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The Screening Room: The Aftermath of Stroke

3 May, 16 | by cquigley

 

Building bridges: two films about self-discovery after stroke

Dr Khalid Ali

 

Two recent films portray the aftermaths of stroke from different viewpoints: that of a stroke survivor in My Beautiful Broken Brain (UK 2016, directed Lotje Sodderland and Sophie Anderson, currently showing on Netflix) and that of the daughter of a stroke survivor in You See Me (USA 2015, directed by Linda Brown, available from http://youseememovie.com/).

Linda Brown is a film maker and an Associate Professor at the University of Southern California (USC). After her father Stanley Brown had a stroke in 2004 at the age of 79, she decided to collate her filmed reflections on his stroke experience in a documentary film, You See Me. Another motivation for making the film was her strong desire to get to know her father better as a human being with a traumatic past and unfulfilled dreams. Using family home videos and interviews with her father, mother, and two sisters, she tells a poignant story of a family afflicted by stroke as well as long-hidden secrets. The blood clot that blocked the blood supply to her father’s brain (cerebellum) has affected him in many ways; his physical weaknesses, poor balance, stuttering speech were accompanied by significant behavioral changes characterized by frustration and outbursts of anger. In spite of Stanley’s determination to walk and communicate and restore his relationship with his family, his frequent paranoid delusions and verbal abuse put significant strain and pressure on everybody around him, particularly his long suffering wife. Documenting the turbulent and volatile family life for 12 years after Stanley’s stroke in film became a journey of self-discovery for Linda and her mother. Watching family home movies enabled them both to re-evaluate their relationship with Stanley, and to come to terms with their own uncertainties about his morbid and enigmatic pre-stroke personality. With poignant realism, Stanley’s death circumstances were honestly shared with the audience. However, ‘unexpected salvation and healing’ come in the guise of a never-before-seen family home video.

Following the film screening in several international film festivals, and after winning major awards, The American Heart and Stroke Association (AHSA) supported the film in public campaigns for its honest portrayal of life after stroke, in addition to caregiver burden in old age, domestic violence, and mental health awareness.

In My Beautiful Broken Brain, we see Lotje Sodderland, another film-maker, who had a massive haemorrhagic stroke at the age of 34. Following life-saving brain surgery, she begins to experience a bewildering and confusing reality; visual images are distorted, sounds are exaggerated – a surreal existence that reminds her of ‘the red room’ experience in Twin peaks, her beloved director David Lynch’s infamous TV series from 1990 (https://en.wikipedia.org/wiki/Twin_Peaks). With the help of another film maker, Sophie Anderson, the two embark on a journey of filming Lotje’s demanding speech therapy sessions, her isolating experience in a hospital rehabilitation unit, readjusting to life again, and joining a research study that involving trans-cranial magnetic stimulation for improving speech.

In her strong desire to turn her ordeal into a positive experience, Lotje and Sophie send a videotaped message to David Lynch (https://en.wikipedia.org/wiki/David_Lynch), sharing Lotje’s day-to-day attempts of ‘restoring her old self’. To their surprise, David Lynch replies, expressing his interest in Lotje’s video diaries, and ultimately joining as an executive producer for the film.

Telling her stroke experience as it is without sugar-coating, Lotje says: ‘My life was hijacked by therapists. I am now defined by my impairments’.  How much she scores on stroke-specific assessment scales becomes her daily pre-occupation. Lotje’s story and observations embody the sense of lack of control that many stroke patients experience both in hospital and after discharge. Stroke therapists as ‘dictators’ controlling the stroke survivors’ recovery, and the challenge for survivors moving towards a ‘reluctant democracy’ has been explored in a seminal article by Norris and Kilbride (1).

In spite of the harsh reality of life post-stroke, Lotje slowly discovers and comes to appreciate her hidden strength and her resilience as she reconnects with a new sense of self. The ethos of self-management post stroke is practiced on a daily basis by Lotje, a reminder of the visionary Bridges approach championed by Professor Fiona Jones in the UK (2).

You See Me and My Beautiful Broken Brain show us how living with, and embracing change after stroke can be the key for healing and liberation for both stroke survivors and their families.

 

References

  1. Norris M, Kilbride C. From dictatorship to a reluctant democracy: stroke therapists talking about self-management. Disabil Rehabil 2014; 36 (1): 32-8.
  2. Self-management – Bridges approach  http://www.bridgesselfmanagement.org.uk/

 

Address for correspondence: Dr Khalid Ali, Screening room editor, Khalid.ali@bsuh.nhs.uk

 

 

The Reading Room: ‘Making Medical Knowledge’

25 Apr, 16 | by cquigley

 

Making Medical Knowledge

By Miriam Solomon

Oxford University Press, 2015

 

Reviewed by Dr Jonathan Fuller, University of Toronto

 

We should forgive anyone unfamiliar with recent trends in ‘scientific medicine’ for thinking that within scientific medicine there are now multiple medicines to choose from: evidence-based medicine (EBM), translational medicine, narrative medicine, personalized medicine, and so forth. These approaches are not distinct professions in the same sense as allopathic medicine and naturopathy. But just what are the relationships among modern medicines many ‘medicines’?

In Making Medical Knowledge [1], philosopher Miriam Solomon sets out to assess four of these movements introduced over the last forty years: medical consensus conferences, EBM, translational medicine, and narrative medicine. She calls them ‘methods’ to be concise, but notes that they are distinct epistemological approaches, or approaches to (medical) knowledge. Solomon writes that she selected these four methods because of their “dual and paradoxical epistemic character” (p. 14): there is something obvious about each of them (of course medicine should be ‘based on evidence’), as well as something odd (‘evidence-based medicine’ deemphasizes many kinds of evidence, including expert consensus). Given how much time, effort and money is being spent in the name of these movements, a close inspection is certainly warranted.

Solomon’s approach in her book is to examine these methods using an interdisciplinary lens. She situates her study in the realms of social epistemology, philosophy of medicine, integrated history and philosophy of science, science and technology studies (STS), and critical medical studies. She describes her approach as “Naturalistic, Normative, Applied, Pluralist, Social Epistemology” (p. 11); in other words, she aims to describe and evaluate actual medical knowledge and practice using a diverse set of tools, and with a focus on the social. She writes for a broad academic audience, including the medical community.

In the introductory chapter, Solomon argues that “[t]he science/art dichotomy is no longer a fruitful disciplinary divide” or a meaningful way of describing medicine (p. 11). She instead argues that a ‘methodological pluralism’ describes contemporary medicine and its many methods for negotiating knowledge. Solomon then spends three chapters examining medical consensus conferences and group process, two chapters on EBM, one chapter on translational medicine, and one chapter on narrative medicine. The penultimate chapter advances Solomon’s ‘developing, untidy, methodological pluralism’. According to this view, medicine’s epistemological approaches do not have exclusive domains of application; all of the methods she describes are in active use, their domains overlap, they sometimes come into conflict with one another, and there is no “hierarchy of methods” (p. 229) to rescue us when they clash. The final chapter summarizes Solomon’s main conclusions.

Making Medical Knowledge is an excellent and pioneering study of some of the dominant movements in early Twenty-First Century medicine, which – with the exception of EBM – are relatively unexplored by scholars. It provides a good entry point, offering detailed and insightful reconstructions of each method within its historical context, thus satisfying Solomon’s descriptive aim. The historical detail is rich, especially for medical consensus conferences. Solomon is charitable towards each method, and manages to find substance amidst the rhetoric, even for translational medicine, which is especially difficult to pin down and appears at first glance to offer no more than metaphor. She also provides thoughtful criticisms of each method, thus satisfying her normative aim.

Overall, I think Solomon pitches the discussion well for the broad audience she has in mind. The philosopher, historian, sociologist and anthropologist should all find something of interest in her book. I expect that clinicians, especially within academic medicine, will find it fairly accessible. Satisfying the needs of her diverse audience perhaps prohibits Solomon from going into as much depth as some philosophers, historians or social scientists might like. Such is the cost of interdisciplinarity, but it pays off in the form of a study that benefits from its use of multiple disciplinary lenses.

While I generally agree with Solomon’s analysis of each method, I was not fully convinced that an ‘untidy, methodological pluralism’ is the best way to understand the relationships among the methods. Solomon accepts that the methods are often active at different stages of research, but nonetheless argues that they do not fall on a “tidy linear spectrum” from research to practice (p. 206). Yet as her own analysis reveals, translational medicine (research from ‘bench to market’, or ‘T1’) refers to basic medical science research as well as Phase I and II clinical trials, EBM appraises and aggregates the results of Phase III trials, medical consensus conferences make therapeutic recommendations based on the results of Phase III trials or systematic reviews of trials, and narrative medicine (in its integrated form) interprets guidelines and the research literature in the context of the patient’s story. In other words, translational medicine applies to medical research, consensus conferences apply to knowledge dissemination, and EBM and narrative medicine apply to clinical practice. The main purpose towards which each method is put is unique: translational medicine develops new medical technologies, consensus conferences develop consensus statements or clinical guidelines (often pertaining to those technologies), EBM appraises evidence and applies it in clinical practice, and narrative medicine uses narrative techniques at the bedside. Thus, their domains are less overlapping and arranged more linearly than Solomon’s untidy pluralism might suggest.

Of course, the practice of EBM might sometimes conflict with the practice of narrative medicine (more on this point in a moment). Moreover, the practice of narrative medicine or of EBM might sometimes conflict with the products of consensus conferences: clinical guidelines. Narrative medicine locates individuality in the patient’s narrative, and EBM is often defined as the use of evidence in the care of individual patients [2]. On the other hand, guidelines make recommendations for broad groups of patients, not for individuals.

Solomon presents the example of breast cancer screening for women in their forties to illustrate the various ways that the methods can clash with one another. However, most of the conflict that Solomon describes occurs within each method: among pathophysiologic theories of breast tumour development, among primary studies and systematic reviews with respect to the magnitude of benefit from screening, and among guidelines making recommendations about mammography. While some of the products of EBM (systematic reviews) might appear to conflict with some of the products of consensus conferences (guideline recommendations), the former recommending against mammography and the latter often recommending in favour of mammography, this appearance is illusory. The evidence, on its own, does not have the power to recommend. Conflicts arise among individuals and groups due to their differing interpretations of the evidence and divergent recommendations for which they use the evidence to argue.

Similarly, it might appear that generalized breast cancer screening guidelines conflict with the individualized practice of narrative medicine or EBM. However, even though guidelines make general recommendations on mammography for women in their forties, Solomon notes that the guidelines explicitly state that patients and their physicians should make an individualized decision. There is thus less conflict among the different methods than first meets the eye.

Rather than an untidy methodological pluralism, another way to describe the situation is as follows. Medical research has a dominant aim (‘translation’), and medical practice has a dominant epistemology (EBM). The aim of translation regulates the funding of research, and motivates the use of consensus conferences to disseminate knowledge. Meanwhile, EBM has been embraced by leading medical journals and medical training programs around the world. While medical consensus conferences and clinical guidelines predate EBM, they are now based on the principles of EBM and can be considered EBM tools (the use of evidence-based practice guidelines has been called the ‘using mode’ of EBM [3]). The practice of narrative medicine might sometimes conflict with the practice of EBM. But narrative medicine is a developing movement and approach to clinical medicine, not a dominant one. It does not yet have the political power of EBM. Thus, within research and medical practice, there is more hegemony and less egalitarianism than Solomon’s untidy pluralism perhaps suggests.

Making Medical Knowledge raises interesting questions about the function, theory and practice of medicine’s most influential movements. Modern medicine is a mess of many ‘medicines’, and while it is not the intention of this book to make this mess look tidy, Solomon does succeed in making it intelligible.

 

Acknowledgments

I gratefully acknowledge funding support from the Canadian Institutes of Health Research.

 

Funding

Canadian Institutes of Health Research.

References

  1. Solomon M. Making Medical Knowledge. Oxford: Oxford University Press, 2015.
  2. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence Based Medicine: What It Is and What It Isn’t. British Medical Journal 1996;312:71 – 72.
  3. Straus S, Glasziou P, Richardson WS, Haynes B. Evidence-Based Medicine: How to Practice and Teach It. Edinburgh: Elsevier Churchill Livingstone, 2011.

PCMD Medical Humanities Conference 2016

18 Apr, 16 | by cquigley

 

Ian Fussell

Community Sub Dean UEMS

 

In 2002, The Peninsula Medical School (now Peninsular College of Medicine and Dentistry (PCMD)) became the first UK medical school to integrate the medical humanities as core curriculum.

Every year since, year four students engage in a six-month project alongside and mentored by an artist. The culmination of the project is a conference organised by the students displaying and presenting their work.

The work thus created has become increasingly sophisticated over the years, as evidenced by the 2016 conference that just took place in Truro (April 2016). In fact, it was probably the highest quality of work seen to date and would not be out of place at any international medical humanities conference.

The morning session was opened by Professor Alan Bleakly, the current President of the Association for Medical Humanities and a leading world expert in the field. This was a particularly poignant conference as 2016 is the final year that it will be run under the auspices of PCMD following the disaggregation of Exeter and Plymouth Medical Schools. It may have been this, or the unsettled future that the current students are facing, that gave this year’s presentations an extra edge.

Following a superb talk by Alan that encouraged a political voice, we were treated to three songs written and performed by “Dull to Percussion”, a band formed in the “Medical School of Rock” module. The songs were indeed political, satirising the split between the universities and included a protest song aimed squarely at our Health Secretary. Search iTunes or Spotify to listen for yourself, and watch “A Song for a Hunt” go viral.

The day was then jam-packed and it was impossible to experience all that was on offer. The range of skill and talent was breathtaking. We were lectured on the human cost of the western desire for sweetness by students from the anthropology module, and invited to debate “Do Christians make better doctors” by the Christian ethics students. This year a number of new Special Study Units (SSUs) were run. They were also extremely good and included a collaboration with Truro’s Hall for Cornwall team.

The students worked at the theatre, but more impressively wrote a play on mental health in medical students. We were treated to a premiere performance – “Permission to be Human” should be performed at every medical school in the country. There was also a monologue by a shy mature student who helped us understand alcoholism and PTSD in war veterans. The mood was lifted by a hilarious stand up routine; how can dislocating your shoulder be so funny?!

There were a number of writing modules, including poetry. The audience was encouraged to write poems in a short workshop. Another new module was “Writing the Knife”, which generated superb short reflections on memorable clinical incidents. One piece called “Quayside” was outstanding and deservedly won a prize. Read it here https://memorablemedicmoments.wordpress.com/author/memorablemedicmoments/ and add your comments.

There was so much more to the students’ work, and this short piece cannot cover everything. However, I do want to mention a some other excellent pieces: working with clay exploring the professional masks doctors wear; pottery boxes representing the mess that doctors get into as they progress through their careers; moving and uncomfortable films that depicted a child’s journey through a hospital; the doctors strike shown as a frightening political movement; dopamine photography; a project on how we smell; and life drawing in conjunction with Falmouth Art School. At the end of the day we were “kettled” into a small room, and forced to party…

The aim of this SSU is to develop student’s tolerance to ambiguity. But the SSU achieves much more than this: it helps students develop a community of practice; it also fosters development of resilience and peer support; and importantly, the students have fun while exploring other perspectives on life and illness. I am extremely proud of our medical students and feel very privileged to work with them in this way. I hope that both Exeter and Plymouth continue with medical humanities in their developing curricula.

 

 

 

The Reading Room: This Living and Immortal Thing

13 Apr, 16 | by cquigley

 

And so it goes…this thing called life

Fergus Shanahan

 

9781783781676

 

This Living and Immortal Thing

By Austin Duffy

Granta Books, 2016

 

If authors write what they know, then Austin Duffy knows a lot, but This Living and Immortal Thing, his first novel, blends experience with fiction and offers more than informed opinion and insight to medicine, science, life and death. This is a story. The story teller is an Irish doctor who has left a childless, stagnant marriage to specialise at a famous cancer centre, recognisable as Memorial Sloan Kettering in Manhattan. As a post-doctoral trainee, he is comparatively mature in his mid-forties, and contemplates life and events in his new surroundings. Thinking of his younger brother Donal back in Ireland, he notices that America differs from home in having relatively few cases of Down’s syndrome. “They would not have allowed him to be born…with their blood tests and ultrasounds and amniocentesis needles…” His brooding juxtaposes several contrasting images: the bustle of the city ignoring a lone street protestor; the urgency of the clinic versus the controlled environment of the research laboratory; and a bored, hung-over clown employed to entertain sick children, bald from chemotherapy, reminds us that for the hospital staff illness is routine, but for the patients it is crisis.

At first, there is a trace of glibness in the narrator’s clichés but these are progressively replaced by more heartfelt prose that unfolds like a diary. His jadedness is jolted by the freshness and allure of Marya, a young Russian immigrant who volunteers as a translator in the hospital. Their dialogue is clipped, droll and loaded with sexual energy. She uses irreverent and refreshingly direct language. “So what sort of doctor are you anyway?” “You’re like, what…forty five? Are you homosexual?” He reveals his story with typical Irish reserve. But this is no ordinary flirtation; she has a secret. She seems hurried and doesn’t bother with his name – ‘post-doc’ will do. Post-doc is both intrigued and attracted, and his scientific mind repeatedly notes that men are seldom distracted from sex for long, regardless of the context.

“…doctors, they’re so stupid!” exclaims Marya, frustrated after witnessing a tactless communication of bad news to a patient. “I don’t translate word for word but only some….”  Silently, post-doc reflects how difficult it is to explain things properly though a translator but also easier because one is removed and less responsible for one’s words. He likens it to a high altitude bomber out of range from the sights and sound of the horror inflicted below. He is dispassionate about his experiences with terminally ill patients: “For the most part,” he says, “there is nothing to do except sit across from them and be kind.” In a commentary on communication, the eminent medical scientist Robert Brook once defined a physician by the following equation: physician = emotion + passion + science. Post-doc surely has emotion and recently switched from clinical to laboratory science, but may have lost his passion.

While grieving the physical and emotional distance from his own potential progeny, his care for the experimental animals is tender and touching, with each identified by name. He is opinionated about what it takes to be a good scientist, and is respectful but deeply critical of his supervisor Dr. Solter. Like all good scientists, post-doc is attentive to detail, painstakingly recording his observations, with a measure of humorous humility when Henrietta, his favourite mouse, is pronounced to be male by the visiting vet.  On the sole occasion when post-doc says something kind about Dr. Solter, it is to concede how well Solter communicates with the next of kin of a terminally ill patient. Curiously, he doesn’t seem very excited about the promise or impact of his own research; he bores a group of students when he is called to explain his project. Perhaps this is disillusionment or perhaps it is the key point: the scientific method is slow and repetitive and gives the lie to the popular misconception that science is fun.

There is, of course, no mystery about where the story will go, but this doesn’t detract from the parallels between the laboratory mice and the patients, the cancer cells and the frozen embryos from post-doc’s marriage, and a vigorous new cell line from a once vibrant donor. Along the way, the story is speckled with informed commentary on topics ranging from cancer to clinical arrogance. Some of post-doc’s asides are authoritative, like those on the poetry of W.B. Yeats and the music of Brazil. Others are enigmatic: “There comes a time when all there is to do is worry” and “Illness makes for an oddly insubstantive discussion,” whereas other pronouncements are quirky: “Generally you are better off when things are not resolved at all. You only have to ask any one of my previous patients that. It is rarely in your interests.”

If this is a book about cancer, then it is also about life, death, loss and replacement, and a book about medicine. With each, there is uncertainty. Medicine is the art and science of managing uncertainty. Post-doc has moved from the clinic to the research laboratory where it is “more controlled and predictable…in contrast to clinical work, where you have only an illusory or – at best – superficial control over things.” When questioned by Marya, he is vague on the reason for his change: “Humans are tricky, I suppose… Unpredictable.” In the research laboratory: “You set your own conditions and, to a large extent, the future is predetermined.” Is this self-serving? Is post-doc a reliable narrator? Later, he claims: “Given the choice I would take uncertainty over certainty every time.” He believes that a true scientist’s mind should move slowly and should “question everything.” He is critical of people like Solter whom he believes “has too much certainty” to be a natural scientist and whose mind is “moving too quickly for science…” Since childhood, post-doc has had a searching mind and was described by his school teacher as “a fan of distraction.” Now, he wants to slow things down in his life, to focus and to cope with the passing of time, and this, in his view, is as good a reason as any for going into the laboratory, where he can focus on the continual cycle of life, death and replacement.

This is a book that I expected not to like, much of it too familiar to me. Now, I miss the accented penetrating language of Marya and the distractions of post-doc.

The Reading Room: ‘Deaf Gain’

8 Apr, 16 | by cquigley

 

Deaf Gain: Raising the Stakes for Human Diversity

H-Dirksen L. Bauman and Joseph J. Murray, Editors

University of Minnesota Press, 2014

 

Reviewed by Dr Paul Dakin, GP Trainer in North London with research interest in the representation of d/Deaf people

 Deaf

This book challenges the commonly held notion that deafness is an existence marked primarily by loss of hearing and a condition that needs to be treated or corrected. Deaf Gain proposes an alternative in which deafness is seen as an evolutionary divergence carrying specific advantages for both non-hearing and hearing communities. Claiming that “Deaf Gain can change the ways in which we appreciate the gifts of all humans” (xxxii), the book argues for a shift in the dominant hearing world view from a perception of what is missing towards a positive recognition of the contributions and advances derived from the experiences of Deaf individuals and Deaf culture.

The basic concept of Deaf Gain was originally formulated in a series of presentations organised by two of the editors, Baumann and Murray, in 2009. These presentations took place at Gallaudet, the world’s only Deaf University, situated in Washington DC.

The 500 page volume was generated out of the resulting discussions and seminars and represents the work of 45 authors mainly based at Gallaudet. The 27 chapters that constitute Deaf Gain are not too long, and are on the whole easy to read, informative, and well researched. The book is arranged in sections that consider applications of the underlying concept around specific themes such as philosophical, language, sensory, social and creative.

The overwhelming approach is positive, optimistic, and even heroic. The concept of Deaf Gain turns on its head the usual idea that deafness should be defined through narratives of suffering and isolation. “The Deaf community has gone to great efforts to deabnormalize deafness. To combat the abnormalizing notion of seclusion due to deafness, we get Deaf cultures. To combat the abnormalizing characterisation of deafness as hearing loss, we get Deaf Gain” (p33).

This may well be true for a minority of people who are non-hearing. The book is written mainly, though not exclusively, from the perspective of the American Deaf Community, most of whom would be deafened at or near birth, and whose first language would be American Sign Language (ASL). Their experience would resonate with other signing communities, such as British Sign Language (BSL) in the UK, although it is not as large, active, or vocal as its counterpart in the USA.

But it should be remembered that the vast majority of individuals who experience deafness are not born Deaf or become deafened at a young age. They actually lose hearing in later life, perceive their experience in terms of communication difficulties with the majority community to which they have always belonged, often feel isolated, and would most certainly characterise deafness as a process of loss.

Claims are made early on concerning the evolutionary advantages of deafness on the basis of the persistence of the deaf gene. Again this is less likely to apply to the majority of people who become deafened later in life. I’m not convinced that just because a gene persists this inevitably means it has enhanced evolutionary potential. For instance, the cystic fibrosis gene is not rare, but its evolutionary rewards, if any, remain unclear. Parallels are also made between the advantages of deafness and those of bipolar disease and Huntington’s chorea, a suggestion that seems rather self-defeating, as I have never come across individuals with these conditions who celebrate such devastating diseases.

Other potential benefits of deafness are more readily and obviously explained. Evidence is given to show that Deaf people have better visual acuity, pay more attention to facial features and to peripheral vision, enjoy greater manual dexterity and enhanced tactile senses, and have improved spatial memory compared to their hearing counterparts. It could be argued that this is not a genetic facility at all but an increased functionality due to loss – an example of when one sense is absent, the brain develops others to compensate. People who have severe visual impairment are traditionally believed to have developed greater abilities to hear and to sense movement, and to even display ‘second sight’. Many people have folk beliefs about the loss of sight leading to enhancement of other senses or even ‘supernatural’ ones. This ‘benefit’ or ‘privilege’ isn’t conferred to those who have lost their hearing but perhaps should be.

An appeal is made to historical records showing how much deafness and Deaf people have contributed to our understanding of the development of language and have pushed forward inventions such as Morse code and the telephone. Deaf people are revealed to be quick learners and good employees, with large companies such as Firestone and Goodyear actively recruiting staff from within the Deaf community. Instances are given of societies around the world in which both hearing and non-hearing people use sign language, with a resulting increase in social cohesion.

The information presented from neuroanatomical studies is fascinating. There is evidence for the gestural origin of language. When children acquire language, spoken or signed, they do so in a similar way. The brain learns communication using similar processes regardless of whether it is visual or auditory, although the right hemisphere is more active with signing. Teaching a hearing baby simple signing conveys advantages in visual processing, language acquisition, vocabulary, and reading.

Creative gains include the notion of Deaf Space in which architecture takes ‘possession of space’ for Deaf people by emphasising vision and touch as the primary means of spatial awareness and orientation. These benefits are available for all, and include emphasis upon exciting features such as building around a common collective space, an emphasis on the placement of light and mirrors, and soft intersections that have destination points within immediate view.

In summary, the book proposes that the world as a whole benefits from the attributes, abilities, perspectives and contributions that arise from deafness, Deaf individuals, and Deaf culture. The concept of Deaf Gain promotes deafness as a positive for the entire community, hearing and non-hearing, not as a genetic or disease abnormality but as “a biological variety in the human race, like skin color or gender” (p287).

I enjoyed reading Deaf Gain, and recommend it as a resource. Although I have reservations about some of its assertions, it catalogues a wide body of evidence and presents well-argued opinion. It is an excellent addition to the understanding of deafness and to the promotion of Deaf culture.

Khalid Ali: ‘Let’s talk about death: a review of ‘Last cab to Darwin’, Australia 2015’

31 Mar, 16 | by Ayesha Ahmad

Let’s talk about death: a review of ‘Last cab to Darwin’, Australia 2015

5*, Directed by Jeremy Sims based on stage play by Reg Cribb

Dubai International Film Festival (DIFF) December 2015, possible release in UK cinemas 2016/17

The controversial subject of ‘euthanasia and assisted suicide’ has been a rich source for films; ‘Whose life is it anyway? USA, 1981, directed by John Badham’, ‘The sea inside, Spain, 2004, directed by Alejandro Amenabar’, and ‘Million Dollar baby, USA 2004, directed by Clint Eastwood’ have all explored the ethical, legal and moral complexities of ‘the right to die’ from a patient’s perspective.

more…

Ayesha Ahmad: ‘Lahore is an Illusion, Lahore is Everywhere’

27 Mar, 16 | by Ayesha Ahmad

The mango tree faded many shadows ago, its fruit became stones and the branches became a skeleton. Yet, the roots remained, and they embrace the soil in the womb of the earth.

images-1

This was the cradle of my family’s birth.

Now, blood is watering Lahore’s gardens.

In sorrow, I remembered these words given to me a few days ago by my father.

 ‘Lahore is an illusion, Lahore is everywhere’

I wondered about them for sometime afterwards and I did not realise the gift that these words were to become.

more…

Franco Ferrarini: The Past: a Friend or Foe? Different Perspectives from ‘Spectre’ and ‘45 years’.

27 Mar, 16 | by Ayesha Ahmad

The Past: a Friend or Foe? Different Perspectives from ‘Spectre’ and ‘45 years’.

Spectre- directed by Sam Mendes, UK, 2015

45 years- directed by Andrew Haigh, UK, 2015

By Franco Ferrarini, Gastroenterologist and film reviewer

In the words of the French philosopher Henri Bergson: ‘The pure present is an ungraspable advance of the past devouring the future. In truth, all sensation is already memory’. In this view the present, as we usually think of it, is virtually non-existent as the past connects directly with the future. Two recent, but very different films, ‘Spectre’ and ‘45 years’ provide thought-provoking insights into this relationship.

more…

The Reading Room: Short-list for the 2016 Hippocrates Prize for Poetry and Medicine

22 Mar, 16 | by cquigley

 

Fragility of the human form: short-list for the 2016 Hippocrates Prize for Poetry and Medicine

 

The Hippocrates Initiative for Poetry and Medicine – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between medicine, the arts and health.

Poets from New York and the UK are among the finalists for this year’s prize. Short-listed in the Open Category are Owen Lewis, child psychiatrist and poet from New York, and from the UK poets Anne Ryland from Berwick-on-Tweed and Jane McLaughlin from London.

Competing for the UK NHS 2016 Hippocrates first prize are paediatric cardiologist Denise Bundred from Camberley, former consultant haematologist Karen Patricia Schofield from Crewe and GP Chris Woods from Bury.

Find out more about the shortlisted poets.

The judges also agreed 16 commendations in the NHS category, and 17 commendations in the Open International category from Australia, France, England, Ireland, Scotland, New Zealand and the USA.

Find out more about the commended poets.

The winners will be announced at an awards ceremony in London on Friday April 15, 2016.

Check out the Medical Humanities poetry section here.

 

 

Ayesha Ahmad: Introduction to Global Humanities—Through Creation, Violence Will Die

15 Mar, 16 | by Ayesha Ahmad

Against the backdrop of violence, I have been examining through my research the qualities of our human condition that perpetuate both our survival and our spirit.

As an introduction to an ongoing series on Global Humanities, I will be discussing ways we can counter the dominant narrative of violence.

Our globalised world, or rather, the collective ‘Other’, is met through encounters from suffering—the patients that enter our clinical settings, the individuals that sacrifice their lives to reach the shores of safety, and the images that we only ever see from afar of stories that breathe suffering.

more…

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