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The drama of medicines
Published in Peri J. Ballantyne, Kath Ryan, Living Pharmaceutical Lives, 2021
Karen C. Lloyd, Paul Bissell, Kath Ryan, Peri J. Ballantyne
Dramas of signification invoke the symbolic potential of medicines – their capacity to signify not only what illness one has, but also who one is. Medicines are intricately entangled in the identity work of narratives and the performative nature of storytelling. While medicines have the potential to signify that individuals are ‘legitimately ill’ and experiencing an illness that reinforces their definition of the situation and their own sense of self (Goffman, 1959), they may likewise, as in Magdalene’s story, signify an illness identity that does not ‘fit’ individuals’ sense of themselves, and dramas about these medicines may be ones of resistance and contestation. Within these dramas, a mismatch, between health professionals’ definitions of the situation and that of people living with illness risk the loss, or at least the public discrediting, of the self. Charmaz (1983) has described how ‘[d]ramatic discrediting occurs during the course of encounters when ill persons experience public mortification. The images of self mirrored to these ill persons can be so unexpected or jarring that they shake the very foundations of their self-concepts’ (Charmaz, 1983, p. 181). In dramas of signification, medicines can become the mirror held up for people to see themselves, calling on them to perhaps do narrative work to make sense of the image reflected back at them.
Implications for pain management
Published in Stephen Buetow, Rethinking Pain in Person-Centred Health Care, 2020
Integral to these processes over time and across settings is a need for clinicians to enable patients to create, coordinate and manage meaning from in ways may defy linguistic limits and mask dissent from social mores. To help negotiate situated meanings, clinicians can share their own stories within a framework that brings both parties together to enhance diagnostic clarity and tailor treatment options. The verbal language used should avoid or decode jargon and give patients the time, permission and assistance needed to re-author pain narratives and share decision-making. This assistance could include non-literal aids to communication such as creative analogies and metaphors,24 and clean language and symbolic modelling from patient-generated metaphors.25
Making a success of the three-part consultation
Published in Roger Neighbour, Jamie Hynes, Helen Stokes-Lampard, Consulting in a Nutshell, 2020
Roger Neighbour, Jamie Hynes, Helen Stokes-Lampard
The way a patient behaves or sets up the consultation can send powerful symbolic signals. If a husband and wife attend together to discuss the failing health of an elderly relative, particularly if one of them has taken a day off work to keep the appointment, you can be sure they intend their ‘something must be done’ message to be taken seriously. The mother who sits to one side with arms folded and a face like thunder while her 15-year-old daughter tells you she has missed three periods is showing you very clearly what she thinks of the situation. The infrequent attender who starts to make weekly appointments about minor illness is trying to tell you something, even if you don't yet know what it is.
HIV Health literacy beyond the biomedical model: an innovative visual learning tool to highlight the psychosocial complexities of care
Published in AIDS Care, 2022
Olivia Hollingdrake, Chris Howard, Chi-Wai Lui, Allyson Mutch, Judith Dean, Lisa Fitzgerald
Following the consultation process, the researchers, QPP representatives, two study participants and a graphic designer met to discuss ideas for graphical representation of key themes, including feedback from the consultation. A roadway was considered the best metaphor to depict a journey across the care continuum. Symbolic and colour analogies are widely used in successful health-related infographics (McCrorie et al., 2016). Imagery of signposts, vehicles, buildings, hazards and short-cuts can draw viewers’ attention to key themes, with red and green “traffic light” colours highlighting barriers and facilitators along the way. Following this discussion, the graphic designer prepared a draft illustration for discussion and feedback (Appendix 3) and met regularly with the research team and QPP representatives over several months, refining the Map while ensuring accurate representation of study findings.
Algorithms for Ethical Decision-Making in the Clinic: A Proof of Concept
Published in The American Journal of Bioethics, 2022
Lukas J. Meier, Alice Hein, Klaus Diepold, Alena Buyx
Opposite the deep-learning paradigm on the artificial-intelligence spectrum are symbolic methods. These methods deal with logical reasoning or search over given high-level knowledge representations. A programmer might, for example, specify a rule according to which if a patient is fully capable to consent and has reached the age of majority, then doctors should adhere to their treatment preferences. Methods like decision trees or integer logic programming—the approach that Anderson, Anderson, and Armen (2006) pursued in their study—can extract such rules from relatively few examples. Since these rules can be expressed in natural language, they are also highly transparent. However, several problems arise when one applies symbolic methods to a domain like medical ethics. First, symbolic methods operate in the realm of true and false, whereas case discussions in clinical ethics require much more nuanced options. Thus, methods like integer logic programming struggle when data is not clear-cut (Evans and Grefenstette 2018). Secondly, medical case discussions often comprise various factors that interact in complex ways, so that accounting for all of them would result in a very long list of convoluted rules.
Indirect work with hypnosis using metaphorical objects through unconscious intelligence in virtualspace
Published in American Journal of Clinical Hypnosis, 2022
In Ericksonian psychotherapy the use of metaphorical expressions (words) used by the patient are a fundamental tool to use so that the change occurs in accord with individual needs (Robles, 2021c). Similarly, Short (2021) argues that, “we use words as tools to help construct our thoughts as we problem solve” (p. 74). I now propose to use and work with the patient’s own personal objects, which, at a symbolic level, represent what the person is feeling, thinking, imagining, and wanting to express. This work also involves using their movements, in what they have identified as their own physical space (Hellinger, 2008). The change of place, not only in the imagination but physically on the outside, provides new perspectives that open up the internal dialogue upon which the patient’s reality rests (Hellinger, 2008).