Objects of safety and imprisonment: Breathless patients' use of medical objects in a palliative setting.

Kate Binnie,Havi Carel,Coreen Mcguire

doi:10.1177/1359183520931900

Kate Binnie, Havi Carel + Show 1 more

Open Access

https://doi.org/10.1177/1359183520931900

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Journal: Journal of Material Culture	Publication Date: Jun 12, 2020
Citations: 3	License type: CC BY 4.0

Affiliation: University of Bristol

Abstract

In this article, the authors consider breathless adults with advanced non-malignant lung disease and their relationship with health objects. This issue is especially relevant now during the Covid-19 pandemic, where the experiences of breathlessness and dependence on related medical objects have sudden and global relevance. These objects include ambulatory oxygen, oxygen concentrators and inhalers, and non-pharmacological objects such as self-monitoring devices and self-management technologies. The authors consider this relationship between things and people using an interdisciplinary approach employing psychoanalytic theory (in particular Winnicott's theory of object relations and object use), Science and Technology Studies (STS) and phenomenology. This collaborative approach allows them to relate patient use of health objects to ways of thinking about the body, dependency, autonomy, safety and sense-making within the context of palliative care. The authors illustrate the theoretical discussion with three reflective vignettes from therapeutic practice and conclude by suggesting further interdisciplinary research to develop the conceptual and practice-based links between psychoanalytic theory, STS and phenomenology to better understand individual embodied experiences of breathlessness. They call for palliative care-infused, psychoanalytically informed interventions that acknowledge breathless patients' dependence on things and people, concomitant with the need for autonomy in being-towards-dying.

Highlights

Since the inception of the Science and Technology Studies (STS) movement in the early 1990s, user interpretations of technology have been given increased attention as a way of understanding technology as a product of social construction, and social construction as a product of technology
We briefly introduce object relations theory, and consider how a phenomenology of breathlessness can be used to deepen our understanding of the use of health objects in respiratory illness
This is what constitutes care, which is interpretative and not merely functional, pre-emptive and prescribed (Winnicott, 1958). It has been suggested in the health psychology literature that a psychoanalytic perspective on responses to chronic illness may help understand why some patients are more distressed than others when experiencing pain, for example (Pietromonaco et al, 2013). We propose that these perspectives have an underexplored relevance in understanding, assessing and treating the varying and complex affective responses found in patients experiencing refractory breathlessness

Summary

Introduction

Since the inception of the Science and Technology Studies (STS) movement in the early 1990s, user interpretations of technology have been given increased attention as a way of understanding technology as a product of social construction, and social construction as a product of technology. We bridge this gap here by exploring the conscious and unconscious relationship breathless patients may have with the health objects they use to negotiate living with advanced illness.

Results

Conclusion