptions of cigarettes as 'companions' or 'friends', deep reliance, sensual pleasure - are sometimes difficult to articulate but can be given full voice in the context of the literary arts. We explore some examples of these sources and argue that a complete picture of smoking meanings is impossible without reference to them. We take a pragmatic approach, following the philosopher William James, who argued that emotional and spiritual experiences contribute to the truth of human existence as much as material explanations, to suggest that this understanding should be part of a critical but supportive engagement with public health research in order to develop more nuanced and humane approaches to smoking cessation.
    Critical Public Health 12/2012; 22(4):455-469.
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    ABSTRACT: We provide the first detailed analysis of how, for what purposes and with what consequences people related to someone with a diagnosis of schizophrenia use 'gene talk'. The article analyses findings from a qualitative interview study conducted in London and involving 19 participants (mostly women). We transcribed the interviews verbatim and analysed them using grounded theory methods. We analyse how and for what purposes participants mobilized 'gene talk' in their affectively freighted encounter with an unknown interviewer. Gene talk served to (re)position blame and guilt, and was simultaneously used imaginatively to forge family history narratives. Family members used 'gene talk' to recruit forebears with no psychiatric diagnosis into a family history of mental illness, and presented the origins of the diagnosed family member's schizophrenia as lying temporally before, and hence beyond the agency of the immediate family. Gene talk was also used in attempts to dislodge the distressing figure of the schizophrenia-inducing mother. 'Gene talk', however, ultimately displaced, rather than resolved, the (self-)blame of many family members, particularly mothers. Our article challenges the commonly expressed view that genetic accounts will absolve family members' sense of (self-)blame in relation to their relative's/relatives' diagnosis.
    BioSocieties 09/2012; 7(3):273-293.
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    ABSTRACT: Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space.
    Health & Place 07/2012;
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    ABSTRACT: In terms of intervening in embodied experience, medical treatment is wonder-full in its ambition and its metaphysical presumption; yet, wonder's role in clinical medicine has received little philosophical attention. In this paper, I propose, to doctors and others in routine clinical life, the value of an openness to wonder and to the sense of wonder. Key to this is the identity of the central ethical challenges facing most clinicians, which is not the high-tech drama of the popular conceptions of medical ethics but, rather, the routine of patients' undramatic but unremitting demands for the clinician's time and respectful attention. Wonder (conceived as an intense and transfiguring attentiveness) is a ubiquitous ethical source, an alternative to the more familiar respect for rational autonomy, a source of renewal galvanizing diagnostic imagination, and a timely recalling of the embodied agency of both patient and clinician.
    Theoretical Medicine and Bioethics 02/2012; 33(2):123-36.
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    ABSTRACT: The puzzle of the brain and mind at rest - their so-called default state - is strongly influenced by the historical precedents that led to its emergence as a scientific question. What eventually became the default-mode network (DMN) was inaugurated via meta-analysis to explain the observation that the baseline "at rest" condition was concealing a pattern of neural activations in anterior and posterior midline brain regions that were not commonly seen in external-task-driven experiments. One reason why these activations have puzzled scientists is because psychology and cognitive neuroscience have historically been focused on paradigms built around external tasks, and so lacked the scientific and theoretical tools to interpret the cognitive functions of the DMN. This externally-focused bias led to the erroneous assumption that the DMN is the primary neural system active at rest, as well as the assumption that this network serves non-goal-directed functions. Although cognitive neuroscience now embraces the need to decode the meaning of self-generated neural activity, a more deliberate and comprehensive framework will be needed before the puzzle of the wandering mind can be laid to rest.
    Frontiers in Psychology 01/2012; 3:321.
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    ABSTRACT: This paper aims to (re)ignite debate about the role of narrative in the medical humanities. It begins with a critical review of the ways in which narrative has been mobilised by humanities and social science scholars to understand the experience of health and illness. I highlight seven dangers or blind spots in the dominant medical humanities approach to narrative, including the frequently unexamined assumption that all human beings are 'naturally narrative'. I then explore this assumption further through an analysis of philosopher Galen Strawson's influential article 'Against Narrativity'. Strawson rejects the descriptive claim that "human beings typically see or live or experience their lives as a narrative" and the normative claim that "a richly Narrative outlook is essential to a well-lived life, to true or full personhood". His work has been taken up across a range of disciplines, but its implications in the context of health and illness have not yet been sufficiently discussed. This article argues that 'Against Narrativity' can and should stimulate robust debate within the medical humanities regarding the limits of narrative, and concludes by discussing a range of possibilities for venturing 'beyond narrative'.
    Medical Humanities 12/2011; 37(2):73-8.
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    BMJ (online) 11/2011; 343:d7323.
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    ABSTRACT: Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine's ways of teaching, working and finding out. This article problematizes medicine's narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine.
    Journal of Evaluation in Clinical Practice 08/2011; 17(5):927-32.
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    Medical Humanities 12/2010; 36(2):66-8.
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    ABSTRACT: The practices of health care in late modernity are informed by competing visions of the ideal human and the nature of care. Western societies typically characterise the ideal human as independent and self-reliant. The resultant welfare systems provide temporary havens away from the everyday, competitive spaces of capitalist societies, termed here the enclave model. Social scientists problematise this model on several grounds: the construction of pathologised and medicalised body forms; the neglect of caring practices that are gendered, invisible and primarily private; the de-politicisation of caring practices. Policy calls reject reference to care and its associations with dependency, make visible and value informal care work or invoke a caring citizenship as a policy goal not just a means. Into this field of contested notions of care enters a well-documented rise in access to, and consultation through, the internet in everyday lives for a vast range of issues. Health care encountered online reflects a similar range in form as that encountered offline and much that is innovative, whilst clearly of benefit, does nothing to challenge the existing dominance of the enclave model of social care. However, certain groups of sites create spaces through which participants can both express and extract caring relationships that are otherwise unforthcoming. The paper argues that these sites afford the potential to develop an alternative model of caring, to reframe questions of how to care about distant others and to demonstrate the centrality of caring relations to human life.
    Anthropology & Medicine 04/2010; 17(1):75-86.
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