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The Touch That Heals: The Uses and Meanings of Touch in the Clinical Encounter
Abstract
This paper investigates the healer's touch in contemporary medical practice, with attention to both allopathic and alternative modalities. Healing is understood as the recovery of an integrated relationship between the self and its body, others, and the surrounding world-the relationship that illness has rendered problematic. In this context, touch can play a crucial role in the clinical encounter. Unlike other modes of sensory apprehension, which tend to involve distance and/or objectification, touch unfolds through an impactful, expressive, reciprocity between the toucher and the touched. For the ill person this can serve to reestablish human connection and facilitate healing changes at the prelinguistic level. The healer's touch involves a blending of attention, compassion, and skill. The clinical efficacy of touch is also dependent upon the patient's active receptivity, aspects of which are explored. All too often, modern medical practice is characterized predominately by the "objectifying touch" of the physical examination, or the "absent touch" wherein technological mediation replaces embodied contact. This paper explores the unique properties of touch as a medium of perception, action, and expression that can render touch a healing force within the clinical encounter.
... The division of the unified body-subject where hands and feet became "them" opposed to the rest of the body, indicates an alienation from one's own body, that according to Svenaeus (2011) contributes to an experience of an unfamiliar and homeless body-"a being me and not yet me" (Svenaeus, 2011(Svenaeus, , 2019). Thus, not being acquainted with one's own body influenced the fundamental understanding of a unified, inseparable bodysubject, which instead turned into a thing-an unfamiliar being and a disintegration of body and self (Leder & Krucoff, 2008). However, making drawings and explaining them for the interviewer seemed to push to an understanding of the sensation of body parts that looked normal but were experienced as unfamiliar and alienated. ...
... Instead they used a strategy of transforming, which is a way of developing new usage patterns that enable the emergence of a new "I can" (Leder, 2021). When they were unable to accomplish motor control due to lacking the sense of different levels of the street or strained not to drop a cup or a glass, they sharpened their attention of their body position and ability to move-their sixths sense, which is connected to the sense of touch (Leder & Krucoff, 2008;Radcliffe, 2008). However, they had lost their former way of being in touch with the world as the sensory disturbances affected their sensory contact with physical surfaces and induced a breakdown in sensitivity due to the reciprocal character of touching. ...
... However, they had lost their former way of being in touch with the world as the sensory disturbances affected their sensory contact with physical surfaces and induced a breakdown in sensitivity due to the reciprocal character of touching. The reciprocal character of touch means that touching, is to be touched back whatever it is about touching another person or touching surfaces (Leder & Krucoff, 2008). Affected by the reciprocity of touching and being touched, the participants kept attention on how to use their fine motor skills, where to put their feet not to fall off the flagstone, sensed with other parts of the body when getting off the bike or used walking sticks to compensate for the disturbed sensations. ...
Purpose: To deepen the understanding of how survivors’ experience and give meaning to the embodied phenomenon of chronic sensory disturbances in everyday life after oxaliplatin treatment for colorectal cancer.
Methods: Data was generated by means of a semi-structured interview guide and drawings with the aim to explore eight survivors’ lifeworld experiences. Data was analyzed through a phenomenological approach.
Results: The essential meaning of sensory disturbances emerged in two main themes and four sub-themes. Theme A: ‘A peculiar experience that is difficult to logically understand’ with the subthemes; ‘An ambiguous perception in hands and feet’ and ‘Being alienated from one’s own body’. Theme B: Losing touch with the world’ with the subthemes: ‘A lack of sensory contact with physical surfaces’ and ‘Breakdown of sensitivity in hands hampers fine motor skills and social contact’.
Conclusion: Sensory disturbances contributed to an ambiguous and discordant perception of an alienated body that was difficult to describe and affected the ability to act and connect to things and other people. Metaphors and drawings were valuable as means to verbalize and illustrate the changed body perception where the ‘I can’ changed into ‘I cannot’. To support the embodied connection to the world new usage patterns were required.
... Touch represents the basis of social interaction conveying information about the emotional and mental state of individuals involved in the relationship. 75 In nursing care, touching has been documented as a useful intervention that alleviates pain, anxiety, depression, sleep disturbances, nausea, and fatigue, thus increasing quality of life. 3,18,19,30,46,57,92,113,132 While touching patients, nurses communicate empathy, compassion, affection, concern, and security, thus facilitating the achievement of the expected outcomes. ...
... 3,18,19,30,46,57,92,113,132 While touching patients, nurses communicate empathy, compassion, affection, concern, and security, thus facilitating the achievement of the expected outcomes. 75 ...
Introduction:
Placebo and nocebo effects represent one of the most fascinating topics in the health care field.
Objectives:
the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research.
Methods:
a narrative review was conducted based on the available evidence.
Results:
Placebo responses (from Latin "I shall please") are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin "I shall harm"), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context.
Conclusion:
Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.
... Touch is performed in an environment of caring, not one of power or condescension. Leder and Krucoff (2008) note that the healing powers of touch can only be realized when compassion is present. The focus of the act of touching cannot be realized when the target is not acknowledged as a full person, the '''Thou' with whom the practitioner can identify.'' ...
... Even as practitioners protect themselves against the pain of contingency, vulnerability, and death, sick persons are experiencing their illness as whole persons, not disconnected from their bodies. As medical philosophers such as Svenaeus (2000) and Leder (2008) have argued, diseases are marked by more than just physical symptoms or numbers that fall outside of a proscribed range. Persons experience illnesses; in sickness, they inhabit a body that feels anything but regular, normal or mundane. ...
In this essay, we argue that touch constitutes a sacred connection between the patient and practitioner. When touch is avoided or overlooked, the enigmatic inner workings of the body are ignored as those aspects of the body that can be quantified and ultimately controlled are emphasized. In utilizing touch as a fundamental way of opening up space for the sacred, the practitioner affirms the humanity for both the patient and herself. Only by returning to the senses can practitioners resist the dehumanizing effects of machinery and re-enchant the health-care profession in caring for persons they have sworn to serve.
... This should be taken seriously and be reflected on in relation to what kind of touch the patients actually are receiving in the healthcare arena. Modern medical practices can often be characterised by the objectifying touch of the physical examination or by the absent touch where the technological mediation replaces the embodied contact (51). Our findings show that there is a risk of harming patients even if the carer's intention is to help. ...
... In terms of the complexity, however, the findings show that touch can be a valuable asset in a bodily dialogue to understand something more about the patients' needs and situation, for example when words are difficult to find, which has also been proposed by Leder and Krucoff (2008). Touch can serve to re-establish human connection and facilitate healing changes at a prelinguistic level as it has been shown that patients can be dumb or speechless in situations of suffering (56,62). ...
This study describes the phenomenon of caring touch from the patients' perspective in an anthroposophic clinical context where caring touch is often used to promote health and alleviate suffering. The aim of the study was to explore and phenomenologically describe the phenomenon of caring touch from the patients' perspectives. The study has been carried out with a Reflective Lifeworld Research approach in order to understand and describe human existential phenomena. Ten female patients were interviewed in an anthroposophic clinic in Sweden. The findings show how caring touch has multifaceted meanings and makes the patients' feel present and anchored in a meaningful context. The patients' feel that they are seen, accepted and confirmed. Furthermore, touch creates a caring space where the patients become receptive for care and has the power to alleviate the patients' suffering, as well as to frighten and cause or worsen the suffering. In order to take advantage of the caring potential, the patient needs to be invited to a respectful and sensitive form of touch. An interpersonal flexible space is necessary where the touch can be effective, and where a dynamic interplay can develop. In conclusion, caring touch is an opportunity for carers to support well-being and health. The carers need to approach their patients in both a sensitive and reflective way. A caring science perspective can serve as a help to further understand touch as a unique caring act.
© 2015 Nordic College of Caring Science.
... In addition, Palese et al., 2019;Leder and Krucoff, (2008) report that the touch adopted by nurses has also been identified as a factor influencing positive treatment outcomes. Consequently, the therapist's touch toward the patient enhances the therapeutic power since it expresses caring, empathy, and compassion. ...
The mental processes that constitute the Power of Mind use thinking as their primary tool. Thought creates emotions which in turn cause corresponding behavior. Consequently, thoughts act as motivators that propel the individual to action. Therefore, the quality of each piece of thinking is fundamental to its evolution. The child gradually develops the ability to read the mental states of others, relying both on the beliefs he has created about himself according to his thoughts and perceptions and on subconscious actions that affect him unconsciously. The current literature review studies the importance of the Power of Mind (PoM) in the human factor and its relationship with Theory of Mind (ToM) in preschool age. The conclusions of the research reflect the importance of the Power of the Mind in the formation of thoughts, beliefs, and emotions in young children, presenting several methods of utilizing it in the educational process.
... En effet, les actions qui les composent, conduisent toutes deux à la relaxation corporelle et à la normalisation des signes vitaux chez le nouveau-né prématuré, sans effets délétères(Whitley & Rich, 2008). Par ailleurs, le toucher de guérison tel que décrit parLeder et Krucoff, (2008), évoque une expérience sensorimotrice. Il permet le rétablissement d'une relation entre soi et son corps, et l'environnement. ...
Ce travail de thèse vise à produire des connaissances sur l’activité réelle, individuelle-sociale d’infirmières-puéricultrices en interaction avec le nouveau-né grand prématuré. Ces connaissances constituent des pistes d’améliorations pour la formation des professionnelles, dans un contexte où la prématurité est un problème de santé publique mondial et où les soins à ces nouveau-nés représentent un enjeu crucial pour leur développement neurosensoriel. Toutefois la formation concernant ces soins à hauts risques possède peu d’ancrage avec les données scientifiques permettant de prendre en compte l’activité humaine déployée dans ces situations complexes. Cette recherche a donc pour objectif de décrire, analyser et caractériser cette activité peu explorée, afin de comprendre comment en situation réelle, deux puéricultrices expérimentées utilisent en-action différentes ressources corporelles, langagières et artefactuelles pour inter-agir avec l’enfant, cet autrui qui ne parle pas et dont les réactions sont spécifiques. Cette étude à visée épistémique et transformative s’inscrit dans le cadre du programme de recherche « Cours d’Action » (Theureau, 2004, 2006, 2015) qui privilégie une approche anthropologique culturelle enactive. L’activité est considérée comme située et s’accompagne en permanence de construction de sens qui s’actualise dans des actions pratiques, des communications, des interprétations, des focalisations et des émotions. Cette approche permet d’accéder à la compréhension de l’activité des acteurs, en partie silencieuse, à partir de leur point de vue. Le dispositif méthodologique articule : des données concernant les contraintes de l’activité dans les corps, situations et cultures construites selon les méthodes usuelles de l’ethnographie ; des données psycho-phénoménologiques construites lors d’entretiens d’autoconfrontation de situations filmées et des données proxémiques extrinsèques. Les résultats montrent que l’activité des puéricultrices est contrainte par l’environnement spatial, humain et technologique nécessaire à la survie de l’enfant. Elle donne à voir un engagement exploratoire associé à un engagement exécutoire qui s’actualisent par des actions intermodales pratiques. Trois préoccupations prépondérantes émergent et structurent l’activité : 1) Maintenir une continuité de présence avec le nouveau-né pendant le soin, en s’appuyant sur l’organisation de l’environnement de travail et une communication multimodale qui vise à conserver une proximité physique ; 2) Exercer une vigilance, dont les activités de prévention, surveillance et enquête constituent les orientations prioritaires, dans lesquelles les appareils technologiques sont médiateurs de l’action et contraignent l’activité des puéricultrices à partir de boucles perception-action ; 3) Soutenir le nouveau-né dans la gestion du stress en s’appuyant sur des perceptions pluri-sensorielles qui favorisent l’articulation d’actions multimodales et contribuent au maintien de l’interaction. Ces résultats montrent l’importance des dimensions sensorielles et sensorimotrices de expérience des puéricultrices qui étayent le prendre soin et donnent à voir leur engagement dans la recherche d’une essentielle coordination avec le nouveau-né. Ils conduisent à envisager des pistes d’enrichissement pour la formation prenant en compte sérieusement les dimensions sensibles de l’activité en situation de soin. Les situations étudiées ouvrent un questionnement plus large concernant toutes les situations de soins auprès de populations fragiles dont les modalités de communication sont altérées et où vont se mêler des aspects techniques et relationnels.
... In contemporary Western life, touch has become a receding sense due to an increasing focus on the visual and on the person as a discrete, independent entity (Classen 2012). In medical practice, touch between medical practitioners and patients is either objectified or absent (Leder and Krucoff 2008). In contrast, the touch requested in the retreats was an intimate, intuitive and loving touch that expressed care and reverence for the body as a living sacred entity. ...
Alternative health care and holistic spiritual practices have become increasingly popular in many Western countries, especially among women, who often claim them to be deeply transformative. This paper presents an ethnographic study of women’s tantric retreats in Northwest Europe that aimed to help women reconnect with their vital sexual energy, rediscover the sacredness of their female bodies, and possibly heal from damaging and even traumatic experiences regarding their femininity and sexuality. It draws on Turner’s influential view on ritual as a liminal space in order to account for the transformative potential of these workshops. Specifically, it applies Hinton and Kirmayer’s flexibility hypothesis, which suggests that healing rituals shift people’s mode of being-in-the-world, including their cognitive, emotional, and physical state or stance, towards openness to new ways of being. First, it highlights different ontological domains where shifts took place, notably somatic state, self-image and relationality. Subsequently, it identifies the main modalities that were used for enabling transformation: the embodiment of the metaphor of the goddess/the divine as present in each woman and the use of intimate, loving touch and meditative awareness. The process of transformation and healing elucidated in this way engaged the physical, emotional and cognitive levels as interacting dimensions, relying foremost on the activation of a vital energy that both gave participants a deep sense of self and connected beyond the self.
... The 2012 review by Zhang [14] showed illustrations of anatomical structures that can be influenced by needling and documented evidence of at least 17 possible pathways involved in needling. Additionally, effects have been described related to touch and pressure to the skin [43][44][45][46], physiological effects of shallow insertion needling [47][48][49][50][51], non-inserted needling [44,52], deeper needling with varying forms of manipulation [14,42] including electrical stimulation of the needles [40,42,53,54]. Other studies demonstrate that acupuncture can also create effects due to modulation of the somato-sensory system [55], autonomic nervous system [51,[56][57][58], and microcirculatory [48,59], antiinflammatory [60,61] and immunological effects [62][63][64]. ...
Acupuncture is a complex intervention that manifests varied theories, treatment methods, diagnostic methods and diagnostic patterns. Traditionally based systems of acupuncture (TBSAs) often have their own diagnostic approaches and patterns. Despite the wide variety that can be found amongst TBSAs, is it possible that they share a common background in clinical observation and practice? Research has shown that multiple physiological pathways and mechanisms can be triggered by different acupuncture techniques and methods. It is highly likely that clinicians will have observed some of the effects of these responses and used those observations as feedback to help construct the patterns of diagnosis and their associated treatments. This review briefly examines this possibility. Pattern identification will have developed out of a complex interaction of factors that include; theories current at the time of their development, historical theories, personal choices and beliefs, training, practice methods, clinical observations and the natural feedback that comes from observing how things change once the treatment is applied. Researchers investigating TBSAs and pattern identification need to be more explicit about the systems they have investigated in order to understand the biological basis of pattern identification and their treatments.
... The act of inserting needles for the practice of acupuncture can trigger multiple pathways, many of which are predictable from knowledge of biology since the living organism has multiple sensory systems for interacting with the environment and responding to its challenges. Biological effects can occur as a result of touch and pressure [26,27,41,48,60,66,85], pricking and other non-insertion methods [41,65], skin penetration (shallow insertion) [3,39,40,57,78,87], stimulation of underlying structures (deeper insertion) and manipulation of the needle (rotation, lifting-thrusting) [30,31,45,68,71,87]. Many of these pathways have already been demonstrated with regards to acupuncture needling [6, 14-16, 20, 30, 31, 37, 68, 71, 87, 88] and can involve analgesic [14,30,31,68,87], anti-inflammatory [61,89], micro-circulatory [37,39], circulatory [53,82], immunologic [1,62,86], autonomic [49,51,64,78] and modulation of the somatosensory system [5,63] effects. ...
The objective of this chapter is to provide an overview of the problems and solutions of randomized placebo-controlled trials in acupuncture. Studies examining how acupuncture might work cover a broad range of physiological systems, ranging from a single biochemical pathway to the whole biological system. Needling, touch, and pressure occur before skin penetration and then surface receptors/structures are stimulated by both shallow and deeper insertions with additional receptors are further stimulated by deeper insertions. This process raises important questions about the use of penetrating and non-penetrating sham acupuncture techniques and placebo effects. In clinical research the placebo treatment must be inert, and only when the provided randomization and blinding are properly used, a trial comparing the test treatment to the placebo treatment can be said as placebo-controlled. A placebo-controlled trial is an explanatory trial since it tests the known mechanisms associated with the treatment. But in hands-on therapies like acupuncture what can constitute a valid placebo control treatment? Are there predictable mechanisms by which acupuncture works suggesting which valid placebo can be used? Are there any sham acupuncture interventions that can constitute placebo treatments? Are they credible to be sham treatments? If they are not inert or credible, then how can we perform placebo-controlled trials on acupuncture? Are such trials possible? Many forms of sham acupuncture have been tried out in efforts to control placebo effects. In the ‘real’ or ‘test’ acupuncture the ‘real’ technique is applied to the ‘real’ acupoints. Thus, sham acupuncture involves varying the techniques of treatment and the locations of treatment. Given these two variables, three basic variations of sham acupuncture are possible. One of these could possibly act as a placebo control research model, provided that the sham techniques are clinically inert and the sites of their application are clinically inert. The other two models act to compare either treatment sites or treatment techniques. In the latter two models placebo can be held equal between treatment groups, but these models are not capable of acting as placebo-controlled trials. The second and third sham models are often used inadvertently as though they were capable of answering the same question as the first or were placebo-controlled clinical trials like the first. This chapter will give an overview on the current status and problems of placebo-controlled trials in acupuncture trials and suggest possible solutions. We can summarize the evidence: so far no sham acupuncture techniques are inert; they are also clinically effective; and no placebo-controlled trials of acupuncture have ever been performed. Given the evidence, we propose to stop performing sham acupuncture studies since they cannot achieve control for placebo effects. We propose a two-pronged approach to address the issues of mechanisms of action and effectiveness.
... The blindness, or paralysis etc still is a fundamental part of their being and experience of the world (Schenk, 1986). The role of the assistive technology is that of incorporating an object that is foreign to the body's unity to address a particular experience in that person's life (Leder, 1990;2008). Therefore the device must not only serve the goals of utility, usability and accessibility, but also the experience, enjoyment, engagement and desired effect within that users being-in-the-world. ...
The work discussed in this thesis contrasts traditional interviewing perspectives with those of phenomenological methods for conducting research for use in the development of assistive technology. Assistive technology helps to provide greater independence by enabling people to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. However, users of certain technologies from the field, such as visually impaired users of navigational devices, often report dissatisfaction based on features of the device that are necessarily linked with their experiences with it. The goal of this comparative analysis is to examine whether incorporating methodology from the field of phenomenology (the discipline of philosophy that studies human experience) would yield a different end result of product/object and development and usability than that obtained from traditional third-person and focus group methodologies, currently employed by designers of assistive technology. Further, this thesis will argue that the kind of data that is gathered from phenomenological interviewing and experimentation, allows for a more complete report of the potential users needs and expectations than traditional focus group reports, consequently providing answers that designers can use to make more informed decisions about the design of their products. Finally, the thesis concludes by providing suggestions regarding the implementation of new directions for phenomenologically informed research for the design of assistive technology.
... In this research, the central question is tact. 18 Touch also has its place in western theology. 19 It may even be said that the Christian religion is a religion of touch, because it is centred on the mystery of the touch of spirit and flesh. ...
The article reflects on digitality and interface design in terms of the multiple senses of touch. Touching is presented as a "pathic" sense of being exposed, which implies that touching exceeds the tactile and even the phenomenal world. A particular focus is set on Aristotle's and Husserl's ways of thematizing the sense of touch. In this way, two extremes of the phenomenological thinking of touching are articulated: touching as an indistinct and heterogeneous constituent of sensitivity and touching as the guarantor of immediacy of the sense experience. Referring to Derrida's critical notes concerning haptocentrism, the article attempts to problematize the hand and the finger as phenomenological figures of touch and as holds of haptic realism. The article concludes that insofar as digital interface design aims at haptic realism it conceives of the sense of touch in terms of narcissistic feedback and thus tends to conceal the pathic moment of touching.
... Instrumental touch is the type of touch most frequently employed by the participants of this study. Healing touch, is in itself healing by utilising natural energy balancing processes within the body (Leder & Krucoff, 2008;J. Watson, 2008). ...
... 21,22 Research on touch demonstrates distinct cultural preference for touch and body distance. [23][24][25][26][27] Therefore, touch is considered to be highly culturally determined and is not included in the E.M.P.A.T.H.Y. acronym. ...
There is a gap in the medical education literature on teaching nonverbal detection and expression of empathy. Many articles do not address nonverbal interactions, instead focusing on "what to say" rather than "how to be." This focus on verbal communication overlooks the essential role nonverbal signals play in the communication of emotions, which has significant effects on patient satisfaction, health outcomes, and malpractice claims. This gap is addressed with a novel teaching tool for assessing nonverbal behavior using the acronym E.M.P.A.T.H.Y.-E: eye contact; M: muscles of facial expression; P: posture; A: affect; T: tone of voice; H: hearing the whole patient; Y: your response. This acronym was the cornerstone of a randomized controlled trial of empathy training at Massachusetts General Hospital, 2010-2012. Used as an easy-to-remember checklist, the acronym orients medical professionals to key aspects of perceiving and responding to nonverbal emotional cues. An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients' communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. A detailed description of the E.M.P.A.T.H.Y. acronym and a brief summary of the literature that supports each component of the teaching tool are provided.
Introduction: Nurses use physical touch to interact with patients and address their needs.
Human touch benefits social development, stress/anxiety reduction, and rapport building.
Touch has been a part of nursing care for centuries, however nurses’ perceptions of expressive
touch are not easily ascertained from the literature. Literature currently offers one review on the
perceptions of various medical professionals regarding touch of all kinds. No reviews specific
to the nurses’ perception of expressive touch exist. This integrative review provides a greater
understanding of nurses’ perceptions of expressive touch.
Methods: Using Cooper’s steps for integrative review, CINAHL, Medline, Academic Search
Premier, and Complimentary Index were searched from 2000-2022; using search term
expressive touch or caring touch or compassionate touch and nurse/nurses/nursing and
perception or perspective.
Results: Of 283 articles identified, 22 articles remained for full-text review after duplicate
removal and application of inclusion/exclusion criteria. Five topics on nurses’ perceptions of
expressive touch were identified: Comfort with touch and job satisfaction, expressive touch
as an essential part of nursing practice, expressive touch as a form of compassion and/or
communication, the impact of expressive touch on the humanization of patients in the nurses’
perception, and nurse discomfort with expressive touch.
Conclusion: This integrative review provides findings that assist in understanding nurses’
perceptions of expressive touch. Further research should examine the impact of gender, education,
and experiences on nurses’ perceptions as they use expressive touch in nursing practice.
Issue: Phenomenology has proven to be a very useful tool for medicine. Descriptive, first-person accounts of patient experiences can reveal new and unique insights. These insights can inform renewed approaches to medical education and practice. However, comparatively little research has been done on the other side of the clinical encounter. This leaves the lived experiences of doctors diagnosing and treating illness unaddressed and the ontological transformation of medical students through medical education unexplored. Evidence: This paper provides a phenomenological description of the clinical encounter and ontological transformation of the medical student into the doctor. I argue doctors have a unique ontology, rooted in the objectification of the patient, for which I use the term being-opposite-illness This is achieved, through phenomenological examination of my experiences as a medical student and through descriptions of three distinct types of face-to-face encounters: the basic encounter with the Other, the encounter with illness, and the clinical encounter, which I argue are all metaphysically distinct. Finally, textual analysis of popular first-person accounts from two doctors, Henry Marsh and Paul Kalanithi, provide an illustration of being-opposite-illness in clinical practice and how this ontological transformation occurs through medical education. Implications: Together, the phenomenology of the clinical encounter and textual analysis of Marsh and Kalanithi reveal clinical practice and medical education be an ontological transformative process. This paper attempts a new understanding of this experience of doctors by accounting for their unique ontology. In sum, I suggest being-opposite-illness can represent a new lens for analyzing the experience of doctors. Through this, I hope to promote new medical education and practice approaches.
Introduction
Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses’ well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses’ mental health and well-being during and post-COVID-19.
Methods and analysis
This randomised, single blinding, two-arm cross-over feasibility study involves a 1-week run-in period, 2-week intervention and 1-week run-in period in between interventions. Thirty-six eligible nurses will be recruited from the community and randomised into either a combination of light acupuncture treatment and five-element music therapy group or no treatment group for 2 weeks. After a 1-week run in period, they will be swapped to the different group. The primary outcome of this study is to evaluate the feasibility of a combination of light acupuncture treatment and five-element music therapy to improve nurses’ mental health and well-being. The secondary outcomes will include anxiety and depression, work productivity and activity, and quality of life assessments. Participants will be asked to complete a set of online questionnaires throughout the trial period. All analyses will be performed in R Studio V.1.1.463.
Ethics and dissemination
Ethical approval was attained from Edith Cowan University’s Human Research Ethics Committee (No. 2021–02728-WANG). Research findings will be shared with hospitals and in various forms to engage broader audiences, including national and international conferences, presentations, open-access peer-reviewed journal publications, and local community workshop dissemination with healthcare professionals.
Trial registration number
Australian New Zealand Clinical Trials Registry: ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx
In this chapter I accept that re-performances differ from both the initial performance and each other and can therefore be seen as adaptations of the initial performance. I argue that in spite of their differences re-performances always contain remnants of the initial performance. Here, I draw upon the Derridian notion of the specter in order to argue that re-performances are always haunted by the initial performance because the remnants of the initial performance form the basis of the re-performance and are therefore visible in the re-performance. Using the case studies of Martin O’Brien’s 2011 performance Mucus Factory and his 2015 piece Anatomy of a Bite as well as Julie Tolentino and Ron Athey’s 2011 performance Self-obliteration #1 Ecstatic, and Dani Ploeger’s performance Electrode (2011), this chapter asserts that re-performances powerfully evoke memories of the initial performance.
Background: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University’s Mensendieck physiotherapy bachelor’s program includes SCT training for the management of PVD.
Purpose: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic.
Methods: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis.
Findings: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change.
Conclusion: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.
Aim
This study sought to understand the experience of living with cystic fibrosis as an adult.
Background
Cystic fibrosis is one of the most difficult chronic diseases to manage long‐term because of numerous challenges faced on a day‐to‐day basis. The majority of studies focus on improving symptom response to new treatment regimens with the hope of prolonging life. Yet few qualitative studies explore the experience of adults with cystic fibrosis. What is missing from the current literature are the voices of people living with cystic fibrosis, especially as they age.
Design
This study follows a hermeneutic phenomenology design guided by Martin Heidegger’s philosophy.
Methods
Semi‐structured interviews were conducted with 9 adults living with cystic fibrosis. Hermeneutic phenomenology guided the data interpretation. This manuscript follows COREQ reporting guidelines.
Results
Hermeneutic analysis revealed the overarching theme The Dance of Cystic Fibrosis which is supported by five themes: 1) The Paradox of Control, 2) Living Deaths, 3) Dancing with Death, 4) Relearning to Dance, and 5) Role of the Dance Partner.
Conclusions
The experience of living with cystic fibrosis as an adult is multidimensional and unique to each person. Despite the uniqueness, there is a shared experience that manifested as The Dance of Cystic Fibrosis . As life expectancy continues to increase for persons with cystic fibrosis, it is essential that researchers and healthcare professionals intentionally consider the life prolonging effects of the treatment regimen alongside the persons’ experience with those effects.
Relevance to Clinical Practice
Nurses at all levels of practice should be prepared to address the multifaceted experience of living with cystic fibrosis through thoughtful incorporation of open‐ended questions. This allows patients to share their experience with nurses, augmenting their practice of delivering holistic care.
Neurological diseases are a wide range of diseases affecting central and peripheral nervous system. Stroke, Alzheimer’s disease (AD), and Parkinson’s disease (PD) are the most common and challenging neurological diseases which lack effective treatment. Chinese medicine (CM) is an ancient yet still alive medical system widely used by Asian people for preventing and treating diseases. The symptoms of stroke, AD, and PD have been described in CM books as early as 2000 years ago. The causes as well as the treatment principles for these diseases are also mentioned in the classic CM books. According to CM theory, the diseases are caused by disharmony of Yin and Yang, thus the treatment strategy is to restore the balance. Throughout the CM history, the etiology and therapy for stroke, AD, and PD have been continuously developed. Currently, Up to 20–40 % of patients with above-mentioned diseases are receiving CM treatment in China, indicating the wide acceptance of CM for the treatment of neurological diseases (Liu in J Am Med Dir Assoc, 2015 [1]; Rajendran et al. in Neurology 57:790–4, 2001 [2]). The widely used formulas for neurological disease treatment include: “Qi Fu Decoction”, and “Tongqiao Huoxue Decoction” for Dementia; “Zhengan Xifeng Decoction”, “Angong Niuhuang Wan” “Tongqiao Huoxue decoction”, “Taohong Siwu Decoction” for Stroke; “Zhengan Xifeng Decoction”, “Lingjiao Gouteng Decoction”, “Dao Tan Decoction”, “Renshen Yangrong Decoction”, and “Dihuang Yinzi Decoction” for PD. Numerous studies have reported the efficacy of CM in the clinic treatment of stroke, AD, and PD. However, most of the clinical studies lack the experimental supports from diseases models and the reports were mainly written in Chinese, thus limiting the recognition of CM by worldwide researchers. With the modernization of CM during the past decades, the experimental data of CM-originated materials (formula, herb extract, and single compounds) on the stroke, AD, and PD models are accumulating rapidly, providing important scientific evidence for the clinic use of CM for treating neurological diseases. This chapter introduces the basic theory of CM for treating stroke, AD, and PD, lists the currently used experimental diseases models for the evaluation of pharmacological activity of CM, and summarizes the CM-originated materials with protective effects in these disease models.
This chapter focuses on the role that intentional touch therapies play in supporting women through pregnancy, childbirth, and postpartum, including learned labor support techniques, massage therapy, and the energy therapies of Therapeutic Touch (TT), Healing Touch (HT), and Reiki. With the advent of increased awareness of integrative modalities and research to support integrative therapy use, all touch therapies can be reexamined within the context of clinical practice. The introduction of touch therapies into clinical practice not only adds another dimension to hands-on care but also invites a reconceptualization of intentional touch. The chapter ends with three case studies. Each case study illustrates the role that touch therapies play in providing comfort and support, reducing the normal stressors that accompany pregnancy and childbirth.
While much recent theorizing into affect has challenged the primacy of discourse in understanding social life, this paper is premised on the intertwining of affective experience with discursive meaning. Furthermore, appreciating the entwining of affect and discourse facilitates broader understanding into the illness experience, medical decision-making and experiences of healing. Today, the biomedical discourse carries particular affective weight that can saturate experiences of affliction. Cultural understandings of disease similarly shape affect that may emerge in affliction. Social meaning, more specifically stereotypes pertaining to identities, interweave with emotion also in the context of medical practice. The doctor-patient relationship is an affect-laden encounter where the entwining of affect with social assumptions carries important, yet poorly understood, repercussions for treatment decisions and for the furthering of health inequalities. Both the elusiveness and the power of affect that unfolds in relation to discursive meaning rest on the way in which affect dwells in and resounds through the body.
Background:
Body image distortion, a distressing problem that precipitates eating disorders, remains a struggle for patients after other symptoms are controlled. Despite a strong physical aspect there is little recognition of physiotherapy intervention. This study aims to assess the effect of a tailored physiotherapy intervention programme for patients with eating disorders in an NHS in-patient unit.
Methods:
The intervention programme, targeted at known, potentially modifiable factors relevant to body image distortion in 7 patients, used touch, massage, drawing exercises and listening skills. Patients received 8 to 38 sessions determined by length of stay on the unit. Self-drawings were completed at each session and a body shape questionnaire (BSQ-34) and a self-assessment silhouette scale in the first and last sessions.
Findings:
Self-drawings showed improved comparative proportions of body areas. Initial silhouette scores of more than 5 out of 10 reduced to less than five. There was a reduction in BSQ-34 questionnaire scores for all patients, and to less than half for 3.
Conclusions:
This pilot study suggests that a tailored programme based on principles of physiotherapy can help to improve body image perception and satisfaction. It draws attention to the potential of physiotherapy intervention programmes in the UK.
Despite a paucity of scientific evidence, complementary and alternative medicines have been found to give rise to feelings of control, empowerment, and agency. These healing experiences call for the development of analytical frameworks beyond biomedical ideas of scientific effect. This article is premised on a phenomenological understanding of embodied subjectivity as paving way for more nuanced understanding into experiences of healing. As such, this article contends that ill health transcends the biomedical body. Healing experiences are also entwined with the values and ideals that are normalized in the complementary health sphere. Discourses of health and wellness thus also play a role in the generation of healing experiences. I draw on qualitative research with clients and practitioners involved in complementary and alternative medicines in England. I will first introduce phenomenological ideals of the body, and the methods underlying the data that are drawn on. I will then turn to interviewee perspectives on the interconnectedness of the mind and the body, before outlining client experiences of alternative health practices. I argue that ideals, such as awareness, that are emphasized in the holistic health domain are important for the generation of healing experiences. Healing experiences also, however, emerge through the caring touch of trusted practitioners. This article will finally turn to the intersections between embodied experience and social inscription.
The purpose of this article is to explore the postmodern, postrational, and postconventional core of DD Palmer's self-sense and philosophy.
DD Palmer's self and philosophy can be viewed as a reaction to the self of modernity and its challenges of a fracture between mind and body, spirit, and nature. It is argued that Palmer's solution to these vexing problems facing the modern self was to use postrational and postconventional logic to overcome the dualisms. His philosophy resonates with similar postrational approaches, most notably, the German idealist Schelling.
It is argued that Palmer was one of the first postrational individuals in America and that chiropractic was an attempt at the first postrational health profession.
Disease and health are commonly thought of as distinct opposites. We propose a different view in which both may be seen to be facets of healthy functioning, each necessary for the other, each giving rise to the other. Thus, disease may be thought of as a manifestation of health. It is the healthy response of an organism striving to maintain physical, psychologic, and spiritual equilibrium. Disease is not necessarily to be avoided, blocked, or suppressed. Rather, it should be understood to be a process of transformation. The process should therefore be facilitated because it is an integral part of the dynamic equilibrium that we ordinarily think of as health. In many cases, perhaps all, people get ill because there is something going "wrong" in their lives. This could occur in a whole range of ways-relationships, environment, food, or job. Our view, however, is that disease is a meaningful state that can inform health workers how to help patients to heal themselves. In this way, instead of being meaningless, people's problems become diseases of meaning, enabling people to see that things are not necessarily "going wrong" but are, in fact, helping them become stronger, to live more fully and with more understanding. Seen from this perspective, depression; cancer; heart disease; neurodegenerative and autoimmune disease; dementia; and conditions such as community violence, genocide, and the problem of environmental devastation are "diseases of meaning." World Health Organization forecasts make it clear that diseases of meaning will continue well into the next millennium to be the major cause of suffering and death worldwide. To deal with them, the world needs to reformulate the biomolecular paradigm that has been exploited in the last two centuries. It does not address the reasons why these diseases arise, attending mainly to their molecular consequences. A paradigm that includes the importance of meaning must now be given top priority. The concept that diseases are a manifestation of health-a call to a different relationship with ourselves and our environment, both animate and inanimate- is in itself a different approach. Programs for care and education based upon it would have immediate application in medicine, industry, education and ecology. We believe that this model would have far-reaching consequences for the understanding, treatment, and prevention of diseases and behaviors that lead to violence and environmental destruction.
Disease and health are commonly thought of as distinct opposites. We propose a different view in which both may be seen to be facets of healthy functioning, each necessary for the other, each giving rise to the other. Thus, disease may be thought of as a manifestation of health. It is the healthy response of an organism striving to maintain physical, psychologic, and spiritual equilibrium. Disease is not necessarily to be avoided, blocked, or suppressed. Rather, it should be understood to be a process of transformation. The process should therefore be facilitated because it is an integral part of the dynamic equilibrium that we ordinarily think of as health. In many cases, perhaps all, people get ill because there is something going "wrong" in their lives. This could occur in a whole range of ways-relationships, environment, food, or job. Our view, however, is that disease is a meaningful state that can inform health workers how to help patients to heal themselves. In this way, instead of being meaningless, people's problems become diseases of meaning, enabling people to see that things are not necessarily "going wrong" but are, in fact, helping them become stronger, to live more fully and with more understanding. Seen from this perspective, depression; cancer; heart disease; neurodegenerative and autoimmune disease; dementia; and conditions such as community violence, genocide, and the problem of environmental devastation are "diseases of meaning." World Health Organization forecasts make it clear that diseases of meaning will continue well into the next millennium to be the major cause of suffering and death worldwide. To deal with them, the world needs to reformulate the biomolecular paradigm that has been exploited in the last two centuries. It does not address the reasons why these diseases arise, attending mainly to their molecular consequences. A paradigm that includes the importance of meaning must now be given top priority. The concept that diseases are a manifestation of health-a call to a different relationship with ourselves and our environment, both animate and inanimate- is in itself a different approach. Programs for care and education based upon it would have immediate application in medicine, industry, education and ecology. We believe that this model would have far-reaching consequences for the understanding, treatment, and prevention of diseases and behaviors that lead to violence and environmental destruction.
In the second half of the 20th century, the body has become a central theme of intellectual debate. How should we perceive the human body? Is it best understood biologically, experientially, culturally? How do social institutions exercise power over the body and determine norms of health and behavior? The answers arrived at by phenomenologists, social theorists, and feminists have radically challenged our cenventional notions of the body dating back to 17th century Cartesian thought.
This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine. Its authors suggest that many of the problems often found in modern medicine -- dehumanized treatment, overspecialization, neglect of the mind's healing resources -- are directly traceable to medicine's outmoded concepts of the body. New and exciting alternatives are proposed by some of the foremost physicians and philosophers working in the medical humanities today.
Technology violates human dignity only to the extent that its use reduces persons to the moral status of objects. The prevalence of technology in health care is an extension of the scientific paradigm, in which the body is reduced to an object void of subjectivity. The empathie paradigm, in contrast, is based upon the moral primacy of subjectivity. Empathic touch-as distinct from instrumental and philanthropic touch-establishes a clinical relation of intersubjectivity, affirming in patients the dignity and worth that morally distinguish persons from objects.
Studies from several labs have documented a 31 to 47% greater weight gain in preterm new-borns receiving massage therapy (three 15-min sessions for 5–10 days) compared with standard medical treatment. Although the underlying mechanism for this relationship between massage therapy and weight gain has not yet been established, possibilities that have been explored in studies with both humans and rats include (a) increased protein synthesis, (b) increased vagal activity that releases food-absorption hormones like insulin and enhances gastric motility, and (c) decreased cortisol levels leading to increased oxytocin. In addition, functional magnetic resonance imaging studies are being conducted to assess the effects of touch therapy on brain development. Further behavioral, physiological, and genetic research is needed to understand these effects of massage therapy on growth and development.
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This study assessed the effects of moderate and light pressure massage on the growth and development of young infants. A recent study by Diego, Field, Sanders, and Hernandez-Reif (2004) showed that persons who were given moderate pressure massage, as compared with persons who received light massage or vibratory stimulation, experienced a decrease in heart rate, EEG changes associated with a relaxation response and positive affect, and the greatest decrease in stress. In the present study, mothers were instructed to massage their newborn infants once per day using either light or moderate pressure. The infants’ growth (i.e., weight, length, head circumference), sleep behavior, and performance on the Brazelton scale were assessed soon after birth and at one month of age. As compared to infants who received a light pressure massage, infants in the moderate pressure group gained more weight, were greater length, performed better on the orientation scale of the Brazelton, had lower Brazelton excitability and depression scores, and exhibited less agitated behavior during sleep.
This book describes some of the technological advances made in the art and practice of medicine during the past four centuries, and shows how those advances altered the methods of diagnosing illness; and how new methods, in turn, have altered the relation between physician and patient and have influenced the systems of providing medical care and treatment. The book concludes that modern medicine has now evolved to a point where diagnostic judgements based on 'subjective' evidence - the patient's sensations and the physician's own observations of the patient - are being supplanted by judgements based on 'objective' evidence, provided by laboratory procedures and by mechanical and electronic devices. The book attempts to trace the historical development of how this happened, and, along with the resulting gains, points out the potential losses to the sick patient, to the physician as clinician, and to society. The development of some of the major technological advances of diagnosis is described - the microscope, the stethoscope, the thermometer, the increasing knowledge of bacteriology and biological chemistry, X-ray devices, electrocardiographs, and the most recent automated devices such as the computer. The reliability of the evidence thus produced is discussed, as well as the hazards involved in its unquestioning acceptance. The growing supremacy of technology in medicine is discussed and how it has led to the rise of the specialist and to the centering of medical care in hospitals; and thus to the decline of the general practitioner and an increasing alienation between doctor and patient. A large number and variety of factors influence medical care and the use of technology, some of them being philosophy and religion, economic and political systems, social and cultural values. This book does not seek to discuss the totality of the factors that are a part of the growth of medicine and technology. It focuses, mainly on the thoughts and actions of doctors and patients as they have responded to the availability of new diagnostic technology, and on the process by which a technical advance is accepted or rejected. The author has not attempted to discuss all the diagnostic methods that are a part of medical history. He examines a selected number of techniques, chosen for their importance in the evolution of diagnosis, and for their illumination of the themes of this book. His analysis is confined principally to developments in Great Britain and the United States, and, from the early twentieth century on, chiefly to those events that shaped American medical care.
En esta obra Burtt analiza el pensamiento de Copérnico, Kepler, Galileo, Descartes, Hobbes, Gilbert y Newton. Es una historia y crítica de los cambios sucedidos durante los siglos XVI y XVII y que hicieron posible el surgimiento de la ciencia moderna. Es por tanto una guía útil para entender los métodos de indagación utilizados por los filósofos y científicos de entonces.
A great gulf exists between the way we think about disease as physicians and the way we experience it as people. Much of this separation derives directly from our basic assumptions about what illness is. Our medical world view is rooted in an anatomicopathologic view of disease that precludes a rigorous understanding of the experience of illness. What we need to remedy this problem is not just the admonition to remember that our patients are people, but a radical restructuring of what we take disease to be. The philosophic discipline of phenomenology is used to present a vision of disease that begins with an understanding of illness as it is lived. "Nonmedical" descriptions of illness show how we can reorient our thinking to encompass both our traditional paradigm and one that takes human experience as seriously as it takes anatomy.
The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
The effects of mother-infant skin-to-skin contact (Kangaroo Care; KC) on autonomic functioning, state regulation, and neurobehavioural status was examined in 70 preterm infants, half of whom received KC over 24.31 days (SD 7.24) for a total of 29.76 hours (SD 12.86). Infants were matched for sex (19 males and 16 females in each group); birth weight (KC, 1229.95g [SD 320.21]; controls, 1232.17g [SD 322.15]); gestational age (GA) (KC, 30.28 weeks [SD 2.54]; controls, 30.19 weeks [SD 2.65]); medical risk; and family demographics. Vagal tone was calculated from 10 minutes of heart rate before KC and again at 37 weeks’GA. Infant state was observed in 10-second epochs during four consecutive hours before KC and again at 37 weeks’GA.
Neurobehavioural status was assessed at 37 weeks’GA with the Neonatal Behavioral Assessment Scale (NBAS). Infants receiving KC showed a more rapid maturation of vagal tone between 32 and 37 weeks’GA (p=0.029). More rapid improvement in state organization was observed in KC infants, in terms of longer periods of quiet sleep (p=0.016) and alert wakefulness (p=0.013) and shorter periods of active sleep (p=0.023). Neurodevelopmental profile was more mature for KC infants, particularly habituation (p=0.032) and orientation (p=0.007). Results underscore the role of early skin-to-skin contact in the maturation of the autonomic and circadian systems in preterm infants.
The Foundations of Bioethics
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Illnesses, diseases, and sicknesses The Humanity of the Ill: Phenomenological Per-spectives
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