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Film review: Julieta

24 Aug, 16 | by cquigley

 

Julieta, Spain, 2016, directed by Pedro Almodovar

In UK cinemas from 26th August 2016

 

Reviewed by Dr Franco Ferrarini, Gastroenterologist with a special interest in functional gastrointestinal disorders and their treatment with hypnosis

 

The opening shot of Pedro Almodovar’s ‘Julieta’ shows a pulsating red cloth that looks like a curtain; as the camera slowly pulls back, we realize that it is actually a lady’s dress. From the outset, we know that we are about to enter one of Almodovar’s favourite arenas, namely the ‘women’s world’. However, ‘Julieta’ is definitely less “Almo-dramatic” than his previous films; it plays as a mystery tale, but there are no victims, no villains and no murder investigation. Nor do we get the usual humour, the defiance and the provocative style that usually permeate Almodovar’s films.

Julieta (Emma Suarez), is a good-looking, well-off woman in her mid-fifties, who is happily planning a vacation with her lover Lorenzo (Dario Grandinetti). Accidentally she runs into Beatriz (Michelle Jenner) who tells Julieta of a recent encounter with Ania, Julieta’s estranged daughter (Imena Solano, Priscilla Delgado and Blanca Parés, at different ages). Julieta abandons her planned journey, and starts writing a diary conceived as a letter to her daughter Ania. Using a series of detailed flashbacks, Almodovar narrates Julieta’s earlier life, starting with her as a 20 year old woman falling in love with Xoan (Daniel Grao) while on a train journey. The two lovers get married soon after their first encounter, and Julieta gives birth to Ania. After Xoan’s death, Ania mysteriously disappears at the age of 18. Repeated attempts by Julieta to get in touch with Ania end in vain. Using a sequence of emotional scenes, Julieta’s feelings of guilt and bewilderment over Anias’ disappearance are poignantly portrayed. Julieta’s torment is masterfully underlined by Lucian Freud’s self-portrait (1985) hanging on a wall in her house, acting as a metaphor for most of Freud’s paintings, the continuous suffering of everyday life.

‘I sometimes have the impression that reality is simply there to provide material for my next film’, Almodovar famously stated. Using imaginative plotting in his films, he underlines the ominous consequences of the unsaid on human lives; the original title of ‘Julieta’ was ‘Silencio’ Spanish for ‘Silence’. A tragic mis-communication between Julieta and Ania, orchestrated by Xoan’s housekeeper, explains Ania’s disppearance, in a plot twist reminiscent of Alfred Hitchcock’s ‘Rebecca’ https://en.wikipedia.org/wiki/Rebecca_(1940_film).

The role of nature and fate in dictating the tragic life course of some human beings saturate the film. Nature, specifically sea water, bestows both survival means and death (Xoan is a fisherman who dies in his ship during a storm). Fate is at play in the train trip of young Julieta where she met Xoan for the first time: she had just rejected the advances of a depressed passenger (Tomas del Estal), who commits suicide fas a result. We are all at the mercy of fate, with significant consequences stemming from the apparently insignificant choices that we make. But even if we do not make those seemingly trivial choices, fate can cruelly hit, for example with a neurodegenerative illness, such as multiple sclerosis that affects Ava (Inma Cuesta), Xoan’s lover, forcing her to give up a career as a sculptor.

Cognitive loss, as in coma and to a lesser degree in dementia, is also explored: Xoan’s wife has been in a vegetative state for years, and Julieta’s mother Sara (Susi Sanchez) is affected by dementia. Both Xoan and Julieta’s father (Joaquin Notario) react similarly to their wives’ cognitive loss by looking for other women.

A subtle message is appreciated when Julieta visits her bedridden mother who has dementia; talking to her, combing her hair, and helping her get dressed is followed by clear improvement in the mother’s wellbeing.

Almodovar’s hard core enthusiasts may be disappointed as ‘Julieta’ is very different from his previous films. Nevertheless, it can be appreciated as Almodovar’s cinematic development into a more reflective and mature look on life.

 

Address for correspondence: francoferrarini.ff@gmail.com 

Book Review – In-Training: Stories from Tomorrow’s Physicians

19 Aug, 16 | by cquigley

front cover

in-Training: Stories from Tomorrow’s Physicians by Ajay Major and Aleena Paul. Pager Publications, Inc., 2016

http://bit.do/intrainingbook

 

Reviewed by Rhys Davies

 

In 2012 two medical students from Albany Medical College, New York, Ajay Major and Aleena Paul, founded in-Training, an online forum where medical students could record and discuss their thoughts as they learnt the art and science of medicine. Since then, they have published more than 850 essays, poems and reflections written by medical students. From this, Major and Paul have distilled the finest contributions into one printed collection, in-Training: Stories from Tomorrow’s Physicians.

It is quite a collection. In its dense 347 pages, it covers a wide range of topics and themes germane to medical students and doctors in training, from pre-clinical studies (the book opens with a section devoted to the dissection lab); to memorable patients, their diagnoses and prognoses, their discharges and deaths; to the introspective struggles of medical students such as living up to the image of a physician, work-life balance and professionalism, as well as burnout and mental ill-health; to taking the pulse of systemic ills such as poverty, racism and global health. Essays and prose reflections are intermingled with poetry, and each entry is tailed by a few questions to direct the reader’s own reflections.

Having completed my undergraduate medical education, I initially found this book difficult to get into. While the prose is articulate and well-written, most of the entries hardly struck me as particularly insightful or inspiring. The contributors are all medical students in various stages of training. As such, their reasoning is still a little green, their conclusions perhaps a bit too simplistic and naïve. But to mark this book down for that is to miss the point. This is not, and was never meant to be, an anthology of professional and professorial essays on the witness and practice of medicine. Instead, there is a gestalt feeling of many diverse minds actively reflecting, documenting how they are affected by the business of (learning) medicine.

Many of the situations these student writers touch on and the feelings they evoke are not original. Many doctors and experienced medical students could read this book and say “This is nothing new. This is how I felt then.” However, that would be unfair. Far from pedestrian, this book brings to light the universality of a host of thoughts, feelings and doubts which condense into the single question, “Will I ever be good enough?”

When viewed from the other side, as a fledgling medical student, this book offers solace and encouragement that there are others out there grappling with the same or similar issues. With this in mind, I see how the in-Training website has become so popular. The contributors are all training in the USA. This does distance readers from elsewhere, such as myself, but there is still enough commonality to the experience of medicine and medical school that it does not affect the reading too greatly.

I wrote earlier that a good number of essays in this book re-trod well-furrowed ground, such as the macabre fascination when one first encounters dissection in the anatomy lab transforming into humbling gratitude for their dissected “patient,” or the realisation that the best and most important lessons to learning medicine come not from textbooks but from encounters with real people. While this is true, in-Training: Stories from Tomorrow’s Physicians is at its strongest when its contributors shine a light on more neglected topics. In the chapter focussed on societal ills, leaping of the controversial death of Michael Brown in Ferguson, Missouri in August 2014, one student polemically describes the systemic racial inequalities in US healthcare and challenges readers to examine their subconscious biases and those of the healthcare culture around them. “It is easy to presume that medicine is colorblind (sic), and the care we give a rational process. But cells are not people, and science is not health care. Doctoring is an inherently social discipline…until doctors acknowledge the position of medicine within institutional racism, our health care system will continue to reproduce tragedies like Ferguson, even in the absence of a smoking gun.” This is followed by an essay criticising silence on social justice and issues under the mantle of professionalism. “To be silent in the face of systematic injustices – legislative, medical, social and otherwise – is to be complicit in them. To believe that medicine is an insular, neutral field is naïve…Though it is understandable easier to focus on the medicine because that’s what we’re taught and hired to do, ignoring the injustices both within and outside of medicine does violate the Hippocratic Oath, because silence – real, nearly tangible, oppressive weight – can and does do harm.”

As mentioned earlier, this book is densely packed with essays and poetry, both in terms of themes addressed, and the sheer number of reflections included in the anthology. There is the feeling that Major and Paul would have included even more essays if possible. It is difficult to read through continuously, unlike the reflections and memoirs of a single doctor, because of the constantly changing narrative tone, style and voice. The converse in fact is true, as in-Training: Stories from Tomorrow’s Physicians provides a deep spring to dip in and out of at the reader’s leisure. It is also supremely convenient for tutors of medical humanities and reflective practice to be able pull out selected essays for their students to read, complete with prompts for guided reflection.

Writing in BMJ Careers in June, Dr Daniel Furmedge1 proclaimed that written reflection was dead. Voicing concerns that junior doctors’ reflective entries in their training portfolios at best serve no purpose, and at worst may be used against them by the hospital trust or lawyers, Dr Furmedge foresees that junior doctors in the future will write meaningless anodyne reflections. in-Training: Stories from Tomorrow’s Physicians serves as a corrective against such pronouncements. It details numerous and diverse medical students who have been affected by what they have learnt and seen and done. There is no reason to think they will grow up to be areflective doctors. Written reflection is very much alive.

 

Dr Rhys Davies

FY2 Doctor, Western Sussex Hospitals NHS Foundation Trust

rj-davies@doctors.org.uk

 

References

  1. http://careers.bmj.com/careers/advice/Written_reflection_is_dead_in_the_water

 

Related reading

Charlotte Blease. In defence of utility: the medical humanities and medical education. Med Humanities 2016;42:2 103108

Global Humanities – A Refugee in the Clinic

15 Aug, 16 | by cquigley

 

“You see a war zone, I see my home”

 

Ayesha Ahmad

 

“In my land”, you say. I trail away from your story into my own exploration; I am wondering about your possession—about your land, what it means for your to be yours, or what it means for you that my land is mine, and not yours.

In hospitals all over Europe, doctors are practicing medicine on the frontline. The patients are seen as refugees, or asylum seekers, or undocumented migrants; categories that are formed to describe who the person is in relation to their status to the land they are in.

When the phrase “in my land” is embedded in a story of war and displacement, a question is begged: how is a doctor to receive a story of a refugee?

The idea of “my country” represents the host of an individual’s existence. There, in their, and our land, the familiarity that we use to navigate our physical, mental, emotional, and existential worlds can be found.

The language, then, between the patient and the doctor, each from foreign lands to one another, is a script from their books; their poems, scriptures, and literature.

Perhaps in this context of travelling cultures and exploring stories, the need for doctors to understand and respond to stories is the way to close the frontiers between the doctor and the patient, and between the clinic and the home.

Boundaries diminish humanity; they separate ‘you’ from ‘I’.

“My country was such a nice place”, you say when you talk to me about how things were for you. “I am here now, but there, there is my Motherland. Once she was vibrant, but now, now she is like a body in a grave”.

Land, like a person, can become ill. As a victim of violence, a country personifies trauma. The soil, then, is felt like blood in those who are cradled in their births, and deaths, in their land.

Translating the relationship between the land and the body takes time. The transcription takes place using the instrument of reflection to tell a story of “what is in my body now is what I have lived”.

“My body is my land, and my land is my body”.

To treat this severing in the clinic setting, new words and new concepts to add to the body the language of the land are needed.

Bringing forth narratives of a land’s literature and lyrics is a way to represent the person who becomes the patient. The clinic setting marks such a unique centre for the meeting point of cultures—medicine with poetry, storytelling, and narratives that otherwise would remain ‘the Other’ as marginalised and defined by boundaries.

As the humanitarian crises of war and forced displacement dispels and unfolds into the home of doctors, the opportunity to make medicine richer is before us. There is no greater practice for listening skills than to hear a language contain a different land, and an unfamiliar body.

There is new terrain on the horizon for the clinical encounter; new lands to be explored and new narratives to share as the doctor-patient relationship continues to learn how to heal.

“You see a war zone, but I see my home”. As the patient leaves, let us hope that we all see the same place.

 

Ayesha Ahmad, Global Humanities Editor

Film review: Crying with Laughter

11 Aug, 16 | by cquigley

 

Crying with Laughter, UK 2009

Written and directed by Justin Molotnikov, available on DVD

Trailer https://vimeo.com/channels/wellington/17373244

 

Reviewed by Professor Robert Abrams, Professor of Psychiatry, Weill Cornell University, New York

 

One can debate about what might be the central message of Crying With Laughter, the production with an oxymoronic title written and directed by Justin Malotnikov—a film that is itself both dark and reassuring. In fact there must be several such messages, but to this reviewer, Crying With Laughter is mainly a stirring testament to the therapeutic power of reconstructive memory. However, this assertion requires quite a bit of explanation and reference to the film’s story line. Warning:  massive spoiler alert.

Crying With Laughter opens with screenshots of a hapless failure of a man. Joey Frisk is a thirty-something-year-old Scottish stand-up comedian who is just about always drunk, profane and seemingly bent on self-destruction. He offends nearly everyone in his world, and while he’s loud and brash, he’s not even all that funny as a comedian. He owes money to his landlord, and he’s estranged from his wife. He’s the living embodiment of Freud’s concept of a “death instinct’—a man driven by a potent if unconscious current of self-defeat. He becomes human and grounded only in the moments when he lovingly and protectively embraces Amy, his sweet 6-year-old daughter.

Soon he is in very serious trouble. As part of his comedy routine he threatens the landlord to whom he is in arrears. When the landlord is in fact assaulted within inches of his life, Joey, who has no alibi, is the prime suspect. The situation is so dire that the viewer is compelled to wonder: what is it that is driving Joey to drink, to promiscuity and to a succession of ever-greater blunders? Is he just immature, a perpetual adolescent, suffering from arrested development? If there is a particular underlying sorrow or trauma he is re-living, or a past transgression for which he is punishing himself, why does he not see it?

A distinctly sinister former schoolmate whom Joey barely remembers, Frank, now befriends him, giving him and his daughter shelter. Frank then lures a reluctant Joey to a school “reunion”. What Frank actually intends is to kidnap a former teacher and execute revenge for a traumatic past secret. Unfortunately the frail teacher now lives in the throes of dementia. Throughout this encounter, Joey remembers neither Frank nor the old schoolmaster with any clarity.

One of the extraordinary and moving truths in the film emerges at this point: there can be no meaningful punishment of helpless and elderly demented individuals for the misdeeds of their past—not only because the revenge is in itself cruel and an “injustice”, but because its recipients cannot appreciate what is happening, and the whole enterprise has no possibility of providing “closure” for the victim. An unforgettable cinematic moment is forged by the incompatibility between the imagined school-master of the past—intimidating and manipulative—and the present image of a helpless old man. By any measure, the window of opportunity for confrontation has closed, and the belated effort to avenge the wrong only results in a deeper misery for all.

Without disclosing too many details of the secret that connects the three doomed characters for the reader, the film skillfully reveals why Joey had no conscious memory of the troubling past. Justin Molotnikov (film writer and director) has a deeper understanding: the powerful repression of traumatic memory that led Joey to “forget”—except for the fact that the willful sabotaging of his own life happened to have been his way of remembering. Even Joey’s choice of career seemed derived from an effort to neutralize the events that took place years earlier in that school: “I had to be funny”, he suddenly realizes.

Over the course of Frank’s rageful but futile scheming, Joey begins to appreciate the “interior fatality” of self-punishment that he has been living out; what had made Frank bitter had led Joey to become a self-created buffoon. Joey finds out that personal freedom can be gained whenever one’s own truth is uncovered and squarely faced. It might even be said that he has undergone a de facto psychoanalysis, or perhaps only a successful purge of the inevitable residua of traumatic memory: misdirected anger and unwarranted guilt. Either way, Frank has unknowingly given him a gift of incalculable value.

Much of what makes this film so satisfying to watch is attributable to the superb performances of the two principal actors, Stephen McCale as Joey Frisk, and Malcolm Shields as his counterpart in suffering, Frank Archer. Joey is wonderfully relatable, and even at his worst, he is also endearing, naïve and innocent. And who cannot recognize in himself at least a kernel of that self-destructiveness and immaturity that Joey had in such abundance? Frank, whose features are distorted into a permanent grimace, is in his bleak obsession as paralyzed in life as Joey had been, and he stands proxy for the destructive force of unresolved grievance.

However one chooses to characterize Joey’s transformational healing process, by the end of the film he unquestionably emerges as a changed man. He is an adult, a reliable sober citizen, more devoted to his daughter than ever. Few closing scenes could be more beautifully, poetically hopeful: in this one Joey walks, buoyantly and confidently, between neatly ordered parallel rows of trees under the brightest sunshine of his life.

Address for correspondence: rabrams@med.cornell.edu

Book review – Exhaustion: A History

9 Aug, 16 | by cquigley

Tired all the time?

scha17230_front

 

Anna Katharina Schaffner, Exhaustion: A History (New York: Columbia University Press, 2016)

Reviewed by Steffan Blayney

 

In 2015 in Newcastle-upon-Tyne, a new specialist NHS clinic was launched to deal with what seems to be an increasingly common British malady.[1] Among the most frequent presentations in GP’s surgeries, the health service has even introduced an acronym – TATT – to denote the problem of being Tired All The Time.[2] Surely in our accelerated age of global technocapitalism, with its constant demands on our attention, our energy, and our desires, we are more exhausted than we have ever been. Political and economic insecurity, and the threat of environmental catastrophe, mean that we live in a state of permanent precarity and ambient anxiety, while new information and communication technologies are blurring traditional lines between work and leisure and turning us all into 24/7 worker-consumers. In fact, argues Anna Katharina Schaffner in Exhaustion: A History, we are far from alone in seeing ours as the most exhausted age. Societies throughout history, from the classical period to the present day, have been quick to diagnose their period as uniquely enervating.

Schaffner’s book, the first historical monograph on the subject, examines understandings of exhaustion in the Western world across a period of over two millennia, from classical antiquity to the present day. The structure is both thematic and chronological, with each chapter considering a key concept around which understandings of fatigue have been structured in successive historical periods (‘Sin’, ‘Saturn’, and ‘Sexuality’, for example, providing three consecutive chapter headings). Schaffner develops what is essentially a continuity thesis. Contrary to those who would paint exhaustion as a particularly modern obsession, she argues, concerns about the relationships between human energy and human civilisation have been a consistent preoccupation of societies stretching back to Ancient Greece.

Exhaustion, Schaffner observes, has typically been understood not only as a physical, mental or spiritual state, but as a broader cultural problem. Physical symptoms such as fatigue, lassitude, and weakness, and their emotional counterparts of weariness, disillusionment, and apathy, have been matched on the cultural side by concerns with decline, decadence, and degeneration. With a background in comparative literature, Schaffner is at her most compelling in her analysis of language and in the wide-ranging discussions of literary texts (or films) which accompany each chapter. Analogy and imagery, she argues, have been unusually central to the science of exhaustion, structuring not only medical conceptualisations, but experiences of patients and forms of treatment. While scientific definitions of energy and fatigue have remained elusive, rich languages of metaphor have developed linking body and mind, culture and society.

From Galen to Freud and beyond, Schaffner argues, medical writing on exhaustion has been characterised by an ambivalent relationship to modernity. Fatigue diagnoses have often been used to pathologise social, cultural and technological changes deemed problematic by their originators. The American physician George M. Beard, who popularised the diagnosis of neurasthenia in the nineteenth century, famously listed ‘steam power, the periodical press, the telegraph, the sciences, and the mental activity of women’ (92) as the chief reasons for an epidemic of fatigue, while in the twentieth and twenty-first centuries, the decline of traditional social structures and the rise of a new self-involved individualism have been called upon to explain the rise in syndromes such as ME or chronic fatigue syndrome (CFS), pejoratively referred to in the press as ‘yuppie flu’ or ‘lazy cow syndrome’ (184). While arguments about the exhausting tendency of our society are often found in left critiques of capitalism and globalisation, Schaffner argues, the structure of the argument is typically conservative, relying on the imaginary evocation of some prelapsarian age of nature, tradition, stability, and rest, which is supposed to have been disrupted or corrupted by modern developments.

Schaffner’s ambitious time-span allows her to make a number of illuminating comparisons between periods not usually studied together. While the material covered in individual chapters will mostly not be new to medical historians of each period, there is a lot to be gained from taking the broad and comparative perspective that Schaffner attempts. Such an approach, however, is not without its problems. As with other recent historical works which have sought to examine the career of certain medical phenomena through time – for example, pain, depression, or psychosomatic illness – there is an important ontological question that requires addressing. How can we be sure, in comparing or concatenating concepts and diagnoses separated by time, place, and language, that we are really writing the history of a single thing or idea? Once we decide upon our object, we run the risk of finding it wherever we choose to look, imposing present-day concepts onto periods in which they are unfamiliar or inappropriate.

While Schaffner is alert to shifts in language, meaning and diagnosis over time, she nonetheless asserts a universal significance to exhaustion as a concept which dramatizes ‘our darkest primordial fears’ as human beings (13). While the particular metaphors and ideas marshalled to understand exhaustion are historically specific, she argues, there are nonetheless ‘transhistorical psychological factors that determine an ongoing interest in the phenomenon’ (12). Such psychological universalism will be controversial among historians of the human sciences, many of whom would argue that human psychology is itself the product of social and historical shaping. Historians of medicine will also question the analytical utility of Schaffner’s penchant for retrospective diagnosis of historical (or literary) characters, and of her at times uncritical “translation” of extinct medical classifications into present-day terminology. Can we really describe the classical theory of the humours, for example, as ‘proto-biochemical’ (21), or the behaviour of Jason in the Argonautica as ‘characteristic of manic or bipolar depression’ (28)?

Schaffner’s argument leads her to emphasise continuity over change in her narrative. While each chapter records the emergence of new historically- and culturally-specific conceptions of exhaustion, the mechanisms of change and divergence are undertheorised. Despite engaging with an impressive breadth of primary material, the chronological and geographical reach of her study means that Schaffner is necessarily forced to rely on secondary literature to contextualise her sources. The result is a book which, while perceptive and often original in dealing with individual texts, is set within a somewhat conventional view of the history of medicine as a succession of explanatory paradigms. It will be up to other historians to see how Schaffner’s broad arguments can be complicated and refined by case studies more circumscribed in place and time.

Exhaustion is very much a history ‘from above’. The story of fatigue is told through the writings of doctors and intellectuals, with the medical orthodoxy of each historical period typically characterised through the ideas of one or two canonical figures. Only in the later chapters (addressing the twentieth and twenty-first centuries) is there any sustained discussion of exhaustion as subjective or lived experience. Likewise, as Schaffner admits, the forms of pathological exhaustion studied in this book are near-exclusively associated with the middle and upper classes. Proletarian forms of exhaustion – for example the “industrial fatigue” which exercised governments and employers in Europe and America in the first half of the twentieth century – are near-absent. Working-class exhaustion is worthy of its own history, as are the important and consequential contributions made to the medical science of fatigue in the pursuit of industrial efficiency. Here again, it can be hoped that Schaffner’s intervention will act as a stimulus to further study.

Overall, Exhaustion is a timely contribution to a neglected area of study, situating present-day concerns about technology and progress, work and leisure, and the body and society within a long history of medical and cultural writing. Schaffner is throughout engaged with contemporary debates, leaping deftly from Hippocrates to Occupy, or from Proust to Piketty, with a clarity of expression and ease of style that will make Exhaustion attractive – and accessible – to a wider readership. In her epilogue, Schaffner brings the concept of exhaustion to bear on the question of climate change –  a problem, she argues, that unlike other worries about exhaustion, is unique to our own historical moment. Fears about the depletion of the planet’s limited resources of energy and materials mean that we are forced to confront the problem of exhaustion not just at the level of mind, body, or society, but as a threat to our environment and our existence. While all societies have been preoccupied with exhaustion, Schaffner concludes, it is only in the present day that it has become an issue of genuinely apocalyptic significance.

 

Steffan Blayney is a PhD student at Birkbeck, University of London. Twitter @SteffanBlayney.

 

[1] http://www.dailymail.co.uk/health/article-3298102/Hope-feel-TATT-s-Tired-Time-Unique-NHS-service-launched-combat-long-term-fatigue.html

[2] http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/why-am-I-tired.aspx

 

Related reading

K G White. Jane Austen and Addison’s disease: an unconvincing diagnosis. Med Humanities 2009;35:98100

Comics and Medicine Conference 2016

4 Aug, 16 | by cquigley

13918876_10154388315637118_1031586701_o

 

Graphic Medicine 2016: Stages & Pages

July 7-9, University of Dundee, Scotland

 

Shelley Wall, PhD, University of Toronto

 

The 7th International Comics & Medicine Conference took place in Dundee, Scotland, from July 7 to 9, 2016. It was (as ever) a superb event: inclusive, humane, intellectually stimulating, and creatively inspiring.

The field known as “graphic medicine”, a term coined by medical doctor, comics creator, and scholar Ian Williams, explores “the intersection of the medium of comics and the discourse of healthcare” (1). It’s a diverse field, ranging from the study of graphic memoirs and novels of illness and caregiving, to the creation of comics in medical training as a means of reflective practice, to the use of comics as an accessible means of communication in patient education and public health, and beyond. Each year since 2010, the Comics & Medicine conference has brought together a community of comics artists, patients, healthcare professionals, academics, caregivers, and others, to present work in progress, case studies, and scholarly analyses. In its mix of perspectives from clinical medicine, literature, anthropology, visual art, public health, media studies, education, psychotherapy, and many other disciplines, graphic medicine makes an exciting contribution to the domain of medical humanities.

The theme of this year’s conference, “Stages & Pages,” called attention to the performative aspects of both comics and healthcare. The comics page is like a theatrical stage; through the narratives enacted in that space, we can explore and question the roles assigned by illness, such as patient, caregiver, healthcare professional, survivor.

In keeping with this theme, the conference kicked off with an evening of actual performance. After warm, humorous welcomes from the Lord Provost and the Director of the Scottish Centre for Comics Studies, comics artists took the stage and performed their work, reading aloud or speaking to accompany a slideshow of images. This DeeCap (Dundee Comics Art Performance) event was both funny and deeply moving—a reflection of the power of comics to speak with incisive humour about life-and-death issues. Elizabeth Shefrin, for example, read aloud from her hand-embroidered comic about her husband Bob’s prostate cancer, accompanied by Bob himself on guitar, and enacted scenes from their relationship using puppets; the performance faded out on the suggestion of x-rated puppet activity. Animation student Jules Valera donned a space helmet during her reading, to enact the experience of “spacing out” during a mental health crisis. Dana Walrath, author of Aliceheimer’s: Alzheimer’s Through the Looking Glass (2016), about caring for her mother with dementia, punctuated her performance with impressive a cappella singing and hilarious impressions. “Laughter is a respite,” Walrath said. “It opens up new possibilities for ways to cope.”

The plenary sessions at the Comics & Medicine conferences traditionally feature a mix of comics creators and comics scholars, and this was the case in Dundee as well. Elisabeth el Refaie, the first keynote, offered a reading of spatial orientation in Ellen Forney’s graphic memoir Marbles: Mania, Depression, Michelangelo, & Me (2012), drawing on conceptual metaphor theory and the semiotics of theatre to analyse the meanings of horizontal and vertical patterning in Forney’s page layouts. It was a fascinating, scholarly demonstration of how the visual language of comics embeds narrative meanings beyond what can be achieved in text alone. Veteran comics artist Al Davison in his keynote presentation later the same day, by contrast, gave a deeply personal talk, tracing the influence of his severe spina bifida, childhood trauma and abuse, and additional health challenges, on his artistic vision and technique. Davison is the author of The Spiral Cage (2003), a graphic memoir, and numerous other books. Comics creator, educator, and force of nature Lynda Barry, who delivered the final talk of the meeting, combined the theoretical and the personal, describing her own work and her teaching approach based on the central place of the IMAGE in thought and experience. A powerful metaphor emerged from Barry’s description of V.S. Ramachandran’s mirror therapy for phantom limb pain: using a mirror-box, a patient sees the reflection of their intact limb in the place of the amputated limb, and is thus able to unclench what they experience as a painful fist. This is what images do, according to Barry: they allow us to “unclench painful things in our lives.” With her colleague Dan Chaon, Barry also gave two intense workshops in visual storytelling during the conference.

Concurrent sessions were a similar and intoxicating blend of the theoretical and the deeply personal. “Moving Stories,” a panel I was privileged to chair, consisted of ten short presentations of completed comics work and work-in-progress, by turns political, critical, humorous, and gut-wrenching. “Comics as Medical Education,” on the other hand, presented valuable case-studies on the use of comics as teaching tools in medical and patient education. Other concurrents were interactive, such as “Diary Comics & the Diary in Comics,” which had participants experiment with the diary mode as a way to slow down and reflect on experience.

If I were a superhero, my chosen superpowers this month would have been to attend ALL of the concurrent sessions at this jam-packed meeting, and to give due credit by name to each of the speakers who presented. The sessions I attended were, without exception, inspiring and thought-provoking; at the same time (literally), the sessions I had to miss were just as rich, judging from the enthusiastic comments from other attendees during the social breaks. The conference programme, with information about all presenters, is available at http://www.graphicmedicine.org/graphic-medicine-2016-conference-stages-pages/.

From the first Comics & Medicine conference I attended, in Chicago in 2011, I’ve been in love with the profoundly democratic ethos of the meeting. Artists, patients, academics, and healthcare providers (not mutually exclusive categories) meet on an equal footing. Everyone learns something; everyone has something to teach. Presenters and attendees share a remarkable openness and willingness to be vulnerable, while bringing an acute critical gaze to the ways that visual narrative enriches and illuminates illness and care. It’s truly an object lesson in humane, engaged scholarship, creativity, and collaboration.

Congratulations and thanks to Andrew Godfrey, this year’s on-the-ground organiser, for bringing this meeting together. Godfrey is a comics creator, graduate of the University of Dundee’s MLitt Comics Studies program, and current PhD student in English at that institution; his own research focuses on the links between graphic medicine and performance, while his comics chronicle and reflect on his experience of living with cystic fibrosis. Special kudos to him for scheduling the warm, sunny, spectacular Scottish weather.

The Comics & Medicine conferences are, to date, a tri-continent event, having been held in the UK, the USA, and Canada. The next Comics & Medicine conference will take place in Seattle, Washington, June 15-18, 2017.

 

Reference

  1. Czerwiec, MK, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith. 2015. Graphic Medicine Manifesto. University Park, PA: Penn State UP.

 

Related Reading

Sarah McNicol. Humanising illness: presenting health information in educational comics. Med Humanities 2014;40:4955.

Ian C M Williams. Graphic medicine: comics as medical narrative. Med Humanities 2012;38:2127.

Michael J Green. Book review: Comics from the dark side of medicine: Thom Ferrier’s Disrepute. Med Humanities 2012;38:121122

Nicola Streeten. Book review: Matilda Tristram’s Probably Nothing. Medical Humanities (blog) 2014. http://blogs.bmj.com/medical-humanities/2014/12/11/the-reading-room-a-review-of-matilda-tristrams-probably-nothing/

 

Film review: The Carer

3 Aug, 16 | by cquigley

 

‘To age or not to age- that is the question’- review of The Carer – 5*

UK, Hungary, 2016, directed by János Edelényi

Starring: Brian Cox, Coco Konig, Emilia Fox, and Roger Moore

In general release in the UK cinemas from 5th August 2016

https://www.regentstreetcinema.com/programme/the-carer/

 

Reviewed by Dr Khalid Ali, Screening Room Editor

 

Watching The Carer at its European premier in Edinburgh International Film Festival in June 2016, I was strongly reminded of the ‘mirror neuron’ theory which postulates the ‘firing of a neuron in an observer that is exactly firing in the brain of another person performing a particular action- (https://en.wikipedia.org/wiki/Mirror_neuron). The eminent Italian neuroscientist Vittorio Gallese argues that ‘mirror neurons’ explain the underlying ‘emotions of empathy with film characters’ that viewers experience when watching a film. In ‘Neurocinematic science’, film audience engages fully and connects with ‘life unfolding on the silver screen’ in an ‘Embodied simulation’ (http://www.huffingtonpost.com/entry/mirror-neurons-and-why-we_b_3239534).

I had a strong sense of understanding and relating to the trials and tribulations of Sir Michael Gifford (Brian Cox) a veteran Shakespearean theatre actor who is suffering from the unkind advance of old age. Recurrent falls due to early Parkinson’s disease is one of many daily humiliations; bowel and bladder accidents, forgetfulness, bad temper and isolation in his country mansion are few others. His daughter, Sophia (Emilia Fox) recognizes the urgent need for a 24 hour ‘carer’ to help with his daily activities. Dorottya (Coco Konig), a young Hungarian refugee, a carer in a nearby nursing home, is offered the job of caring for him after a grilling interview by Sophia. Unbeknown to everyone, Dorottya is a young amateur actress aspiring to join the prestigious London Academy of Music and Dramatic Arts.  Living with Sir Gifford is not ‘a walk in the park’; she has to survive the daily challenges; language barriers are insignificant compared to his snobbery, arrogance, and cantankerous behavior.

Slowly the two find a common ground in Shakespearean plays; one of the most moving scenes is when Dorottya helps Sir Michael after an embarrassing bowel accident by quoting Shakespeare while cleaning him up. Outings to the local pub and an impromptu visit to the nursing home where Dorottya used to work, and performing scenes from ‘King Lear’ to the residents strengthen the bond between them. Their burgeoning fondness for each other is met with suspicion from his daughter, and old time friend and manager Milly (Anna Chancellor). The inevitable confrontation between Sir Gifford, Dorottya and his family happens when he insists on accepting a lifetime achievement award which will be broadcast live on national TV. His family and private physician, Dr Satterthwaite (Andrew Havill) are seriously worried that he will subject himself to national mockery if he falls over or forgets his lines in the live awards ceremony. Collectively they dismiss his capacity to make decisions and hold him hostage in his mansion. What follows is a delightful and powerful testament to the resilience of old age fuelled by creativity and a touch of recklessness.

Never before have the four Giants of Geriatric Medicine, a term coined by Bernard Isaacs (1924-1995) (http://www.bgs.org.uk/index.php/geriatricmedicinearchive/203-biographies/2220-a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995) , been so poignantly portrayed in film; falls, immobility, incontinence and confusion are so masterfully played by Brian Cox, CBE, in a tour-de-force performance.

In today’s world where ageing is viewed negatively as a ‘demographic time bomb, and a financial burden’ it is refreshing to find a film where ageing is not a ‘curse’. Intergenerational dependency is sensitively handled; Dorottya teaching Sir Gifford how to use a mobile phone while he teaches her how to hone her acting skills is a master-stroke. Nurturing creativity and embracing new technology can contribute to the well-being of both the older person as well as their carers.

In addition to its genuine exploration of ‘physical and psychological health in old age’, the film also manages to handle other serious issues such as ‘Capacity in senior citizens’; where time and time again families and doctors neglect the wishes of an older person claiming they are ‘acting in their best interests’ as an excuse for not seeking their opinion.

In a film exploring the world of a retired Shakespearean actor, a plethora of ‘quotable one liners’ is to be expected. However the final speech has to be repeatedly viewed to appreciate its nuance, wisdom and playfulness. Another fact the film masterfully puts forward is the notion that ‘old people are neither angels nor demons’ they are not aliens, they are similar to younger generations as fellow human beings struggling with everyday life, trying to make the best of difficult times and circumstances.

The frustration of the motor and non-motor symptoms of Parkinson’s disease is keenly observed; an eye-opener for doctors and other professionals caring for people with Parkinson’s disease.

The film is a ‘labour of love’- from its writers Tom Kinninmont, the late Gilbert Adair, and director János Edelényi. Targeting primarily an ‘older audience’, The Carer might well be 2016 sleeper hit that attracts a wider audience from all age groups; The Best Exotic Marigold Hotel meets Quartet meets Youth. Watching The Carer, I was convinced that ‘mirror neurons’ exist and explain the strong emotions of empathy I experienced with the characters on the silver screen. I was reminded once more that films have the power to ‘teach doctors how to communicate with and care for patients, their families and carers’.

To see a trailer of the film: http://www.imdb.com/video/wab/vi3754669081/

Podcast of interview with writer Tom Kinninmont:

 

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

Book Review: Keywords for Disability Studies

2 Aug, 16 | by cquigley

Keywords

Keywords for Disability Studies. Edited by Rachel Adams, Benjamin Reiss and David Serlin. New York University Press, 2015.

 

Reviewed by Kathryn Lafferty, PhD student in Comparative Humanities, University of Louisville

 

Disability studies as a field has extended into many areas of scholarship, from literature to sociology, gaining much attention as it grew out of the activism of the 1960s and 1970s. Since then, scholars have made a distinction between the “medical model” of disability, which focuses on individual deficiencies that need to be cured, and the “social model” of disability that puts emphasis on the physical and social environments that impact the individual, such as stigmatization of the disabled.

Keywords for Disability Studies, edited by Rachel Adams, Benjamin Reiss, and David Serlin, provides sixty-two significant concepts within the field of disability studies, covering topics from “ability” to “vulnerability” from a social model perspective. This comprehensive overview of the major concepts within disability studies is a well-organized and detailed array of essays from over sixty different authors, many of whom are notable scholars in the field. Keywords for Disability Studies is an excellent addition to the most recent scholarship and offers both scholars and students an in-depth look at some of the core concepts that drive disability studies as a field. The language throughout the book is easily accessible for scholars and students at all levels, concepts and theories explained in detail, making this an ideal text for someone new to disability studies. It is also an equally beneficial text for those already familiar with the field. Although there is not always cross-over between the essays, the text was undoubtedly crafted as a cohesive unit as the essays complement each other. With over twenty pages of cited material, this text is also useful as a reference guide for further scholarship on disability studies. In addition, the structure of the text is creatively designed, a welcome change from the more “traditional” chaptered format.

The book is not necessarily meant to be read cover-to-cover, but can be used more as a conceptual reference. Focusing on one essay at a time provides the reader with an in-depth view of a concept within disability studies and not simply an account of events or a brief definition of the term. All sixty essays are relatively short, each between two and four pages in length. This style is modeled from Raymond Williams’ Keywords: A Vocabulary of Culture and Society (1976).

The introduction, written by all three editors, is brief but provides an overview of what disability studies is and how it has evolved over time. The authors state that “the goal in designing this volume was not simply to define terms but to use them to delineate the field’s debates and problems, while also establishing their importance to many other areas of inquiry across disciplines” (3). A truly interdisciplinary work, this text provides the reader with various viewpoints and ways of addressing disability throughout many fields, with the authors asserting that “disability has become a remarkably heterogeneous category” (3).

Contributing authors include scholars such as Lennard J. Davis, Rosemarie Garland-Thomson, Michael Bérubé, and Robert McRuer. With such a wide variety of concepts, the text could have become overwhelming, but Keywords for Disability Studies breaks down and refocuses many concepts that scholars might already be familiar with into easily-understood and tangible notions. Some authors provide helpful background information on various concepts, others apply them to specific case studies, with all contributors offering useful ways to rethink disability.

The first essay, written by the editors, focuses on the keyword “disability”, demonstrating how the concept has changed throughout history and that it “is more fluid than most other forms of identity in that it can potentially happen to anyone at any time” (5). The authors conclude, “the meanings of disability and the words we use to describe its various manifestations will no doubt undergo profound shifts as a category of identity; a social, legal, and medical designation; and an embodied condition” (11). Adams, Reiss, and Serlin provide a valuable introduction and essay, and although they state that disability “is more fluid” than other identities, they are still able to define it and discuss it as a coherent concept.

Another entry that was especially effective, and one that builds to some extent on the earlier “disability” essay, is Lennard J. Davis’ piece on “diversity”. Davis is quick to argue that disability is omitted from conversations on diversity, and explores this “structural” problem. He asserts that “diversity as an ideological paradigm is structurally related to the goals of neoliberalism” (63), and as a result “diversity must never be allowed to undermine the basic tenets of free choice and the screen of empowerment that conceals the lack of choice and the powerlessness of most people” (63-4). Davis acknowledges that disability studies attempt to classify disability as a “real identity” and many of the essays included in this text argue from a similar viewpoint, noting the troublesome path in achieving this classification.

Keywords for Disability Studies also has resources on a separate webpage with suggestions on how to incorporate the essays into a classroom setting. Not only would this be helpful for those planning to teach disability studies, but it also has the potential to lend a refreshing approach to nearly any text read in a classroom setting, regardless of content. Keywords for Disability Studies is also helpful for scholars who plan to focus on disability studies or diversity more broadly, as there are many concepts which cross over into other disciplines.

In summary, the entries, which do not have to be read in any particular order, are a brief but comprehensive take on some of the concepts found within disability studies. Coherent, direct, and informative, Keywords for Disability Studies will undoubtedly generate questions and provide valuable resources for students and scholars alike in nearly any discipline for the foreseeable future.

 

Related reading

Rebecca Green. Disability and narrative: new directions for medicine and the medical humanities. Med Humanities 2010;36:7074.

Rebecca Green. Who speaks for whom? Health humanities and the ethics of representation. Med Humanities 2015;41:7780

Mohamed Khan – a tribute

1 Aug, 16 | by cquigley

 

Mohamed Khan – A visionary Egyptian film maker

 

Mohamed Khan, (born on 26-10-1942), an Egyptian film director, script writer, and actor died on 26-7-2016 in Cairo following a short illness. He was one of the eminent film makers who led the 80’s wave of social realism in Arab cinema. Born to a Pakistani father, and a British/Egyptian mother, he left Cairo in 1956 to study architectural design in London. Years of fascination with the world of cinema, living in London in the swinging 60’s and a friendship with a neighbour, a film student, made him abandon architecture, and switch to studying film at the London School of Film Technique in 1962.
After a few years of working as an assistant director in Lebanon, and a script consultant in the General Egyptian Film Organization, he made his first film ‘Heat stroke, 1978’ which premiered at the Montreal Film Festival.

His films portrayed the lives of recognizable characters from Egyptian society, with an emphasis on marginalized people. His fresh cinematic style of telling stories, outside the confines of film studios, with a richly-detailed social and political background- endeared him to the public and critics alike. A succession of influential films crossed over to international audience and festivals earning prestigious awards. ‘Dreams of Hind and Kamilia, 1988’- is quoted in the list of the 100 landmark films in Egyptian cinema.

Khan refused to be described as a social reformer, he preferred to ‘underline the social ills, rather than offer answers or cure’, https://soundcloud.com/bmjpodcasts/mohamed-khan-egyptian-screenwriter-and-director-on-what-clinicians-can-gain-from-his-films)

He adapted literary classics such as F. Scott Fitzgerald ‘The great Gatsby’ in ‘Desire, 1980’, and H. E. Bates ‘The darling buds of May’ in ‘Gone and never come back, 1984’.
Fascinated by women stories; ‘A dinner date, 1982’, ‘Downtown girls, 2005’, ‘In the Heliopolis flat, 2007’, and ‘Factory girl, 2014’ his films appealed to several generations.

As a tribute, the Arab British Centre and the Institute of Contemporary Arts (ICA) in London will screen his last film ‘Before the summer crowds’ on 14th September 2016, http://www.arabbritishcentre.org.uk/safar-2016/full-programme-listing/.

Khalid Ali, Screening room editor

Khalid.ali@bsuh.nhs.uk

Poetry Book Review: Thinks Itself a Hawk

22 Jul, 16 | by cquigley

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Review: Thinks Itself A Hawk, Wendy French, The Hippocrates Press, 2016.

by Rebecca Goss

On June 30th this year, I headed to University College London Hospital (UCLH) Macmillan Cancer Centre to listen to Wendy French read from her new poetry collection Thinks Itself A Hawk. As I approached the revolving doors in the middle of the wide glass frontage, a woman was leaving the building via the doors’ slow spin. She was wearing a headscarf, and carrying several plastic bags of what looked like shopping or bundled belongings. She was alone. She looked tired. She looked sad. And she looked ill. I have spent a lot of time in hospitals, but I have never come close to cancer. As the doors ejected us in opposite directions it began to dawn on me where I was going, and what I might see. My naivety overwhelmed me. I thought I was going to a building about cancer, not a building that contained it.

In 2014, Wendy French became UCLH’s first ever poet in residence at the Macmillan Cancer Centre. To quote from the foreword to Thinks Itself a Hawk, French’s resulting book, ‘the residency’s intention was to extend access to poetry and the spoken word and assist with improving patients’ well-being.’ French ran weekly creative writing groups for patients and wrote her own poetry in response to her time spent at the centre.

Throughout the book there are many references to walking and movement and ‘openings’ – the paths our lives take. An early poem in the collection is titled Cancer’s Daily Walk. Cancer itself ‘will walk in the town, in the city,//enter St. Paul’s when doors are open,/will walk……where its feet take it.’ But eventually the cancer enters ‘distracted bodies/whose cells are greedy for change’ and then all routes will lead to those revolving doors. French is there to document the process of arrival as people ‘try to shake off//their fears as they shake/their coats from the rain.’ (The Waiting Game)

Cancer’s impact on daily life and family relationships is all studied here. A poignant stanza in Today’s Appointment shows how family ‘outings’ have been transformed with ‘a wave of a dark wand’. Rather than trips out with picnics the sick now carry ‘bags of medication, nebulisers/in a field of white coats.’

In an environment at times harrowing and bleak, French is able to show us the real people who live with cancer. French sees the blatant effort needed to survive – ‘blood is exchanged like currency’ – yet we can also tell French got extremely close to these people. French respects them, utterly, as do the medical staff, but French is able to give them something not always prescribed. She gives them time. ‘We sit together not talking but dawdling…’ (In the Wood). ‘She tells me that pain is unpredictable/but there’s refuge in books and music.’ (This Girl).

French accepts there is a world inside the centre, and a world outside it. Referring to a tunnelled walkway that connects the Macmillan Centre to the rest of UCLH, French writes ‘down here…time is marked differently…We know we are unique we hold our heads high/and picture the outside.’ (Because)

Illness can cut people off from the ‘real’ world, but French is keen to show that the Macmillan Centre does not just house patients. Behind its doors are patients’ relatives, clinicians, volunteers, ambulance drivers, catering staff, Kingsley the ‘concierge’ – everyone is accounted for, and illness feels less isolating as a result. I remember hearing the broadcaster Andrew Marr in a radio interview about his stroke say that illness is nothing to be ashamed of. French’s poems take the shame away from suffering by scattering light on everyone involved. In Mammogram, a witty but never crass depiction of a medical examination, we focus on a list of apologetic utterings from the clinician: ‘Unfortunately I have to ask you to put your breast here/Unfortunately this may hurt for five seconds/Unfortunately we have to do this five times’. To see the appointment from the medic’s perspective highlights issues of identity in the book. The repetitive use of ‘unfortunately’ hints at the ‘human being’ behind the façade of ‘doctor’.

The latter section of the book concentrates on the story of Zipora, aged 66 when French first met her, and suffering from aggressive ovarian cancer. Zipora died during French’s residency. Before her death, Zipora shared much about her life as a Jewish woman coming from what the book’s blurb describes as ‘the darkest days of the twentieth century’. It is a very moving sequence, interspersed with letters written by Zipora to her mother. These letters were never sent, but shared with French, and French mirrors each letter with a poetic response.

Guy Noble, Arts Curator at UCLH, writes of French’s work “It touches on the challenges faced by people living with or facing a cancer diagnosis, and reflects upon the “everyday” which perhaps many of us overlook.’ I agree with Guy’s statement, but something we also overlook is that severe illness can define a person. We have to remember that there was a whole life before illness set in. Zipora’s story is a valuable addition to the book, as we learn of such a life. Through both French’s voice, and Zipora’s, we discover a family’s lineage fractured by war, a child orphaned by the age of two and raised in a kibbutz, a marriage not always happy – it’s all survival of a different kind. French’s poems reflecting on Zipora’s story are tender, wise and considerate, and we can only be grateful French was there to record it.

Thinks itself A Hawk is a moving, candid, illuminating and necessary collection. We are drawn to look closely at illness and suffering, the poet never once shying from the awfulness of things. But there is gentleness too. Reading the book is like having French push open a door, beckon us, and with her arm around our shoulders, she tells us to look. And all the time we’re looking, French is there, watching with us. She is the poet, the observer, the chronicler and the guide.

 

 

 

 

 

 

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