We have made huge progress in understanding the biology of mental illnesses, but comparatively little in interpreting them at the psychological level. The eminent philosopher Jonathan Glover believes that there is real hope of progress in the human interpretation of disordered minds.
The challenge is that the inner worlds of people with psychiatric disorders can seem strange, like alien landscapes, and this strangeness can deter attempts at understanding. Do people with disorders share enough psychology with other people to make interpretation possible? To explore this question, Glover tackles the hard cases—the inner worlds of hospitalized violent criminals, of people with delusions, and of those diagnosed with autism or schizophrenia. Their first-person accounts offer glimpses of inner worlds behind apparently bizarre psychiatric conditions and allow us to begin to learn the “language” used to express psychiatric disturbance. Art by psychiatric patients, or by such complex figures as van Gogh and William Blake, give insight when interpreted from Glover’s unique perspective. He also draws on dark chapters in psychiatry’s past to show the importance of not medicalizing behavior that merely transgresses social norms. And finally, Glover suggests values, especially those linked with agency and identity, to guide how the boundaries of psychiatry should be drawn.
Seamlessly blending philosophy, science, literature, and art, Alien Landscapes? is both a sustained defense of humanistic psychological interpretation and a compelling example of the rich and generous approach to mental life for which it argues.
Information on prenatal testing abounds, but few books are addressed to prospective parents in need of practical guidance. In this comprehensive and sensitive account, Elena Nightingale and Melissa Goodman offer remarkably clear answers to the set of bewildering questions generated by the concerns of parenthood.
Prospective parents are given the guidance needed to make informed choices about whether or not to undergo testing and, if they elect to do so, how best to use the results. As humans, we are recipients of a rich genetic heritage. Each human cell contains 46 chromosomes with a total of 50,000 to 100,000 genes distributed among them. Such richness carries immense possibilities for error when gene replication occurs; it is therefore not surprising that gene disorders such as Down syndrome, Huntington's disease, and neural tube defects pose a major public health problem. Rapid development of sophisticated new techniques has vastly increased our ability to diagnose genetic disorders during the prenatal period. For example, the amniotic fluid sampled in the middle trimester can be tested for such biochemical abnormalities as Tay-Sachs disease. The advent of more recent techniques, such as sampling the cells of the villi of the chorion (a procedure that can be carried out in the first trimester), employing gene probes, and using ultrasonographic detection, has advanced the diagnosis of genetic disorders faster than most researchers would have thought possible.
Nightingale and Goodman carefully explain the practicalities of this potentially confusing array of prenatal tests: how they are performed, what they reveal, and what their limitations are. The book concludes with a thoughtful consideration of the economic, ethical, and legal issues related to prenatal screening. Although primarily intended to assist prospective parents, this volume is also of interest to health care providers, public health officials, and policymakers who struggle with these difficult decisions.
How global health practices can end up reorganizing practices of care for the people and communities they seek to serve
Commodities of Care examines the unanticipated effects of global health interventions, ideas, and practices as they unfold in communities of men who have sex with men (MSM) in China. Targeted for the scaling-up of HIV testing, Elsa L. Fan examines how the impact of this initiative has transformed these men from subjects of care into commodities of care: through the use of performance-based financing tied to HIV testing, MSM have become a source of economic and political capital.
In ethnographic detail, Fan shows how this particular program, ushered in by global health donors, became the prevailing strategy to control the epidemic in China in the late 2000s. Fan examines the implementation of MSM testing and its effects among these men, arguing that the intervention produced new markets of men, driven by the push to meet testing metrics.
Fan shows how men who have sex with men in China came to see themselves as part of a global “MSM” category, adopting new selfhoods and socialities inextricably tied to HIV and to testing. Wider trends in global health programming have shaped national public health responses in China and, this book reveals, have radically altered the ways health, disease, and care are addressed.
Saunders’s analyses are informed by strands of cultural history and theory including art historical critiques of realist representation, Walter Benjamin’s concerns about violence in “mechanical reproduction,” and tropes of detective fiction such as intrigue, the case, and the culprit. Saunders analyzes the diagnostic “gaze” of medical personnel reading images at the viewbox, the two-dimensional images or slices of the human body rendered by the scanner, methods of archiving images, and the use of scans as pedagogical tools in clinical conferences. Bringing cloistered diagnostic practices into public view, he reveals the customs and the social and professional hierarchies that are formulated and negotiated around the weighty presence of the CT scanner. At the same time, by returning throughout to the nineteenth-century ideas of detection and scientific authority that inform contemporary medical diagnosis, Saunders highlights the specters of the past in what appears to be a preeminently modern machine.
1999 Al Sturm Award for Excellence in Faculty Research of the Phi Beta Kappa chapter at Virginia Tech
What if your father had Alzheimer's disease? And what if there was a test to tell you if, as you grew older, you might develop it, too? Would you have the test? And if you did, how would the results affect the way you live your life? How would they affect your family? Your job? Your medical insurance?
Breast cancer, sickle-cell anemia, Huntington disease, muscular dystrophy--every day, people have to face the fact that a hereditary disorder runs in their family. The painful knowledge that they or their children might be at risk for a genetic disorder influences all their decisions about the future. They ask, "Is there a genetic test to let us know if we are really at risk? If there is such a test, do we really want to have it done?"
For an ever-growing number of disorders, testing is possible--but the existence of a test can raise new and troubling questions. In this book, geneticist and science policy expert Doris Teichler Zallen explains clearly and sympathetically how genetic disorders are passed along in families; which hereditary disorders can be tested for using genetic technology; how the new DNA tests for genetic disorders work; what genetic tests can and can't reveal, and why the tests often do not give clear-cut answers; what questions one should ask doctors and genetic counselors; how the health care system, government policies, and insurance companies influence our options; and what the resources are for obtaining more information and counseling.
Through the stories of real families and the choices they made about genetic testing, Zallen helps readers think through their own alternatives and discuss them with relatives. Does it Run in the Family? is essential reading for every family coping with inherited medical conditions and for the medical and genetics professionals involved in their decisions. It will also interest all readers who seek a clear explanation of the new DNA tests and the issues surrounding them.
Competent physicians make accurate diagnoses. How are accurate diagnoses made? This readable book gives some important answers to that question. Experienced physicians were presented with diagnostic problems and asked to solve them. Through the use of trained actors serving as “patients” and with a variety of supplementary techniques, the investigators were able to dissect the process by which diagnoses, right and wrong, are made.
Reporting on the most comprehensive investigation of clinical reasoning yet conducted, the authors present data and conclusions of importance not just to medical educators but to anyone interested in the psychology of problem solving. Rigorous attention to methods, thorough grounding in contemporary theories of problem solving, and a healthy respect for the complexity of real-life situations characterize this remarkable study.
A sampling of its salient findings only suggests the richness of this book. Successful diagnosticians begin to form hypotheses almost as soon as they encounter a patient. They entertain a limited number of hypotheses, but these are tested repeatedly during a workup. New findings are treated as confirming, refuting, or not contributing to the solution contemplated; more elaborate schemes based on a knowledge of probabilities are not used. A common error is to relate new information to a working hypothesis, although the information is, in fact, non-contributory. The performance of even an experienced physician varies markedly from case to case. Two of the most important determinants of competence are information and experience; problem-solving skills without a rich supply of facts are insufficient for diagnostic acumen.
Big data, genomics, and quantitative approaches to network-based analysis are combining to advance the frontiers of medicine as never before. Network Medicine introduces this rapidly evolving field of medical research, which promises to revolutionize the diagnosis and treatment of human diseases. With contributions from leading experts that highlight the necessity of a team-based approach in network medicine, this definitive volume provides readers with a state-of-the-art synthesis of the progress being made and the challenges that remain.
Medical researchers have long sought to identify single molecular defects that cause diseases, with the goal of developing silver-bullet therapies to treat them. But this paradigm overlooks the inherent complexity of human diseases and has often led to treatments that are inadequate or fraught with adverse side effects. Rather than trying to force disease pathogenesis into a reductionist model, network medicine embraces the complexity of multiple influences on disease and relies on many different types of networks: from the cellular-molecular level of protein-protein interactions to correlational studies of gene expression in biological samples. The authors offer a systematic approach to understanding complex diseases while explaining network medicine’s unique features, including the application of modern genomics technologies, biostatistics and bioinformatics, and dynamic systems analysis of complex molecular networks in an integrative context.
By developing techniques and technologies that comprehensively assess genetic variation, cellular metabolism, and protein function, network medicine is opening up new vistas for uncovering causes and identifying cures of disease.
Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing is the first book-length study of the rhetoric inherent in and surrounding HIV testing. In addition to providing a history of HIV testing in the United States from 1985 to the present, J. Blake Scott explains how faulty arguments about testing’s power and effects have promoted unresponsive and even dangerous testing practices for so-called healthy subjects as well as those deemed risky.A new afterword to the paperback edition discusses changes in testing technology, treatments, and public health responses in the last ten years. The ultimate goal of Risky Rhetoric is to offer strategies to policy makers, HIV educators and test counselors, and other rhetors for developing more responsive and egalitarian testing-related rhetorics and practices.
A physician with thirty-five years of experience treating people with brain injuries shares the latest research on concussions and best practices for care.
The explosion of attention to sports concussions has many of us thinking about the addled brains of our football and hockey heroes. But concussions happen to everyone, not just elite athletes. Children fall from high chairs, drivers and cyclists get into accidents, and workers encounter unexpected obstacles on the job. Concussions are prevalent, occurring even during everyday activities. In fact, in less time than it takes to read this sentence, three Americans will experience a concussion. The global statistics are no less staggering.
Shaken Brain offers expert advice and urgently needed answers. Elizabeth Sandel, MD, is a board-certified physician who has spent more than three decades treating patients with traumatic brain injuries, training clinicians, and conducting research. Here she explains the scientific evidence for what happens to the brain and body after a concussion. And she shares stories from a diverse group of patients, educating readers on prevention, diagnosis, and treatment. Few people understand that what they do in the aftermath of their injury will make a dramatic difference to their future well-being; patient experiences testify to the best practices for concussion sufferers and their caregivers. Dr. Sandel also shows how to evaluate risks before participating in activities and how to use proven safety strategies to mitigate these risks.
Today concussions aren’t just injuries—they’re big news. And, like anything in the news, they’re the subject of much misinformation. Shaken Brain is the resource patients and their families, friends, and caregivers need to understand how concussions occur, what to expect from healthcare providers, and what the long-term consequences may be.
Within forty-eight hours after birth, the heel of every baby in the United States has been pricked and the blood sent for compulsory screening to detect or rule out a large number of disorders. Newborn screening is expanding rapidly, fueled by the prospect of saving lives. Yet many lives are also changed by it in ways not yet recognized.
Testing Baby is the first book to draw on parents’ experiences with newborn screening in order to examine its far-reaching sociological consequences. Rachel Grob’s cautionary tale also explores the powerful ways that parents’ narratives have shaped this emotionally charged policy arena. Newborn screening occurs almost always without parents’ consent and often without their knowledge or understanding, yet it has the power to alter such things as family dynamics at the household level, the context of parenting, the way we manage disease identity, and how parents’ interests are understood and solicited in policy debates.
Every year, millions of healthy women undergo a variety of screening tests without understanding why or the meaning of the outcome. If you are among those women, overwhelmed by information and baffled by results, this is the book you've been waiting for. In straightforward, personable prose, A Woman's Concise Guide to Common Medical Tests surveys a wide variety of standard tests commonly suggested by doctors.
Using the recommendations of the U.S. Preventative Health Services Task Force as a starting point, physicians Michele C. Moore and Caroline M. de Costa describe and explain screening tests for STDs and other communicable diseases, diabetes, thyroid disease, bone loss, various genetic tests, pregnancy, and cancer (including breast, colon, and skin). A section on common blood tests demystifies the numerical results that can be virtually impossible to interpret for women outside the medical profession. The authors detail what is considered "normal" as well as what's not-to help women make sense of their results.
As practicing physicians, both authors have fielded patients' questions about standard screening tests and understand what women should know but often feel afraid to ask about. For each test, there is an explanation of why it may be ordered, how it is done, what sort of preparation may be involved, and what risks may be incurred.
As the health-care industry continues to evolve, the amount of medical information available to women about their health can be overwhelming and confusing. Without being encyclopedic or intimidating, A Woman's Concise Guide to Common Medical Tests offers all the facts you need about screening tests, all in one place.
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