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Suffering, Sacrifice and Stigma
Published in Clare Gerada, Zaid Al-Najjar, Beneath the White Coat, 2020
The idea of the wounded healer dates back to antiquity. Plato, the founder of Western philosophy, considered the most skilful clinicians to be those who had suffered from all sorts of illnesses. The psychoanalyst Carl Jung considered the wounded to be one of the human archetypes. An archetype is something all humans have in common, irrespective of their culture, gender or period of history in which they live. Archetypes repeat themselves in the collective unconscious of mankind. This could be in the form of dreams, stories, art or even myths, all of which cross cultural boundaries. As such, they are universal and embody a hereditary factor in the human psyche incorporated metaphorically into our genetic make-up.
Storytelling and narratives: sitting comfortably with learning
Published in Jan Woodhouse, Dorothy Marriss, Strategies for Healthcare Education, 2019
Storytelling can be used as a research tool to identify the archetypes that exist in the healthcare setting. In addition, it could be used as an alternative to the traditional academic essay, as an assessment tool to measure the level of learning that the student has attained,20 or as a measure of competence.31
‘All fur coat and no knickers'
Published in David M. Brock, Michael J. Powell, C. R. Hinings, Restructuring the Professional Organization, 2012
This chapter has described two alternative archetypes that are extant in the field of UK hospitals. First, primary and secondary data were combined to show that, following the birth of the NHS in 1948, most UK hospitals developed similar structures and systems that were underpinned by a common interpretive scheme. These similarities were represented as the PB hospital archetype which shares many characteristics with Mintzberg's (1979; 1983a) notion of the professional bureaucracy. The structures and systems of the archetype were characterized by distinct medical and administrative domains. The defining feature of the PB interpretive scheme was the consensus that supported professional autonomy, stability and the peer review of practice as the primary means of quality assurance.
Two faces of the teacher: Comparing editions of Charcot’s Leçons du mardi
Published in Journal of the History of the Neurosciences, 2022
Christopher G. Goetz, Emmanuel Drouin
Of key historical and medical interest, the direction of the lesson immediately following these very similar transcriptions is quite different, although not specifically discordant. In the hand-transcription, the theme adopted for the rest of the lesson is one of Charcot’s favorites: the complementary value of studying archetypes of diseases and their variants. In his view, a case like this one is the disease archetype, embodying all aspects of pathology in full and classic development. Naturally, the archetype is the most revealing scientifically and the most malignant clinically, hence his pleasure in showing the case to his scientific audience, but also lamenting the “abominable” prognosis and “implacable” progression. However, he is quick to emphasize that such a grim view is the current status, and he poses the question to his audience: “Will it always be so?”7Le sera-t -elle éternellement? (February 28, 1888). The exercise he proposes is to study the archetype and then find the variants or formes frustes, as they represent the same disease but in modified or attenuated forms that are not so aggressive or implacable. The message is one of the power of diagnostic discipline and open-mindedness when the sensitized mind and observant eye are mobilized.
Leaving hypnosis behind?
Published in American Journal of Clinical Hypnosis, 2021
Over the ensuing century-and-a-half – from the global adoption of Braid’s term “hypnosis” in the 1850s (Tinterow, 1970) through the meticulous revelations of 1990’s Decade of the Brain (US-LOC, 2000) – application of and research on hypnosis has held to this bicameral paradigm. This archetype evolved to fit within an emerging biomedical frame. The various reductionist and ritualistic approaches to hypnosis that were fostered by Elliotson, Braid, Liébeault, Bernheim, Janet, Charcot, Freud, and on to modern research and professional training (Hammond & Elkins, 1994) aligned the prevailing and emerging medical culture. Writing about the evolution of professional education in clinical hypnosis, Alter and Sugarman (2017) describe the model in this way: The reductionist, clinico-pathologically-correlated, disease-based, allopathic approach was founded on three principles: (1) measurable and predictable biological factors led to pathological states that could be modeled as diagnoses; (2) different individuals with common diagnoses therefore manifested common pathophysiology and so could and should be treated similarly; and (3) to optimize reproducibility and results, prescriptive therapies ought to be delivered in a formalized and structured manner. This is the basis of the disease-defined, diagnosis-driven revolution in medicine and in medical education in the United States (Flexner, 1910) that set the standard of accurate diagnosis and refined treatment based upon measurable, evidence-based outcomes. (p. 240)
Clinical reasoning – a Scotoma in the medical gaze?
Published in Education for Primary Care, 2021
Torsten Risør, Charo Rodríguez
In their widely read book ‘Clinical Rationality’, Wulff and Gøtsche note that diagnostic reasoning is more difficult if the patient has more than one medical condition, especially if they affect each other [2]. Decision-making is more complex with children, with the elderly or with pregnant women. Migrants offer additional aspects of complexity. But these ‘deviations’ are not deviations in real life: adults suffering from co-morbidities are the norm in family practice. Indeed, diagnosis is only a small part of the reasoning and decision-making clinicians engage in. Analysis of hundreds of clinical encounters in a variety of specialities shows that the prevailing archetype for a clinical decision is only one particular kind of animal in a larger zoo, and the diversity of animals in it is so large that we cannot transfer analysis and solutions from one to the other without problems [6].