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Intersections of American Medicine, Law, and Culture
The American culture of death changed radically in the 1970s. For terminal illnesses, hidden decisions by physicians were rejected in favor of rational self-control by patients asserting their "right to die"—initially by refusing medical treatment and more recently by physician-assisted suicide. This new claim rested on two seemingly irrefutable propositions: first, that death can be a positive good for individuals whose suffering has become intolerable; and second, that death is an inevitable and therefore morally neutral biological event. Death Is That Man Taking Names suggests, however, that a contrary attitude persists in our culture—that death is inherently evil, not just in practical but also in moral terms. The new ethos of rational self-control cannot refute but can only unsuccessfully try to suppress this contrary attitude. The inevitable failure of this suppressive effort provokes ambivalence and clouds rational judgment in many people's minds and paradoxically leads to inflictions of terrible suffering on terminally ill people.
Judicial reforms in the 1970s of abortion and capital punishment were driven by similarly high valuations of rationality and public decision-making—rejecting physician control over abortion in favor of individual self-control by pregnant women and subjecting unsupervised jury decisions for capital punishment to supposed rationally guided supervision by judges. These reforms also attempt to suppress persistently ambivalent attitudes toward death, and are therefore prone to inflicting unjustified suffering on pregnant women and death-sentenced prisoners.
In this profound and subtle account of psychological and social forces underlying American cultural attitudes toward death, Robert A. Burt maintains that unacknowledged ambivalence is likely to undermine the beneficent goals of post-1970s reforms and harm the very people these changes were intended to help.
Anesthesia and Birth in America
Despite today's historically low maternal and infant mortality rates in the United States, labor continues to evoke fear among American women. Rather than embrace the natural childbirth methods promoted in the 1970s, most women welcome epidural anesthesia and even Cesarean deliveries. In Deliver Me from Pain, Jacqueline H. Wolf asks how a treatment such as obstetric anesthesia, even when it historically posed serious risk to mothers and newborns, paradoxically came to assuage women's anxiety about birth. Each chapter begins with the story of a birth, dramatically illustrating the unique practices of the era being examined. Deliver Me from Pain covers the development and use of anesthesia from ether and chloroform in the mid-nineteenth century; to amnesiacs, barbiturates, narcotics, opioids, tranquilizers, saddle blocks, spinals, and gas during the mid-twentieth century; to epidural anesthesia today. Labor pain is not merely a physiological response, but a phenomenon that mothers and physicians perceive through a historical, social, and cultural lens. Wolf examines these influences and argues that medical and lay views of labor pain and the concomitant acceptance of obstetric anesthesia have had a ripple effect, creating the conditions for acceptance of other, often unnecessary, and sometimes risky obstetric treatments: forceps, the chemical induction and augmentation of labor, episiotomy, electronic fetal monitoring, and Cesarean section. As American women make decisions about anesthesia today, Deliver Me from Pain offers them insight into how women made this choice in the past and why each generation of mothers has made dramatically different decisions.
Conundrums in Modern American Medicine
In Diagnosis, Therapy, and Evidence, Gerald N. Grob and Allan V. Horwitz employ historical and contemporary data and case studies, combining into one book a variety of medical and psychiatric conditions. They utilize case studies and examine tonsillectomy, cancer, heart disease, PTSD, anxiety, and depression, and identify differences between rhetoric and reality and the weaknesses in diagnosis and treatment.
The State, Society, and Public Health in the United States, France, Great Britain, and Canada
From mad-cow disease and E. coli-tainted spinach in the food supply to anthrax scares and fears of a bird flu pandemic, national health threats are a perennial fact of American life. Yet not all crises receive the level of attention they seem to merit. The marked contrast between the U.S. government’s rapid response to the anthrax outbreak of 2001 and years of federal inaction on the spread of AIDS among gay men and intravenous drug users underscores the influence of politics and public attitudes in shaping the nation’s response to health threats. In Disease Prevention as Social Change, sociologist Constance Nathanson argues that public health is inherently political, and explores the social struggles behind public health interventions by the governments of four industrialized democracies. Nathanson shows how public health policies emerge out of battles over power and ideology, in which social reformers clash with powerful interests, from dairy farmers to tobacco lobbyists to the Catholic Church. Comparing the history of four public health dilemmas—tuberculosis and infant mortality at the turn of the last century, and more recently smoking and AIDS—in the United States, France, Britain, and Canada, Nathanson examines the cultural and institutional factors that shaped reform movements and led each government to respond differently to the same health challenges. She finds that concentrated political power is no guarantee of government intervention in the public health domain. France, an archetypical strong state, has consistently been decades behind other industrialized countries in implementing public health measures, in part because political centralization has afforded little opportunity for the development of grassroots health reform movements. In contrast, less government centralization in America has led to unusually active citizen-based social movements that campaigned effectively to reduce infant mortality and restrict smoking. Public perceptions of health risks are also shaped by politics, not just science. Infant mortality crusades took off in the late nineteenth century not because of any sudden rise in infant mortality rates, but because of elite anxieties about the quantity and quality of working-class populations. Disease Prevention as Social Change also documents how culture and hierarchies of race, class, and gender have affected governmental action—and inaction—against particular diseases. Informed by extensive historical research and contemporary fieldwork, Disease Prevention as Social Change weaves compelling narratives of the political and social movements behind modern public health policies. By comparing the vastly different outcomes of these movements in different historical and cultural contexts, this path-breaking book advances our knowledge of the conditions in which social activists can succeed in battles over public health.
The Politics of African American Medical Care
For enslaved and newly freed African Americans, attaining freedom and citizenship without health for themselves and their families would have been an empty victory. Even before emancipation, African Americans recognized that control of their bodies was a critical battleground in their struggle for autonomy, and they devised strategies to retain at least some of that control. In Doctoring Freedom, Gretchen Long tells the stories of African Americans who fought for access to both medical care and medical education, showing the important relationship between medical practice and political identity.
Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century
Offering a new perspective on medical progress in the nineteenth century, Steven M. Stowe provides an in-depth study of the midcentury culture of everyday medicine in the South. Reading deeply in the personal letters, daybooks, diaries, bedside notes, and published writings of doctors, Stowe illuminates an entire world of sickness and remedy, suffering and hope, and the deep ties between medicine and regional culture.In a distinct American region where climate, race and slavery, and assumptions about "southernness" profoundly shaped illness and healing in the lives of ordinary people, Stowe argues that southern doctors inhabited a world of skills, medicines, and ideas about sickness that allowed them to play moral, as well as practical, roles in their communities. Looking closely at medical education, bedside encounters, and medicine's larger social aims, he describes a "country orthodoxy" of local, social medical practice that highly valued the "art" of medicine. While not modern in the sense of laboratory science a century later, this country orthodoxy was in its own way modern, Stowe argues, providing a style of caregiving deeply rooted in individual experience, moral values, and a consciousness of place and time.In this deeply researched study of white country doctors in the mid-nineteenth-century South, Stowe examines their training, practice, and reflective writing. In three parts, the book investigates the education doctors received; doctor/patient relationships and the related dynamics of race, economics, and community structure; and how doctors wrote about and understood the wider meaning of their work. Stowe's argument centers on the rural practice of medicine; the fluid boundary between "orthodox" practice and the vernacular practice of midwives, healers, herbalists, and family members; and the ways in which race did and didn't enter the spheres of sickness and healing.Stowe examines the role of the white country doctor in the mid-nineteenth-century South and explores what their training, their practice, and their writings tell us about community and culture in the rural antebellum South.Offering a new perspective on medical progress in the nineteenth century, Steven M. Stowe provides an in-depth study of the midcentury culture of everyday medicine in the South. Reading deeply in the personal letters, daybooks, diaries, bedside notes, and published writings of doctors, Stowe illuminates an entire world of sickness and remedy, suffering and hope, and the deep ties between medicine and regional culture.In a distinct American region where climate, race and slavery, and assumptions about "southernness" profoundly shaped illness and healing in the lives of ordinary people, Stowe argues that southern doctors inhabited a world of skills, medicines, and ideas about sickness that allowed them to play moral, as well as practical, roles in their communities. Looking closely at medical education, bedside encounters, and medicine's larger social aims, he describes a "country orthodoxy" of local, social medical practice that highly valued the "art" of medicine. While not modern in the sense of laboratory science a century later, this country orthodoxy was in its own way modern, Stowe argues, providing a style of caregiving deeply rooted in individual experience, moral values, and a consciousness of place and time.
Humanitarian Quests, Impossible Dreams of Médecins Sans Frontières
Médecins Sans Frontières / Doctors Without Borders (MSF) is a private international medical humanitarian organization that was created by a small group of French doctors and journalists in 1971. In 1988, MSF was awarded the Nobel Prize for Peace in recognition of the worldwide assistance it provides for people in distress who are victims of manmade and natural disasters and armed conflict. Committed to the principles of neutrality, impartiality, and independence, the men and women of MSF bear witness by speaking out about conditions of extreme need and suffering, acts of violence against individuals or groups, and threats or hindrances to medical care that they observe in the course of carrying out their work. Renée C. Fox is a sociologist known particularly for her pioneering work in medical sociology and for her ethnographic research and writing. Doctors Without Borders is based on the first-hand research she conducted about and within MSF since 1993. Its vivid, “thickly descriptive” data are derived from her participant observation, in-depth interviewing, and collection of primary and secondary documents in numerous MSF contexts. The book begins on the ground with the blogs of women and men of MSF in the field, recounting their experiences in moving detail. From there it chronicles MSF’s early history and development, paying special attention to its inner struggles, during the first decades of its existence, to clarify and implement its principles and to more fully realize its “without borders” transnational vision. Detailed case studies form the core of the book, describing MSF in postapartheid South Africa, dealing with that nation’s rampant epidemic of HIV/AIDS, and MSF in postsocialist Russia, responding to the thousands of homeless persons on the streets of Moscow and to the massive epidemic of tuberculosis in the penal colonies of Siberia. The book ends with an account of the fortieth anniversary meeting of MSF in Paris and with the author’s exit from the field. Doctor Without Borders tells a narrative enriched by photographs of MSF missions and by ironic, self-critical cartoons drawn by a member of the Communications Department of MSF France.
Memoirs of a Nurse Practitioner
Osteopathic Medicine in America
Overcoming suspicion, ridicule, and outright opposition from the American Medical Association, the osteopathic medical profession today serves the health needs of more than thirty million Americans. The DOs chronicles the development of this controversial medical movement from the nineteenth century to the present. Historian Norman Gevitz describes the philosophy and practice of osteopathy, as well as its impact on medical care. From the theories underlying the use of spinal manipulation developed by osteopathy's founder, Andrew Taylor Still, Gevitz traces the movement's early success, despite attacks from the orthodox medical community, and details the internal struggles to broaden osteopathy's scope to include the full range of pharmaceuticals and surgery. He also recounts the efforts of osteopathic colleges to achieve parity with institutions granting M.D. degrees and looks at the continuing effort by osteopathic physicians and surgeons to achieve greater recognition and visibility. In print continuously since 1982, The DOs has now been thoroughly updated and expanded to include two new chapters addressing recent and current challenges and to bring the history of the profession up to the beginning of the new millennium.
L'isolement en asile, traitement grandement utilisé à la fin du XIXe siècle pour guérir la folie, a été remis en question au fur et à mesure que le XXe siècle passait. La conception des réseaux de santé, le développement des disciplines psychiatrique et psychologique dans l'après-guerre, la découverte des neuroleptiques au début des années 1950 et les contrecoups de la Révolution tranquille, accompagnés d'un vent de décléricalisation, ont mené à une révolution psychiatrique : la désinstitutionnalisation. Cet ouvrage expose les tenants et les aboutissants d'une première vague de désinstitutionnalisation qui a marqué les années 1960 et 1970 en contexte canadien-français (Québec, Ontario et Nouveau-Brunswick). Proposant une étude sociohistorique et une analyse critique de cette période charnière en santé mentale, les auteurs évaluent les conséquences des transferts sur la vie des patients sortis des asiles ainsi que le rôle des intervenants en matière d'accompagnement. Ils soulèvent également des pistes d'intervention entourant les nouveaux enjeux de la prise en charge des personnes souffrant de maladie mentale. Alliant criminologie, histoire, sociologie, travail social et sciences infirmières, -l'ouvrage traite autant de politiques d'hygiène mentale, de contrôle social, de médicaments psychotropes que de marginalisation des malades mentaux. Il met au jour un vaste patrimoine matériel et immatériel de la santé mentale au Canada.