Repetitive unpleasant thoughts and ritualized behaviors are the key features of obsessive-compulsive disorder (OCD). The classical neuroethological models of OCD rely largely on behavioral similarities between animal stereotypies and human compulsive rituals and are unable to account for the cognitive component of OCD. The cognitive symptoms of OCD need to be addressed in an evolutionary psychological context that incorporates information about human brain evolution. OCD can be understood as an extreme on a continuum of evolved harm-avoidance strategies. A pathological exaggeration of our evolved capacity to cognitively represent future scenarios, including imagined consequences of our own thoughts and actions (metarepresentation), may be part of the set of evolved psychological mechanisms contributing to the psychopathology of OCD. The costly side of the adaptive ability to anticipate future needs or threats could be that etiologically heterogeneous affections of the underlying striatal-frontal brain circuits may render an individual vulnerable to develop OCD.
Benjamin Franklin had at least two accidents that resulted in electricity passing through his brain. In addition, he witnessed a patient's similar accident and performed an experiment that showed how humans could endure shocks to the head without serious ill effects, other than amnesia. Jan Ingenhousz, Franklin's Dutch-born medical correspondent better known for his discovery of photosynthesis, also had a serious accident that sent electricity though his head and, in a letter to Franklin, he described how he felt unusually elated the next day. During the 1780s, Franklin and Ingenhousz encouraged leading French and English electrical "operators" to try shocking the heads of melancholic and other deranged patients in their wards. Although they did not state that they were responding to Ingenhousz's and Franklin's suggestions, Birch, Aldini, and Gale soon did precisely what Ingenhousz and Franklin had suggested. These practitioners did not appear to induce convulsions in their mentally ill patients, but they still reported notable successes.
Heart -- Diseases -- Treament -- Technological innovations -- United States -- History -- 20th century.
Ambulatory electrocardiography -- United States -- History -- 20th century.
Gel electrophoresis -- United States -- History -- 20th century.
Ambulatory cardiology began in 1959 in a department of pathology to answer a question raised at the autopsy table: are high heart rates in apparently healthy individuals a risk factor for developing coronary artery disease? This question led to the development of a miniature monitor and a new kind of electrode, which enabled clinicians to measure EKG signals during activity and over prolonged periods of time. These electrodes are now used universally for diagnosis and for monitoring the heart during a myriad of different activities and circumstances. The story of the development of the monitor and electrodes illustrates the ways in which ideas and discovery lead to applications and advances in medicine.
Since its origin in the 19th century, epidemiology has faced an internal tension between an approach oriented toward biology and the study of mechanisms, and an approach oriented toward populations and their interactions with the environment. Initially, this tension took the form of an opposition between microbiology and statistics. We describe the early roots of the quantitative approach to health and disease and several historical examples of the above tension. The search for the causes of pellagra exemplifies our thesis. In Italy, where pellagra was endemic, contrasting opinions coexisted between the hypothesis of contaminated maize, supported by Cesare Lombroso, and the hypothesis of a prevailing role of poverty and poor nutrition. In the United States, Joseph Goldberger found no evidence for the hypothesis of contaminated maize or for a microbiological agent, but recognized the central role of nutrition. The "cure" Goldberger proposed was land reform, but he continued studying the disease from a mechanistic point of view; shortly after his death, niacin deficiency was identified as the cause of pellagra. The tension between mechanistic and population-based studies is still present within epidemiology and is in fact essential for the success of the discipline.
Aristotle was a remarkable observer of the living world. He made detailed observations on the anatomy and life history characteristics of many organisms as part of a larger study into the differentiae (diaphora) of groups of animals. This reexamination of Aristotle's observations of two small fishes is a study into the work or the way of being of particular organic wholes. As such, it is directed by three main objectives: to evaluate the accuracy of those observations Aristotle makes with regard to the kobios and phucis in the History of Animals, as well as to understand how he might have conducted his research; to determine whether aspects of those observations would ground more philosophical arguments; and to contribute to the understanding of the basic biology of these fishes. In so doing, this article also may introduce a new generation of biologists to the richness of Aristotle's biological observations and the questions that motivated them.
Recent critics make William Osler "the father of cool detachment" in medicine, largely because of his "Aequanimitas" address emphasizing objectivity and imperturbability. Closer analysis suggests that Osler's aequanimitas resembles more nearly the metriopatheia of later Stoic philosophy than the apatheia of the early Stoics. A previously unpublished memoir clarifies at least in part Osler's motive for teaching control of the "medullary centres" to minimize facial expression: he did not want to frighten patients, who typically had serious illnesses for which he lacked effective therapy. Twenty-first century challenges to medicine as a profession differ substantially from those of Osler's era. Physicians and educators must focus more closely on the tension between detached concern ("competence") and humanistic empathy ("caring") if medicine is to thrive as a learned profession as opposed to a technical service, a commodity to be bought and sold like any other.
Physician power has been attacked, and tabooed, in legitimate efforts to strengthen patients' rights. Yet the structural and symbolic power wielded by doctors is what makes good and right healing actions possible. Avoiding the power issue contributes to a confusing state, where patient trust is faltering and physicians are uncertain about how to fulfill the doctor's role with the intellectual tools of mere science and technology. I argue that constitutive characteristics of health, illness, and the clinical encounter necessitate a prescriptive and responsible healing agent who is more than a technocrat, an information broker, or a seller. The article proposes clinical leadership as a concept offering practical and ethical direction to clinicians, education, research, and health policy. Leadership presupposes reflective awareness of physicians' structural and symbolic power, and is displayed as discerning, empowering improvisations in critical situations, based on empathy and willingness to learn from patients. The notion of clinical leadership highlights patient vulnerability, medicine's ethical core, and the importance of character development in medical education.
Since the 19th century, we have come to think of disease in terms of specific entities—entities defined and legitimated in terms of characteristic somatic mechanisms. Since the last third of that century, we have expanded would-be disease categories to include an ever-broader variety of emotional pain, idiosyncrasy, and culturally unsettling behaviors. Psychiatry has been the residuary legatee of these developments, developments that have always been contested at the ever-shifting boundary between disease and deviance, feeling and symptom, the random and the determined, the stigmatized and the value-free. Even in our era of reductionist hopes, psychopharmaceutical practice, and corporate strategies, the legitimacy of many putative disease categories will remain contested. The use of the specific disease entity model will always be a reductionist means to achieve necessarily holistic ends, both in terms of cultural norms and the needs of suffering individuals. Bureaucratic rigidities and stakeholder conflicts structure and intensify such boundary conflicts, as do the interests and activism of an interested lay public.
The medical, legal, and lay communities utilize a range of words to describe a pregnancy that does not result in live birth. These terms, including abortion, miscarriage, and stillbirth, are more than just words: they carry with them a range of meanings and social consequences. This paper explores the complex implications embodied in the language used to designate fetal death and describes how they simultaneously, and paradoxically, establish conflicting subject positions for mother and fetus. It also examines the statutory regulations that affirm the problematic terms in a manner that may leave grieving families without ritual outlets for the expression of their loss. This paper draws on specific examples from Aotearoa New Zealand, while recognizing similarities across Western cultures.
Fetus -- Research -- Massachusetts -- South Hadley -- History -- 20th century.
Mount Holyoke College -- History -- 20th century.
When I found myself at the center of a controversy over the disposition of an old collection of human fetal specimens at Mount Holyoke College, I was motivated to explore the historical transformation that turned embryo collecting for research and pedagogical purposes from a noble to a disparaged practice, and dead fetuses from prized anatomical specimens to ugly, anomalous entities. Using Linda Layne's analysis of the literal and symbolic erasure of dead fetuses from American cultural discourse, this article examines the shifting circumstances that once encouraged the collection of fetal specimens but that now mandate their disappearance. Using Mount Holyoke as a case study, it describes the scientific logic and specific social exchange networks that led to the acquisition of hundreds of fetal specimens in the first half of the 20th century. It also examines the factors—including changes in biology education, concerns about handling hazardous fixatives, and especially the prominence of beautified and lifelike fetal images consistent with the so-called "culture of life"—that prompt the dissolution and demise of human embryo and fetal collections.