The article maintains that chronic fatigue syndrome can be properly understood only by taking an integrated perspective in which evolutionary, developmental and ecological aspects are considered. The integrative approach, supplemented by a complexity theory and psychoneuroimmunological research, is capable of explaining why there are so few structural aberrations to be found in chronic fatigue syndrome and why specific treatment is so difficult to establish. A major outcome of the investigation, that all individuals with chronic fatigue syndrome are diseased in their (...) own way, emphasises the need to study the development of personalised life histories. It also highlights an ethical dimension; personalised disease defies essentialist thinking on patient management. Another major outcome, which follows from the developmental systems perspective, is the dissolution of ontological mind-body dualism. This in turn allows for a methodological complementation of the biological and phenomenological approaches to knowledge. New research strategies that may help to resolve chronic fatigue syndrome, grounded in the revised perspective on individual development, are suggested. (shrink)

This paper attempts to define the concept of placebo as it is used in the clinical context The author claims that X is a placebo if and only if X has such a property dp, that whenever in a therapeutic situation T a stimulus S appears, then in attending conditions A, it will cause a beneficial reaction R in the patient. Formally, the same structure may be used to define any pharmacologically active drug. The main difference between the drug and (...) a placebo is in the range of possible substitutions for X and the property d. For the active drug there is only one possible substitution for X and property d and it can be scientifically explained why, and how the drug works. In the case of a placebo a set of possible substitutions for X and d is open, and so far it is impossible to offer any scientifically valid explanation of the action mechanism of placebo. (shrink)

This paper attempts to define the concept of placebo as it is used in the clinical context The author claims that X is a placebo if and only if X has such a property dp, that whenever in a therapeutic situation T a stimulus S appears, then in attending conditions A, it will cause a beneficial reaction R in the patient. Formally, the same structure may be used to define any pharmacologically active drug. The main difference between the drug and (...) a placebo is in the range of possible substitutions for X and the property d. For the active drug there is only one possible substitution for X and property d and it can be scientifically explained why, and how the drug works. In the case of a placebo a set of possible substitutions for X and d is open, and so far it is impossible to offer any scientifically valid explanation of the action mechanism of placebo. (shrink)

The article presents a doctor–patient relationship model based on the assumptions of a holistic approach to the patient. The author draws attention to selected patients’ needs, ones taken into account in this model. These are the right to autonomy and an individualised approach to the patient. These issues, considered in relation to philosophy, show a conflict between patients’ values and aspirations and doctors’ values and their experience. Nowadays, patients’ needs are protected by consumer rights as well as being strengthened by (...) postmodern philosophy, which shapes society’s awareness of various definitions of health and underlines the right of the individual to self‐determination. This situation creates an incredible challenge for doctors because attempts to assist is, according to medical knowledge, associated with an inevitable collision with the subjective perception of a patient’s health. Because of this issue, the author considers it necessary to enquire about the needs and aspirations of not so much patients as doctors themselves. It is assumed that the definition of what is currently important for this group determines the scope of any possible admission or intentional ignorance of patients’ needs. (shrink)

This paper contends, following Plato and Broekman, that seeing images as images is crucial to theorizing medicine and that considering clinical pictures as images of images is a much-needed epistemic complement to the domineering view that sees clinical pictures as mirrors of disease. This does not only offer epistemic, but also ethical benefits to individual patients, especially in those cases where patients suffer from chronic, debilitating, and terminal illnesses and where medicine provides no, or limited, answers in terms of treatment, (...) intervention, and meaning. By creating room for a theory of clinical pictures that rightfully emphasizes its pictorial nature, patients and doctors alike may be encouraged to consider under what authorship, and with which epistemic tools, alternative, supplemental images may be produced to get at the existential reality of disease and suffering. Ultimately, this paper argues that the epistemic tools provided by aesthetics may offer such glimpses into the reality of disease and suffering, and I conclude by discussing a few artistic renditions of breast cancer to illustrate my point. (shrink)

High-dose chemotherapy and autologous stem cell transplantation is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the (...) strict and demanding protocols required for successful ASCT.The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant.Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains—understandings of the transplant itself and its underlying theory, of the relationship between the components of the ‘transplant’, of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox informationPatients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur. (shrink)

Suffering, defined as a state of undergoing pain, distress or hardship, is a multidimensional concept; it can entail physical, psychological and spiritual distress that prompts the sufferer to seek medical attention. As a construct originating from and unique to each patient, no patient’s suffering is equal to another’s or completely reducible to any generalizable frame of understanding. As it happens in a common medical encounter, the suffering patient requires an anamnesis provided by attentive and comprehensive listening to both the said (...) and unsaid parts of his or her discourse interpreted through the hermeneutical skills of the physician. Suffering can then be decoded into a complex construct, which can guide the formulation of a strategy to help patient coping by attempting to find meaning in it. To help this search for meaning, one may employ philosophic therapy, bibliotherapy and counseling, among other approaches. Suffering-based medicine (SBM) thus circumvents the limitations of the reductionistic Allopathic medical frame of understanding of disease. Such an attitude should be a common goal for all scientific medicine practitioners, as it complements and does not conflict with any of its therapeutic modalities. Furthermore, medical education should include humanistic disciplines to empower physicians to better understand their patients’ experience of suffering. (shrink)

In the face of increasing intervention in childbirth, ‘normal birth’ is currently being promoted by the World Health Organization, national governments, professional bodies and other organisations throughout the world. This paper takes a postmodernist stance and explores the idea of the ‘normal’ before going on to analyse normal childbirth, referring to concepts of the normal and the natural. It refers to historical developments in childbearing and lay organisations along with research relating to women’s views of childbirth, to question the appropriateness (...) of using ‘normal’ to describe the very individual experiences of childbirth. It laments the way in which women have been treated and arguably continue to be ‘cared for’ in maternity/obstetric services. It adds to the current discussion by recalling psychoanalytical theory and philosophical analysis to conclude with a call for future consideration of the ‘good‐enough’ birth instead of concentrating on promoting normal birth which is very difficult, if not impossible to define in retrospect, or to prospectively promote. (shrink)