NARRATIVE AND MEDICINE 2012

Title of the paper:

“Searching for trust: Towards a full recognition of alterity in psychotherapy”

Abstract: Within psychotherapy, dialogical perspectives have been arising as a promising pathway of development in the last two decades. This presentation will focus upon the developmental processes by which trust is achieved, in two interconnected directions: the development of a trusting relationship in client’s life; and the building (and the tear and repair movements) of a trusting relationship between client and therapist. Clients usually bring to psychotherapy life stories in which distrust plays a central role, stories in which the Other is somehow built in a distrustful way, prolonging the past into the future. It will be illustrated how their change involve a development of trust in others, and some specific processes by which this takes place will be presented (e.g., putting words in silenced experiences). Trust lies at the very core of this social situation, and a delicate balance between trust and distrust, showing and hiding, moving back and forth are established between therapist and clients. Some possible pathways of development will be analyzed, including those in which there is a degradation of the relationship between therapist and client. Some possible implications of these developmental routes to everyday life will be sketched.

Biographical information: JOÃO SALGADO, Ph.D., is the Head of Department of Psychology and Communication at ISMAI, Portugal. He is also a psychotherapist and the Director of the Counseling Service of his university. His main research interests are associated with the developments of a dialogical perspective within psychology, and with the applications of this framework to the field of psychotherapy and clinical psychology. At the moment, he is the Principal Investigator of a research project founded by the Foundation for Science and Technology (FCT), the Portuguese national agency for R&D, named “Decentering and Change in Psychotherapy”.

Title of the paper:

“Being-in-stories: On reasons and causes in self-narratives”

Abstract: Reasons and causes typify two grammars that belong to contrasting realms and operations of discursive semiotics tending to incommensurability. These grammars institute a qualitative discrimination between the self-efficacy of being someone and the symmetric (selfless) efficacy of being something or undergoing something. To be someone consists, it shall be argued, in the semiotic competence for the user of signs to interpret and describe herself in agreement with the grammar of practical reasons. This competence is actualized by a self-narrative performance in which the dialectical relationship between reasons and causes, actions and events, becomes a structuring force. The events constrain agents to question themselves and wonder if a meaningful account is possible. In so doing, agents (re)define their practical strategies of self-interpretation, strategies that include the fact of declaring life (non)understandable-and/or-(non)explainable or understandable-and-explainable or neither-understandable-nor-explainable. In the last instance the autonomy of the grammar collapses and the ontology and phenomenology of experience shows how agents live in the midst of an unstable and ambivalent tension (encompassing autopoiesis and autophagy) due to the continuous crossing-over between the possibility of the self-efficacious force of reasons and the actuality of the blind force of exogenous causes.

Biographical information: Paulo Jesus, BA/MA in Psychology 2000 (Coimbra University, Portugal, and Louvain Catholic University, Belgium), PhD in Philosophy and Social Sciences 2006 (EHESS, Paris), was a Visiting Scholar at the Philosophy Department of NYU and Columbia (2007/08), and Invited Professor at EHESS (Paris, 2009). He is currently a Researcher at Philosophy Center of Lisbon University and Assistant Professor at Oporto Lusophone University. His main research interests include the philosophy and psychology of selfhood, time and narrative. His major publication is a book entitled “La poétique de l’ipse: Etude sur le ‘je pense’ kantien” (Peter Lang, 2008, 508p.)

Title of the paper:

“Patient narrative, witness and clinical interpretation: lessons from a brain disease”

Abstract: It was usual during training in Neurology to learn that listen the patient was the best approach to know what kind of health problem he/she had. This approach was usual and determinant to the diagnosis. At the time clinical judgment was ahead from any complementary examination. Training in Neurology was, at that time, a rather elegant opportunity to discuss brain function and brain diseases. The trainers, recognized as excellent neurologists, teach us that patient history of illness (Anamnesis) was the most relevant factor for neurological diagnosis. In more clear terms: a neurologist as Corino de Andrade, that was at that time “our director” tell us that “to know what happens in a patient with a neurological disorder was necessary and fundamental to know the anamnesis”.

In present times, and in everyday practice, neurologists go back to the patient anamnesis to find out a good diagnosis. But, because doctors are driving patient narrative, more and more the doctor does not pay attention to what the patient says.

Doctors lose witness and patient narratives. Doctors commitment is more and more with “the things they can see” as imaging diagnostics than on “the things they tell me” – the patient and witness – the history of disease. Because doctors, more and more, adapt such narrative to the possible solution found on extremely powerful complementary examinations. Doctors are not thinking about what they listen. More and more doctors are thinking about what they see. And they see a lot of things on the exams that explore brain diseases.

A brain disease in which the narrative is many times the only key for the diagnosis - type or categorization and location or origin of the phenomena on a brain region – is the epilepsy. The narratives of seizure occurrence from patients with epilepsy – what they know and they feel on the development of epileptic seizure are splendid examples of narratives that we cannot miss. If we miss such narratives we also miss the diagnosis in terms of seizure description and classification and of seizure origin.

We took examples of such narratives from the literature. Narratives that are different if they belong from writers (such as Dostoevsky) or from renamed epileptologists (such as Hughlings Jackson). We will see how seizures description from patient (feelings, evolution), are different and most definitive to interpret patient behaviour and establish the location of the brain dysfunction.

Title of the paper:

“Regressing: From Interpretation to the Desire for Meaning”

Abstract: The academic tradition of studies on the problem of interpretation envisages its problem on the grounds of a silent presupposition: interpretation is anactivity. On the basis of this non-explicit formulated decision, interpretation has made itself prone to the kind of repeated and widespread criticism which in the last decades has turned into open skepticism concerning the explicit mechanisms of hermeneutic work, in particular in the field of the experience elicited by artistic objects.

The road from activity to passivity is regressive – the road taken by the effort that re-directs us from poiein to pathein –, and it may lead us to think the role of the desire for meaning as a type of small configurative operation underlying the large global meaning configurations which are at play in the hermeneutic field. Thus, the desire for meaning could be seen as the seminal factor generating a multiplicity of discourses that genetically show a legitimate tendency to escape from the work of rationalized conceptualization, while all along, from the point of view of their ulterior development, they may also be able to deflect their trajectory – under certain specific circumstances – towards the type of architectonic closing typical of the rationalized hermeneutic procedures.

Biographical information: José Miranda Justo (b. 1951) obtained his Ph.D. in 1990 at the University of Lisbon with a thesis on "Themes of Philosophy of Language in J.G. Hamann and J.G. Herder". He has taught since 1976 at the Faculty of Humanities of the University of Lisbon in the following areas: Philosophy of Language, History of Hermeneutics, Translation Theory, Modern and Contemporary Art, and Literary Theory. He is a member of the Research Center for Philosophy at the University of Lisbon where he currently leads a project on the translation of Kierkegaard’s works from Danish into Portuguese. He has published extensively on the above mentioned areas.

Title of the paper:

"La Narrative De L’Homme Souffrant"

Abstract:

La douleur qui se lamente s’enchâsse dans une forme, sort comme une chose

ou meurt pour devenir chose – puis au-delà s’echappe avec la félicité du violon

Title of the Paper:

"Mary Shelley's Frankenstein: Writing a Way out of Trauma"

Abstract: This paper looks not at the literary object Frankenstein, but rather at the process that led to its conception. Mary Shelley described the genesis of the story as follows:

Night waned upon this talk [of writing a ghost story] …When I placed my head on my pillow, I did not sleep, nor could I be said to think. My imagination, unbidden, possessed and guided me, gifting the successive images that arose in my mind with a vividness far beyond the usual reverie (Shelley, 1818; 8-9).

This description is reminiscent of a waking dream and bears very strong resemblances to the free associative process that Freud would later define. Shelley later described the summer of its conception as when I first stepped out from childhood into life (Sunstein, 1991; 117).

Despite the difficulties of her early life, the notoriety of her involvement with Percy Shelley, and the recurring bouts of depression she suffered as a young mother and wife, Mary Shelley led a highly productive and balanced if controversial life. In this paper, I propose that Frankenstein and the free association nature of its conception allowed her to write “her way out of trauma.”

Title of the paper:

“Representations of Illness in Contemporary Short-fiction: Some Portuguese and British Examples”

Abstract: In contemporary fiction one can find various examples of literary texts that deal with the theme of disease and the suffering that in most cases is linked with this condition. Disease and death in literature are often two inseparable subjects.

Through the analysis of three examples of contemporary short fiction my aim is to discuss the different representations of disease in short narratives by both Portuguese and British women writers.

The texts selected are “Cavalos nocturnos” by Teolinda Gersão, “O companheiro sinistro” by Maria Isabel Barreno and Where Three Roads Meet by Salley Vickers. In these narratives all the main characters are portrayed according to the way they deal with different kinds of disease. The construction of various fictional realms illustrates the myriad of possibilities associated with the theme of disease as an object of artistic representation.

Biographical information: Dr Ana Raquel Fernandes obtained her first degree at the Universidade de Lisboa, in Modern Languages and Literatures. She received an MA in Comparative Literature (Universidade de Lisboa, Centro de Estudos Comparatistas, 2004). Her thesis was published in a book entitled: O Pícaro e o Rogue. Sobrevivência e Metamorfose de Daniel Defoe a Julian Barnes (Lisboa: Colibri, 2006). She has recently completed her PhD entitled What about the Rogue? Survival and Metamorphosis in Contemporary British Literature (Universidade de Lisboa, Centro de Estudos Comparatistas, 2008). During her last research years she worked at the Department of Hispanic Studies at the University of Birmingham, U.K. Currently she is a researcher at the ULICES – University of Lisbon Centre for English Studies. She has been awarded a grant by the Fundação para a Ciência e Tecnologia, Portugal, to carry out research for her Postdoctoral work on the short story in contemporary British and Portuguese women’s writing. The research project will be carried out in joint collaboration with the Cátedra Gil Vicente in the University of Birmingham. She has also been conferred upon the title of Honorary Research Fellow in the School of Languages, Cultures, Art History and Music, University of Birmingham.

Title of the paper:

“Semiotics, Nursing and Meaning-making – the one-to-one relationship in professional care”

Abstract: The dichotomy health-illness is a fertile ground to be explored in terms of our understanding of the social, cultural and historical trends, paradoxes and challenges of each epoch or time period. The current transitional context of the post-industrial knowledge economy of the information era brings about specific concerns that affect all levels of production and consumption. This presentation focuses on the importance of the personal, one-to-one relationship in terms of the role it plays within the setting of professional health care. The processes of meaning creation are directly linked to the narratives that are created and recreated within these personal interactions. Semiotics, in particular bio and social semiotics, enable addressing these issues through a non-dualistic approach, integrating theory and practice, mind and body, interior and exterior and individual and social perspectives. Nursing theory and practice has acquired an autonomous position in contemporary society. In a close relationship with other health care professions and scientific knowledge areas it has created a specific narrative characterised by the integration of both formal and informal aspects of the nursing profession. The formal side includes norms, procedures, rules, statistics, standards, protocols and routines. Conversely, the informal side is embedded in phenomenological concerns where meaning-making emerges from the use of language, the being part of specific communities and the participation in social practices. Both formal and informal aspects are moulded by personal, one-to-one relationships. Even before formal-informal distinctions, all that is informal prefigures and determines that which will become formal later, i.e. all formal processes were informal first. The present paper argues that there is the need to further explore and disseminate these insights for the benefit of the patients, the professionals and society at large.

Biographical information: Angela Lacerda Nobre, born in 1960, has an academic background in nursing and economics, has a master in economics, a post-graduation in philosophy and a PhD in management, information systems stream (Semiotic Learning: a conceptual framework to facilitate learning in knowledge-intensive organisations). A. L. Nobre has professional experience as a nurse and as an economist; she has been working at a management school (esce.ips.pt) for the last twelve years and has published her research in the areas of semiotics, knowledge management and organisational learning.

Title of the paper:

Abstract: Pour nous, êtres humains, rien n’existe en dehors du vécu. Tout ce qui existe, doit être vécu par nous pour être. Ainsi, à tout point de vue, la vie phénoménologique est la seule réalité qui compte. Si chaque instant doit être vécu pour exister, il est aussi la seule certitude. Sans doute pas une certitude, qui doive être apprise de façon théorique ou être prouvée de l’extérieur, mais une certitude, qui est ressentie de façon immédiate. L’impression, la sensation, le sentiment est le nom pour cette vie immédiate, que je suis. Il n’existe aucun sentiment qui ne puisse dire « je », car le sentiment n’existe qu’en tant qu’il est ma vie. Ainsi chaque instant est ma vie, et il n’existe pas de vie comme généralité abstraite, par exemple la vie biologique des sciences, car elle serait sans sentir particulier, ce qui est absurde. Si chaque instant possède une valeur unique et éternelle, Nietzsche l’appelait l’ « enivrement » de la vie, Fichte la « félicité », Spinoza la « béatitude », le Nouveau Testament la « vérité ». C’est le sentiment d’être dans la vie de façon absolue – la joie d’éprouver le « bonheur indicible de la vie », comme disait Michel Henry pour caractériser cette « narration immanente » du pathos selon une phénoménologie radicale de la vie.

Biographical information: Rolf Kühn, né en 1944 en RFA, études de philosophie et de théologie à la Sorbonne et à l’Institut Catholique de Paris ; professeur de philosophie aux Universités de Vienne, Beyrouth, Nice, Lisbonne, Fribourg-en-Brisgau; traductions de Michel Henry en allemand; maintes publications sur la phénoménologie actuelle, dont en langue française: Radicalité et passibilité. Pour une phénoménologie pratique, Paris, L’Harmattan, 2003 (cf. htp://www.michelhenry.de/kuehn.pdf.).

Title of the paper:

“La présence des œuvres d’art à l’hopital : une consolation”

Abstract: Que voit-on dans un hôpital? Dans les lieux de circulation, dans les chambres des malades ou les salles de recueillement, il n’y a le plus souvent et au mieux des reproductions d’œuvres d’art qui correspondent au goût moyen – impressionnisme, Klee, Matisse.

Certains hôpitaux passent commande à des artistes contemporains. Je m’interrogerai - à partir d’ exemples français d’aujourd’hui et de quelques décors historiques – sur l’engagement des artistes et la fonction attribuée aux œuvres d’art dans des lieux de douleur et d’affliction. Memento mori, consolation, apaisement. Les œuvres d’art peuvent aider à mettre en forme la douleur, à préserver la vie jusqu’à sa fin, à restituer la confiance par un « don de beauté » qui tient à leur consistance propre. Mais il faut que ce soit des œuvres et non des reproductions, qu’il y ait une œuvre « vraie », « réelle » et non une reproduction, une image décorative et ornementale. Je tenterai d’expliquer pourquoi.

Biographical information: Philosophe, Danièle Cohn enseigne l’esthétique à l’Ecole des hautes études en sciences sociales. Elle a publié La Lyre d’Orphée, Goethe et l’esthétique (Flammarion 1999) Y voir mieux, y regarder de plus près, autour d’Hubert Damisch (Editions Rue d’Ulm, 2003) Anselm Kiefer au Grand Palais, (éd. Du Regard , 2007), Daniel Arasse, historien de l’art ( Editions des Cendres, 2010), et traduit et édité en francais Dilthey, Panofsky, et Fiedler. Elle dirige aux Editions Rue d’Ulm la collection AESTHETICA, appartient à de nombreux comités de rédaction de revue et participe à des catalogues d’exposition. Visiting Professor à Johns Hopkins University, Baltimore et à la Freie Universität, Berlin, titulaire de la chaire Marc Bloch (Berlin, Humboldt Universität) en 2008-2009, scholar au Getty Research Institute ( Los Angeles 2009-2010) elle écrit actuellement, pour les éditions Hazan, L’esthétique, les arts et le sens commun.

Title of the paper:

“Can you die from not being listened to?”

Abstract: This paper focuses on the relational nature of narrative, namely on the interdependence between speaking and listening, and the mutual responsibility that binds speaker and listener in a desirably non-authoritarian environment.

Though noting how relevant this issue is in every interpersonal and intercommunal relation, I shall specifically address its ethical implications within the medical setting. Drawing both on a personal testimony that instances how vital it is to listen, and on existing literature of patients’ stories and doctors’ reflections on the doctor-patient relationship, I argue that these contributions highlight the insufficiencies of inherited positivistic models and ingrained practices, and suggest a range of aspects that need to be included in medical training and clinical practice, starting with the awareness that the relational component of medicine is not merely critical to providing more humane medical care: it is also critical to providing better clinical care, starting with diagnosis.

I therefore propose that caring for the patient, and attending to the experience of illness and the prospect of death, requires that health care providers be trained to deal with the intra- and interpersonal implications of their own daily exposure to our common vulnerability, embodied creatures that we are.

Biographical information: I graduated in Modern Languages and Literatures at the University of Oporto, Portugal, and hold a Ph.D. in Literary Studies from the University of Lisbon, where I am an Assistant Professor lecturing in English, Irish Studies, and Literary Translation. My research interests include fictional and non-fictional literary narrative, memory, the disabling effects of violence and the challenge they pose to our response-ability so as to find enabling modes for interpersonal and communal relations.

Title of the paper:

“On the limits of Narrating Suffering”

Abstract: In extending my earlier work on the limits of knowing Suffering, I would like to discuss here the limits of narrating Suffering. The paradigmatic cases of silent pain and unvoiced sufferingare distinguished precisely by our inability to translate certain sensory or emotional experiences into communicable concepts that testify to our awareness and clear representation of the situation. These cases serve as fundamental structures in the general layout of Suffering, exposing the possibility that a person in a state of unaware suffering may be engaged in a totally different mode of experiencing: a manner that does not enhance the “power of knowing” but which does offer a different outlook by explaining why the lived and felt is not always intelligible.

Yet, the problem with these prototype cases is not only that they are insufficiently recognized and thus mistakenly considered as puzzling exceptions in the area of pain research which scientific progress should ultimately be able to resolve. But even if we recognize their possibility, deciphering them remains challenging. In viewing pain as something that may be experienced beyond the level of knowledge (see Elaine Scary on the one hand and the French Post-phenomenological tradition on the other), we wonder what conveys these objectless, non-conceptualized lived moments that resist representation and often remain wordless. In order to answer this question, I will defend the idea that Suffering/Pain may fall out of words but not out of language, showing how the wounded can still speak to us in a manner that does not obey the rules of narration (whether spoken or written) but which demonstrates the impact of the pre-reflective dimension in life. A dimension that is very decisive, after all, in determining the nature and the meaning of Pain.

Biographical information: Dr. Bustan Smadar. Double PhD in philosophy (Sorbonne/University of Tel-Aviv). Co-founder of the Interdisciplinary Working Group on Suffering and Pain (Harvard. Feb. 2008). http://www.suffering-pain.net/. Now at the University of Luxembourg

She has written on German phenomenology, French contemporary philosophy and more recently, on the possible bridge between Continental and American philosophies. She has translated three books. Her project on suffering is a long-term research plan, underlying her thesis on pre-reflectivity, the conductive thread of a planned trilogy: The first book in ethics "From Intellectualism to Ethics - Emmanuel Levinas and the phenomenology of Edmund Husserl" (ed. Ousia, Jan. 2011). The second book demonstrates the role of pre-reflectivity in the social and political domains. The third book, a treaty on suffering and pain, intends to show a post-phenomenological way of linking the body and the mind.

Title of the paper:

"Screams, Shouts and Silences. The noise of the wor(l)d and the impossibility of narrative"

Abstract: In my presentation I want to talk about how my academic research into the literature of Nonsense was induced by the encounter of a radical other (Lévinas) for whom language remained divorced from meaning and emotion. Intentionally ignoring medical and scientific descriptions and explanations, I want to speak about what it takes to step into unmapped territory, where conceptual categories are of no avail and where “making sense of things” demands leaps into points of view that question the basic assumptions with which we categorize, reflect, think and construct narratives. What I have learned (from living with a person diagnosed with childhood development disorder/autism and from living in a foreign language and culture) is that each speech situation (Murdoch) depends on “necessary nonsense”: the engagement of all our senses in the postures of our bodies (Hall), the material dimension of language (Kristeva and Hoffman) and the ethological word (Cyrulnik). The pre-condition of narrative, so it seems, is a pre-verbal capacity to establish contact with the other so that body language and sounds do not appear as signs of attack but as means of connection that build “the common road upon which we are all embarked” (Charon).

When the pre-verbal capacity to connect is absent, nonsense syllables may coax the other into a realm where proximity, eye-contact, touch and sound become tolerable and pave the way for words, sentences and narratives where meaning is in a most literal way carved out of the material support of language.

Biographical information:

- Flemish and Portuguese. Assistant Professor at the University of Lisbon. Researcher at Ulices (Group 4).

- Research topics:

• The Literature of Nonsense and the communicative potentialities inherent in language form.
• Canadian Literature

- Some Publications:

• “Nonsense and Other Senses”, in Tarantino, Elizabetta (ed.) Nonsense and other Senses. Regulated Absurdity in Literature (Cambridge Scholars Publishing, 2009). Ch. XIII, pp. 259-274.
• ‘Peter Ibbetson’ or the Limbo of Memory”. Revista Anglo-Saxónica, Série II. Nº 18, 2003, 213-230.
• "Dissemination: Dickens, David, Mr Dick and Derrida", Revista Anglo-Saxónica, Série II, nºs 16717, Lisboa: Edições Colibri, 2002, pp. 382-408.

Title of the paper:

“William Shakespeare and the Representation of Female Madness”

Abstract: Starting with a quotation from a letter by the Portuguese poet Fernando Pessoa, this paper makes a comparison between his gendered conception of hysteria and the Shakespearian representation of male and female madness in two of Shakespeare’s tragedies: Hamlet and Macbeth.

The characters of Ophelia and Lady Macbeth are approached in terms of their differences and similarities, and also in contrast with their male counterparts, in plays which deal with insanity as a central topic. By means of an analysis which includes notions from Sigmund Freud, Michel Foucault and Elaine Showalter, as well as references to visual representations of the characters, we may come to the conclusion that in these Shakespearian plays female madness tends to be expressed through “silence and poetry”.In fact, the silencing of female voices and the interiorization of their emotions are here presented by William Shakespeare as a way for self-destruction, eventually culminating in suicide, and in the supreme silence of death.

Biographical Information: Maria Isabel Barbudo is Associate Professor on Habilitation in the English Department of the Faculty of Letters, University of Lisbon, and has been a researcher of CEAUL/ULICES since its foundation.

She has taught undergraduate courses on English literature from the 16^th to the 20^th century and English cinema, and postgraduate courses focusing mainly on British drama from the 16^th to the 20^th century. Besides some prefaces and several articles and essays on British drama, published in specialized journals, she has written a book on British comedy of manners and the intersection of ethics and comedy. As a CEAUL/ULICES researcher, she has also dedicated herself to the translation of British plays into Portuguese.

Title of the paper:

Title of the paper:

“Bring the patient in!”

Abstract: This presentation is about the importance I attribute in nursing to the two-way process of talking and listening to the patients; how this helps bringing them into their own care through their own stories about past and present life experience.

It is based on true patients with whom I came across throughout my nursing studies and career, such as a French cuisine cook and a lady with physical and learning disabilities. I shall maintain the principles of confidentiality throughout this presentation. These case studies and the narratives they enclose have taught me how crucial understanding these stories can be for doctors, nurses and patients and the potential bridges that can be built throughout the patients’ care and journey in a hospital setting.

It aims at being a reflection about the importance of these stories for an approach suited to each individual patient and for an effective treatment. It also aims at demonstrating how stories can often carry a richness of information which often does not fit in any yes/no questionnaire or form but which is extremely valuable. This can be picked up and worked around and then it may even integrate our care-plans serving the interest of the patients, healthcare workers, student nurses, or even relatives/friends of those patients.

Above all, sharing these stories is the main aim of this presentation, hoping that they enhance the potential therapeutic effect of narratives in nursing and maybe in healthcare as a whole.

Biographical information: After a Degree in Biology concluded in Lisbon in 2006, Maria Albino decided to go to London and start a Diploma in Higher Education in Nursing. The necessity of being with people and working with people made her leave behind nature, the labs and the field work and embrace a totally different pathway. She has now been working for 2 years as a staff nurse in a surgical ward at Kings College Hospital in London and wishes to pursue a career in this field. At the same time she has been an interpreter for Portuguese patients across various hospitals in London.