Biomedical Tradition Research Articles

Recovery-Oriented Cross-Sectoral Network Meetings between Mental Health Hospital Professionals and Community Mental Health Professionals: A Critical Discourse Analysis.

Aims and objectives: In the medical field, we lack knowledge on how interprofessional collaboration across sectors is carried out. This paper explores how healthcare professionals and users perceive recovery-oriented cross-sectoral discharge network meetings between mental health hospital professionals and community mental health professionals and which discourses manifest themselves within the field of mental healthcare. Method: Ten professionals from a mental health hospital and eight community mental health professionals participated. In addition, five users with experience in mental health services in both sectors participated. Fairclough’s discourse analysis framework was used to explore their experiences. The study was designed following the ethical principles of the Helsinki Declaration and Danish law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study). Results: The healthcare professionals in both sectors are governed by steering tools, legislation and a strong biomedical tradition to solve illness-related problems, such that users must be offered treatment and support to achieve self-care as soon as possible. This can be seen as a reflection of, and a driving force in, a change in the wider social practice that Fairclough terms the ‘marketisation of discourse’—a social development in late modernity, whereby market discourse colonises the discursive practices of public institutions. The user of psychiatric and social services experiences a structured system that does not offer the necessary time for deep conversations. Users do not consider recovery as something that is only seen in relation to the efforts of the professionals, as recovery largely takes place independently of professionals. Recovery depends on users’ internal resources and a strong network that can support them on the journey. Conclusion: Healthcare professionals perceive recovery-oriented cross-sectoral discharge network meetings to reflect paternalistic and biomedical discourses. Users want to be seen more as whole persons and did not experience sufficient involvement in the intersectoral care. Relevance to clinical practice: Healthcare professionals need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

An African response to the philosophical crises in medicine: Towards an African philosophy of medicine and bioethics


 
 
 In this paper, I identify two major philosophical crises confronting medicine as a global phenomenon. The first crisis is the epistemological crisis of adopting an epistemic attitude, adequate for improving medical knowledge and practice. The second is the ethical crisis, also known as the “quality-of-care crisis,” arising from the traditional patient-physician dyad. I acknowledge the different proposals put forward in the quest for solutions to these crises. However, I observe that most of these proposals remain inadequate given their over-reliance on the Western biomedical tradition (WBT) and the medical hegemony that underpins the proposals themselves. Contrary to the approach employed in these proposals, I propose medical pluralism as a viable platform for resolving the philosophic crises in medicine, by critically engaging non-Western medical traditions (NMTs) and thought systems. Ultimately, I make a push for the deliberate inauguration of an African philosophy of medicine and bioethics (APMB) and other context-specific or indigenous philosophies of medicine and bioethics that will ensure continuous investigations into NMTs and their contribution to global medical issues.
 
 

Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway

ObjectiveEffective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP)...

Traditional Chinese Medicine Explanatory Models of Depressive Disorders: A Qualitative Study

Traditional Chinese medicine (TCM) is an alternative medical system utilised by many Chinese. However, the knowledge of TCM concepts of depression is limited amongst clinicians with training in Western biomedicine. The purpose of this study was to obtain a better understanding of the conceptualisation of depression from a group of TCM practitioners. Semi-structured interviews in Chinese were carried out with 10 TCM practitioners in Hong Kong. A case description of major depression disorder (MDD) was used as a basis. Interview texts were transcribed, translated and analysed using qualitative content analysis. Most informants identified the case as a depression pattern, a term that lacked clear definition and standardised criteria. The mechanism of disease for MDD symptoms were regarded to be liver-qi dysregulation and an imbalance of yin and yang. The TCM practitioners implemented individualised diagnosis, treatment, and a holistic concept without clear distinction between the mind and the body. This contrasted with the biomedical tradition of separating psychologisation and somatisation. The meanings given to the concept of depression did not correspond with current DSM or ICD definitions, and the TCM normativity can result in variations in explanatory models.

Combining psychiatry and spiritism: Therapies employed in a Brazilian sanatorium (1934-1948).

The purpose of this article is to present an historical account of an intersection that occurred in Brazil between popular healing treatments and conventional psychiatric practices during the first half of the 20th century. To illustrate our argument, we analyzed data retrieved from the medical records of patients admitted to the Spiritist Sanatorium of Uberaba, Brazil, between 1934 and 1948. Although the Uberaba Spiritist movement founded the institution, it was directed by a physician educated in the biomedical tradition at the Rio de Janeiro School of Medicine. Based on the theory of the circulation and appropriation of knowledge, we elucidated the adaptations and negotiations that were necessary for the reception and dissemination of the practice of the two different therapeutic methodologies on Brazilian psychiatric soil. (PsycINFO Database Record

Using focused ethnography to explore and describe the process of nurses' shift reports in a psychiatric intensive care unit.

To explore and describe the cultural routine of shift reports among nursing staff in a psychiatric intensive care unit and further to develop a taxonomic, thematic and theoretical understanding of the process. Lack of communication among healthcare staff is associated with risks for medical errors. Thus, handovers and shift reports are an essential and integral routine among nurses to pass on information about the patients' health status. Previous studies within the field have highlighted the benefits of structured reporting tools. However, shift reports as a cultural activity within the nursing tradition have been given less attention, not the least in psychiatric care. Focused ethnography was used. The data comprised 20 observational sessions. The observations ranged over a time span of 5months and were conducted in a psychiatric intensive care unit in Sweden. The process of shift reports encompassed the following three phases: (a) getting settled, (b) giving the report and (c) engaging in the aftermath. The results demonstrate that the phases entail different cultural activities, which take place in different areas of the ward and that the level of formality varied. Shift reports are not an isolated event with clear boundaries. The study enriches the understanding of shift reports as a "fuzzy process". The individual phases were found to be tied to cultural connotations, such as activities, places and roles with certain meanings for staff members. The new insights are useful for nurses in overcoming an uncritical adoption of the biomedical tradition regarding pace and tone during shift reports. The reporting nurse has the potential to transform shift reports from a monologue with a foreclosed style to a more dialogical interaction with colleagues that focuses on the patients' needs rather than the needs of staff.

Indigenous Medical Tradition and Biomedical Tradition: A Historical Relation of Hegemony

The indigenous medical tradition is a system of knowledge, practices and beliefs about health-illness process, used by many social groups in Mexico, which has prevailed in a context marked by the epistemic, social and political hegemony of the biomedical tradition, a situation that has shaped its historical development, has impeded its recognition and appraisal as an effective and legitimate way to attend the health-illness process, and has been excluded from the official medicine. The above is the result of a historical process of long duration, which has its origins in the colonial era and was favored by the epistemic supremacy of science. This work analyzes the established relations, during the Spanish colonial era, between the indigenous and the Western medical traditions, to understand how that led to epistemic, social, political and institutional exclusion of the indigenous medical tradition. The historical stages of this study were established to identify the major events in the hegemony relationships among both traditions, which were analyzed based on the concepts of hegemony and tradition. The conclusion is that the hegemony relationships between the biomedical tradition and the indigenous medical tradition are the result of a historical and dynamic process of selection, reinterpretation and redefinition of cultural elements of the indigenous medical tradition, which involved the imposition of modern western culture’s concept of the world and of the epistemic criteria of science, as well as the establishment of institutions responsible of the control and regulation of the indigenous medical practice.

The Benefits of Social Support for Listeners with Impaired Hearing

The Benefits of Social Support for Listeners with Impaired Hearing

Historical Biography for Translational Medicine: An Important Genre for Translational Science

Historical Biography for Translational Medicine: An Important Genre for Translational Science

Co- and multimorbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT Study and theoretical reflections concerning basic medical models

Rationale and aims: Accumulating evidence shows that diseases tend to cluster in diseased individuals, so-called multimorbidity. The aim of this study was to analyze multimorbidity patterns, empirically and theoretically, to better understand the phenomenon. Population and methods: The Norwegian population-based Nord-Trøndelag Health Study HUNT 3 (2006-8), with 47,959 individuals aged 20-79 years. A total of 21 relevant, longstanding diseases/malfunctions were eligible for counting in each participant. Multimorbidity was defined as two or more chronic conditions.Results: Multimorbidity was found in 18% of individuals aged 20 years. The prevalence increased with age in both sexes. The overall age-standardized prevalence was 42% (39% for men, 46% for women). ‘Musculoskeletal disorders’ was the disease-group most frequently associated with multimorbidity. Three conditions, strategically selected to represent different diagnostic domains according to biomedical tradition; gastro-esophageal reflux, thyroid disease and dental problems, were all associated with both mental and somatic comorbid conditions. Conclusions and implications: Multimorbidity appears to be prevalent in both genders and across age-groups, even in the affluent and relatively equitable Norwegian society. The disease clusters typically transcend biomedicine’s traditional demarcations between mental and somatic diseases and between diagnostic categories within each of these domains. A new theoretical approach to disease development and recovery is warranted, in order to adequately tackle ‘the challenge of multimorbidity’, both empirically and clinically. We think the concept allostatic load can be systematically developed to “capture” the interrelatedness of biography and biology and to address the fundamental significance of “that, which gains” versus “that, which drains” any given human being.

Everyday life and health concepts among blue-collar female workers in Denmark: implications for health promotion aiming at reducing health inequalities

This article introduces a perspective on the health of women with low levels of education in terms of organisation of their everyday life. The aim is to demonstrate the ways in which the women's concept of health is contingent on the conditions encountered in everyday life. A qualitative study based on interviews with the women forms the basis for the discussion. The analysis shows that the women find it difficult to adopt the official discourse on health and its foundation in a biomedical tradition. The article argues that it is necessary to move away from the educational approach focusing on risk and lifestyle with the goal of regulating individual behaviour. Instead, an approach is suggested which can provide the women with the opportunity to gain control of the everyday health determinants which are normally beyond their immediate reach. This is based on the argument that it is necessary to work with a health promotion and education strategy capable of operating within the various interactive patterns between 'environment' and 'individual' which form the foundation for health.

Producing children in the 21st century: A critical discourse analysis of the science and techniques of monitoring early child development

The purpose of this article is to identify the implications of commonly held ideologies within theories of child development. Despite critiques to doing so, developmental theory assumes that children's bodies are unitary, natural and material. The recent explosion of neuroscience illustrates the significance of historical, social and cultural contexts to portrayals of brain development, offering the opportunity for a critical departure in thinking. Instead, this neuroscience research has been taken up in ways that align with biomedical traditions and neoliberal values. This article uses a critical discursive approach, supported by Haraway's ideas of technoscience, to analyse a population-based early child development research initiative. This initiative organises a large-scale surveillance of children's development, operating from the premise that risks to development are best captured early to optimise children's potential. The analysis in this article shows an intermingling of health and economic discourses and clarifies how the child is a figure of significant contemporary social and political interests. In a poignant example of technobiopolitics, the collusion between health research, technologies and the state enrols health professionals to participate in the production of children as subjects of social value, figured as human capital, investments in the future, or alternatively, as waste. The analysis shows how practices that participate in what has become a developmental enterprise also participate in the marginalisation of the very children they intend to serve. Hence, there is the need to rethink practices critically and move towards innovative conceptualisations of child development that hold possibilities to resist these figurations.

When the Third World Comes to the First: Ethical Considerations When Working With Hispanic Immigrants

This article briefly reviews concerns related to the “cultural colonialism” of applying Western biomedical models of research ethics to non-Western groups. The feasibility of alternate ethical models is discussed and found wanting. In practical terms, many academic researchers in the United States are funded by federal agencies and are required to adhere to Title 45, Part 46 of the Code of Federal Regulations, legislation that is clearly grounded in the Western biomedical research tradition. Consequently, the question is not whether this system of ethics should be applied but rather how it can be applied most sensitively, appropriately, and wisely. The remainder of this article discusses of how the authors have attempted to do so in each stage of their own research with Hispanic immigrants to the United States.

Social vaccines to resist and change unhealthy social and economic structures: a useful metaphor for health promotion

The term 'social vaccine' is designed to encourage the biomedically orientated health sector to recognize the legitimacy of action on the distal social and economic determinants of health. It is proposed as a term to assist the health promotion movement in arguing for a social view of health which is so often counter to medical and popular conceptions of health. The idea of a social vaccine builds on a long tradition in social medicine as well as on a biomedical tradition of preventing illness through vaccines that protect against disease. Social vaccines would be promoted as a means to encourage popular mobilization and advocacy to change the social and economic structural conditions that render people and communities vulnerable to disease. They would facilitate social and political processes that develop popular and political will to protect and promote health through action (especially governments prepared to intervene and regulate to protect community health) on the social and economic determinants. Examples provided for the effects of social vaccines are: restoring land ownership to Indigenous peoples, regulating the advertising of harmful products and progressive taxation for universal social protection. Social vaccines require more research to improve understanding of social and political processes that are likely to improve health equity worldwide. The vaccine metaphor should be helpful in arguing for increased action on the social determinants of health.

Grasping at straws: a recent history of health promotion in Canada

Despite Canada's reputation as a leader in the development of health promotion concepts, implementation of these concepts in the service of health has always been far from stellar. Much of this has to do with Canada's liberal political economy and the recent further ascendance of neo-liberal approaches to public policymaking. These developments have combined with longstanding biomedical and epidemiological traditions in health policy to inhibit health promotion approaches that incorporate the principles and themes of the Ottawa Charter. Additionally, the emergence in Canada of population health as a competing–and displacing–discourse to health policy has further eroded health promotion's profile and presence. There is increasing interest in the social determinants of health concept, yet government spending, media attention, and health sector activities lavished on ‘lifestyle’ approaches to health promotion and the emergence of the ‘obesity epidemic’ as a focus of public, media, and health sector attention serves to further reinforce this dreary picture.

Mission Creep in the IRB World

The system in the United States for protecting human participants in research engages the earnest efforts of thousands of scientists, community volunteers, and administrators. Through untold hours of service on Institutional Review Boards (IRBs), they watch over the safety of human research subjects. Unfortunately, much of that effort is increasingly misdirected as the system succumbs to “mission creep” that could compromise its central goals. Our IRB system is endangered by excessive paperwork and expanding obligations to oversee work that poses little risk to subjects. The result is that we have simultaneous overregulation and underprotection. IRBs were established after the 1979 Belmont Report from the Department of Health, Education, and Welfare, with the goal of protecting human subjects involved in potentially risky medical and behavioral research. But IRBs' burdens have grown to include studies involving interviews, journalism, secondary use of public-use data, and similar activities that others conduct regularly without oversight. Most of these activities involve minimal risks—surely less than those faced during a standard physical or psychological examination, the metric for everyday risk in the federal regulations. And IRBs are pressured to review an expanding range of issues from research design and conflicts of interest to patient privacy. These are beyond the scope of research protection and are best left to others. The IRB system is being overwhelmed by a focus on procedures and documentation at the expense of thoughtful consideration of the difficult ethical questions surrounding the welfare of human subjects, especially as complex clinical trials burgeon. Their work is afflicted by unclear definitions of terms such as “risk,” “harm,” and “research.” Because ethical behavior is difficult to measure, many IRBs rely on stylized documentation over substantive review, out of concern that one case in a thousand could slip through and generate bad publicity or penalties, or potentially shut down research. The result is that many protocols receive exaggerated review, and the paper piles up. Society loses as potentially productive research is discouraged or self-censored. Ironically, this obsession with paperwork and mechanical monitoring may undermine protection of human subjects. IRB members spend too much time editing documents, marking typos, and asking for more details. One researcher, 10 years into a longitudinal study, was asked by an IRB to remove the term “anemia” from consent forms because participants might not understand it. Such actions, about which we hear frequently, carry a serious risk: They reduce trust in the guidance of IRBs and may alienate some researchers enough to turn them into scofflaws. ![Figure][1] CREDIT: ROYALTY-FREE/CORBIS Oversight of the IRB process by federal agencies reinforces these tendencies. “Poor or missing ‘Standard Operating Procedures'” and “poor minute-keeping” account for about half of all U.S. Food and Drug Administration citations, and quorum failures for another 13%, according to one review. In seeking compliance, universities have multiplied the number of IRBs, depleting the supply of willing and competent faculty. All this has generated a trend in which researchers increasingly think of IRBs as the “ethics police.” In fact, all researchers must take primary responsibility for professional, ethical conduct. Our systems should reinforce that, not work against or substitute for it; the IRB should be a resource, not the source, for ethical wisdom. All compliance systems require the buy-in and collaboration of the regulated, and it will be a sad day if scholars come to see human protection in research as the source of frustrating delays and expensive paperwork. What can be done? Our University of Illinois white paper,[*][2] based on 2 years of study after an interdisciplinary conference of researchers and IRB leaders, addresses the problems of mission creep and offers possible solutions. Our recommendations include the exemption from IRB oversight of some activities that have ethical standards of their own, distinct from the biomedical tradition. We also support gathering information in a national clearinghouse that supports IRBs and researchers alike. This would provide examples of good and poor practices rooted in disciplinary standards, and help IRBs make priority determinations about what constitutes risk and harm in different human research settings. The IRB system is in trouble, and that means trouble for the safety and efficacy of research on human subjects. We should refocus our efforts on the core issues and stop expanding the mission into less productive territory. [1]: pending:yes [2]: #fn-1

Vulnerability as a strength: Why, when, and how?

The purpose of this issue of the journal is to explore preconditions for transforming demanding experiences from life and sickness into personal health resources, shifting the attention of healthcare providers from risk and weakness to strength and resources. Turning vulnerability into potential assets, the contributors aim for knowledge about the strengths of people who suffer from chronic illness or belong to marginalized groups. Knowledge about people’s personal resources may encourage doctors towards empowering strategies in health promotion, diagnosis and treatment of disease, and rehabilitation suited to accommodate the diversity of members of different marginalized groups. Chronic illness and life conditions that create experiences of oppression give rise to challenges for medical epistemology and practice [1]. The biomedical tradition appreciates objective findings, while subjective symptoms have less clout. Patients with medically unexplained disorders complain that they do not feel taken seriously by the doctor for this reason. Yet, there is evidence for the impressive and independent predictive power of people’s selfassessed health regarding future disease, death, and reduced functional capacity [2]. Patients’ perspectives are underestimated resources to understand more about health and illness, especially when these are different from the doctor’s assessments or assumptions. Salutogenetic perspectives underpin the importance of acknowledging the patient as a person and mobilizing his or her strengths [3], so that the patient’s resistance resources are given the best possible conditions in the fight against illness, suffering and oppression [4]. The concept ‘‘recovery’’, as it has been developed within psychiatric rehabilitation, means to reflect on oneself in a broad sense – creating meaning and functionality, while still recognizing the realities of disability and suffering [5]. Deegan says that the aim is to be the unique human being every person is, based on his or her assets [6]. The placebo effect demonstrates that the belief that something works – hope – can mediate a medical effect. Biomedical research describes neuroimmunological mechanisms functioning as molecular messengers [7]. Healing and recovery may also be mediated through such mechanisms. Modern culture values conformity, effectiveness, independence, and health. People who are dependent on others, or who deviate from what is considered ‘‘normal’’, run the risk of social marginalization. In the time of modernity, a widespread belief is that suffering, disability, and deviance can and should be eliminated or normalized by medical intervention. The patterns of disease in Western society have changed from infections diseases towards chronic conditions such as musculoskeletal disorders, mental illness, dementia, and consequences of accidents or social stigma. When cure is not optional (chronic disease) [8] or desirable (diversity) [9], the tasks of healthcare providers are changed from ‘‘repairing the failure’’ towards commitment, care, or support. Yet, doctors may also function as agents of modernity, mediating

Placebos, Placebo Effect, and the Response to the Healing Situation: The Evolution of a Concept

In spite of its impressive progress, medicine has been strongly criticized for relying on its modern biomedical tradition to the neglect of the psychosocial aspects of health. This neglect may account for patients' dissatisfaction and eventual use of alternative health approaches. The concept of placebo has sustained dramatic "protean" metamorphoses through the ages. For centuries, placebos have been regarded as powerful deceptive therapies. From the middle of the twentieth century, however, conventional medicine has used placebos as methodologic tools to distinguish the specific from the nonspecific ingredients in treatments. In modern medical research, the double-blind, placebo-controlled, randomized clinical trial has been established as the gold standard for the assessment of any new treatment. Recently a new trend regarding placebos seems to have emerged. The placebo and other nonspecific effects elicited by the "healing situation" have been independently subjected to scientific study. Progress in this area may promote useful clinical applications, enabling physicians to broaden their perspectives on the healing process. We present the historical changes of the concept of placebo and the ethical issues raised by their use.

SOCIAL CONSTRUCTIONS OF BREAST CANCER

In contrast to other life-threatening diseases, in which mortality is understood as the fundamental threat, much popular and professional discourse about breast cancer focuses on such issues as the identity, body image, and self-worth of the afflicted woman. Within the Western biomedical tradition, the meaning ascribed to breast cancer has been strongly influenced by competing social interpretations. In this paper, we contend that such social constructions shape the manner in which women experience breast cancer, including their decision making in response to treatment options as well as their strategies for coping with and making sense of breast cancer illness. We argue that an appreciation of the historical and cultural contexts in which breast cancer imagery has been constructed helps to explain the confusing array of ideologies that confront contemporary women diagnosed with breast cancer.

The changing emphasis of mental health and learning disability nurse education in the UK and ideal models of its future development.

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.