The Chief Concern of Medicine: The Integration of the Medical Humanities and Narrative Knowledge into Medical Practices

Notes

/ 391 / notes Introduction 1. While these distinctions might be idiosyncratic to english, the fact that english offers such detailed distinctions—much like french elaborates distinctions among the terms langue, parole, and langage that are not found in english and other languages—should be seen as a tool of understanding rather than an accident of english . We note in appendix 1 how “ordinary language philosophy” assumes that distinctions embodied in the ordinary usages of language present useful distinctions honed by the functional adaptiveness of linguistic distinctions. Such distinctions, we suggest, can be “unpacked” and schematically described in ways that can make people—and, in the context of The Chief Concern, physicians and health care workers—more selfconscious and efficient in their work. The definitions of “health” we are describing here present an instance of such linguistic “unpacking.” 2. in Narrative Medicine, Rita Charon notes that “facing one’s desires vis-à-vis one’s texts may be something more aptly and expertly done in the department of medicine than the department of english. it may be an area in which narrative medicine can make original contributions to literary studies” (2006a: 126). human suffering and the causes of human suffering are implicit in Joyce’s definitions of pity and terror in terms of the human sufferer and the “secret cause” we quoted earlier. 3. in an earlier draft of The Chief Concern of Medicine and in earlier essays (see Schleifer and Vannatta 2011; Schleifer 2012), we had begun to discuss this concept under the designation of “paradigm-based medicine.” While we hope that our exposition of schema-based medicine will allow readers to notice why we thought this earlier term useful—including its various definitions we will describe and its relation to the work of Thomas Kuhn—we have come to see that the term paradigm too easily lends itself to misunderstanding. Moreover, the term schema lends itself more readily to the practical work of checklists that fulfills our practical goals in this book; and insofar as discussions of phronesis have regularly described it as a skill that grows from experience, it is notable that schemas in cognitive psychology were developed to account for the seeming immediacy of “experience” itself. Still, one reason we began with the concept of “paradigm” is because it is our contention that paradigms (or the 392 / note to page 16 larger, inclusive set of schemas) are the building blocks of the humanities taken as intellectual disciplines, just as, it could be argued, mathematics is the methodological basis of physics, and just as the concept of natural selection is the basic explanatory schema of evolutionary biology. But in this regard, “schemas”—particularly as a more precise description of paradigms in commentators concerned with Kuhn’s work whom we cite here—are similarly useful in isolating the disciplinary “building blocks” of the humanities. We set forth a description of the humanistic disciplines in appendix 1. 4. in The Right Mind, a study of the right brain in relation to the left brain, Robert ornstein offers a possible neurological and physiological account of the intellectual and experiential phenomenon of global apprehension. he notes that “both halves of the brain are needed for the two elements of everyday language. The left side looks after the basic text, the conventional features of language: choice of words, syntax, and literal meaning. But taking part in a conversation requires a lot more than using the right words in the right order and knowing what individual sentences mean. To understand fully what someone is saying, you have to be able to interpret his or her tone of voice, apply the conventions of polite conversation, follow a narrative, understand gestures, and so on. you need to know when sentences don’t have their usual function and be able to fathom the speaker’s purpose” (1997: 113). all of these experiences of “full” understanding, although ornstein does not use the term, are conditioned by provisional schemas of understanding and experience. Thus it is significant that his catalog includes the experience of “following a narrative,” an example of great importance in our argument. Throughout his book, one chief example of this relationship between the hemispheres of the brain is the narrative example of “getting” a joke. (in a very different tradition, this is a. J. greimas’s initial starting point in his examination of the “meaningful whole” of discourse in his study of semantics [1983: 79ff.].) People with right-brain damage, do not get jokes, and both ornstein and...