Narrations have been able to influence medicine, giving rise to a new approach call " narrative medicine ". In this paper we consider the patient as a text, such is, an open book that the physician intervenes, but also from which the physician may and need to learn a lot. To deepen a little in the narrative perspective of patient understanding and his/her situation helps us to discover how the patient is object of compassion by physicians, (...) but also how he/she turns into subject of compassion. We conclude that it is important for physicians to dedicate time in their initial medical training, as well as in their permanent training, to explore and exploit the value of narrations, that help them to categorize their living experiences and that of the patients. -/- As narrativas estão chegando a influenciar na medicina, dando origem a uma nova abordagem chamada " medi-cina narrativa ". Neste trabalho consideramos o paciente como um texto, em outras palavras, um livro aberto que o médico intervém, mas também, que deve aprender muito. Aprofundar-se um pouco na perspectiva narrativa da compreensão do paciente e de sua situação ajuda a descobrir como o paciente é objeto da compaixão dos médicos, embora também como se converte em sujeito desta compaixão. Concluímos que é importante que os médicos dediquem mais tempo em sua formação médica inicial, bem como em sua formação permanente, para explorar o valor das narrativas que ajudam a categorizar suas experiências e a dos pacientes. -/- Las narraciones han llegado a influir en la medicina, dando lugar a un nuevo enfoque llamado " medicina narrativa ". En este trabajo consideramos al paciente como un texto, es decir, un libro abierto que el médico interviene, pero también del que el médico puede y necesita mucho aprender. Ahondar un poco en la perspectiva narrativa de la comprensión del paciente y de su situación nos ayuda a descubrir cómo el paciente es objeto de la compasión de los médicos, pero también cómo se convierte en sujeto de esa compasión. Concluimos que es importante que los médicos dediquen tiempo en su formación médica inicial, así como en su formación permanente, a explorar y explotar el valor de las narraciones, que les ayuden a categorizar sus experiencias vividas y las de los pacientes. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Selon l’une des thèses les plus répétées de la médecine narrative, la théorie littéraire, ou plus largement, la narration, permettrait aux membres du personnel médical d’appréhender les récits des patients et par là, de prendre en considération leurs expériences dans leur singularité absolue. Dans ma contribution, je soulignerai quelques limites de cette thèse. J’appuierai mon analyse sur un exemple de récit dominant de maladie, les récits portant sur le cancer du sein aux États-Unis au XXe siècle, à partir des (...) analyses féministes qui en ont été faites. Ainsi je montrerai d’une part qu’il est peu plausible que les récits des patients soient absolument singuliers et uniques, en un sens pertinent, et d’autre part que certains récits peuvent devenir dominants et marginaliser des récits qui voudraient s’en démarquer. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these (...) approaches is problematically reduced to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

A brain death case is presented and reinterpreted using the narrative approach. In the case, two Japanese parents face a dilemma about whether to respect their daughter’s desire to donate organs even though, for them, it would mean literally killing their daughter. We argue that the ethical dilemma occurred because the parents were confronted with two conflicting narratives to which they felt a “narrative responsibility,” namely, the responsibility that drives us to tell, retell, and coauthor the (often unfinished) (...) narratives of loved ones. We suggest that moral dilemmas arise not only from conflicts between moral justifications but also from conflicts between narratives and human relationships. (shrink)

Many people report that reading first-person narratives of the experience of illness can be morally instructive or educative. But although they are ubiquitous and typically sincere, the precise nature of such educative experiences is puzzling—for those narratives typically lack the features that modern philosophers regard as constitutive of moral reason. I argue that such puzzlement should disappear, and the morally educative power of illness narratives explained, if one distinguishes two different styles of moral reason: an inferentialist style that generates the (...) puzzlement and an alternative exemplarist style that offers a compelling explanation of the morally educative power of pathographic literature. (shrink)

Positivist medical historians, guided by the savoir of modern western biomedicine, have long depicted medieval medicine as an aberration along the continuum of scientific and medical progress. Historical epistemology, founded in the ideas of Cavailles, Foucault, Davidson, and Hacking, however, allows the historian to disrupt this false continuum and to unchain medieval medicine from modern medicine. Postmodernist approaches, such as those sourced in Lyotard, Barthes, and Derrida, allow the historian to further deconstruct medieval and modern medical discourse, (...) revealing a multitude of narrative lenses spinning around biomedical and biocultural strands. In liberating these two medical systems and setting them within the distinct historical and epistemological contexts that both shaped and were shaped by them, the historian can revision the theories, practices, and culture of medieval medicine without having to anachronistically justify them according to modern medical discourse. (shrink)

Near-death experiences have been described with a variety of forms and narratives. Different medical conditions leading to loss of consciousness or causing a restriction in the perceptive field have been related with the appearance of near-death experiences. A few literary narratives of these experiences are available, with fictional characters exposed to helplessness and despair during the impending death. A situation of near-death experience is described in the last part of the seventh chapter of an Albanian novel „The castle‟ of Ismail (...) Kadare. The last two pages of this chapter describe the confusion following the crash of a tunnel dug deep underground from Turkish soldiers, which aimed to reach inside a besieged castle. Darkness-related hallucinations and restriction of cognitive field due to environmental factors will be responsible of the aftermath following the deliberate crash of the tunnel, caused from the castle inhabitants, after fierce fighting during the siege. A fictional description of these experiences and of the psychological and physical agony will complete the rest. Near-death moments and respective descriptions have been an important field of medicine, humanities and forensic sciences. Only some writers have hazarded into describing such personal experiences of despair and helplessness during the agony and impending death. (shrink)

Metaphysics, seen as a legitimizing narrative or a paradigm (Lyotard, 1984), prop up a certain practice in providing the basis for its assumptions. While Western medicine can be properly characterized as governed by a biophysical model (Hewa, 1994; Bates, 2002), such a model for traditional healing practices in the Philippines has yet to be derived. No philosopher has attempted to derive an indigenous metaphysics from traditional healing practices. The only study made so far (Fajardo & Pansacola, 2013), however, (...) needlessly pigeonholes these unique practices into incommensurable Western scientific concepts. While they collated data from healers all over the country, they attempted to use Western scientific concepts such as oxygen, carbon, electro-magnetic force, and others. These concepts dangerously obfuscate indigenous understandings of the human body and reality as a whole since they are directly lifted from a language and practice informed by Western metaphysics. Therefore, there has yet to be an adequate extraction of a locally derived metaphysics that informs and self-legitimizes these medicinal practices. Conscious of recent critiques to homogenizing tendencies in Philippine Studies (Guillermo, 2009) and Filipino philosophy (Pada, 2014; Abulad, 2016), specifically that of Mercado (1972) and Timbreza (2017), I attempt to derive a Filipino metaphysics from the traditional healing practices of two traditional healers in San Mateo, Rizal of the Southern Tagalog Region in Luzon through a particularist anthropological approach in Filipino philosophy. I derive four distinct characteristics of this metaphysics which are distinct from the biophysical presuppositions of Western medicine: (1) a law of conservation based on the concept of “balik,” (2) predestination, (3) an ontological dualism between the visible and the invisible, and (4) the performativity of words as utterances. (shrink)

The internet of things is increasingly spreading into the domain of medical and social care. Internet-enabled devices for monitoring and managing the health and well-being of users outside of traditional medical institutions have rapidly become common tools to support healthcare. Health-related internet of things (H-IoT) technologies increasingly play a key role in health management, for purposes including disease prevention, real-time tele-monitoring of patient’s functions, testing of treatments, fitness and well-being monitoring, medication dispensation, and health research data collection. H-IoT promises many (...) benefits for health and healthcare. However, it also raises a host of ethical problems stemming from the inherent risks of Internet enabled devices, the sensitivity of health-related data, and their impact on the delivery of healthcare. This paper maps the main ethical problems that have been identified by the relevant literature and identifies key themes in the on-going debate on ethical problems concerning H-IoT. (shrink)

Narrative medicine explores the stories that patients tell; this paper, conversely, looks at some of the stories that patients are told. The paper starts by examining the ‘story’ told by the Shambaa people of Tanzania to explain the bubonic plague and contrasts this with the stories told by Ghanaian communities to explain lymphatic filariasis. By harnessing insights from memory studies, these stories’ memorability is claimed to be due to their use mnemonic devices woven into stories. The paper suggests (...) that stories can be unpatronising, informative, and appropriate vehicles for communicating medical information to all age groups across all cultures. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, (...) I will describe our dominant model, which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

The illness immersion condition prevents patients from enjoying everything worth living life for. In any case, according to Frank, this condition could represent one of the most insightful experiences towards understanding the meaning of life. Using the metaphor of phoenix taken from May, Frank identified four kinds of embodiments through which the phoenix can reveal itself in a patient after an illness immersion experience: the phoenix that could ever be and the phoenix that might have been; the recurrent and cumulative (...) phoenix and the reluctant phoenix. Based on these considerations, a qualitative study was conducted in order to give voice to the different phoenix embodiments focusing on several autobiographies of patients afflicted with severe or terminal illness. The analysis highlights several similarities that the different phoenixes shared ; however, a deep difference emerged in their worldview which proves able to lead them towards different epiphanies. These evidences reveal that every sick person should be understood, stimulated and accompanied throughout his lived experience of illness by an expressly designed and dedicated care. (shrink)

The increased complexity of health information management sows the seeds of inequalities between health care stakeholders involved in the production and use of health information. Patients may thus be more vulnerable to use of their data without their consent and breaches in confidentiality. Health care providers can also be the victims of a health information system that they do not fully master. Yet, despite its possible drawbacks, the management of health information is indispensable for advancing science, medical care and public (...) health. Therefore, the central question addressed by this paper is how to manage health information ethically? This article argues that Paul Ricœur’s ‘‘little ethics’’, based on his work on hermeneutics and narrative identity, provides a suitable ethical framework to this end. This ethical theory has the merit of helping to harmonise self-esteem and solicitude amongst patients and healthcare providers, and at the same time provides an ethics of justice in public health. A matrix, derived from Ricœur’s ethics, has been developed as a solution to overcoming possible conflicts between privacy interests and the common good in the management of health information. (shrink)

Despite centuries of colonization in the Philippines, the traditional Filipino healing system has survived. However, as modern education has continued to spread and Western medicine has grown in influence, traditional healing practices have been pushed to the margins and labeled as unscientific or mere superstition. This also suggests that unrecorded information may be lost forever. For future generations to appreciate this rich cultural heritage, cultural mapping of traditional healers in a local community is necessary. Thus, the researcher explored, identified, (...) documented, and analyzed the cultural profile of the traditional healers in a local community. Specifically, he studied the (1) background information, (2) description of the intangible cultural heritage, (3) stories/narratives associated with traditional healing, (4) significance of the practice, (5) assessment of the practice, and (6) references/supporting documentation of the traditional healers. The study was conducted in one of the local communities in the province of Quezon. The research participants were selected using inclusion criteria, and 11 traditional healers served as the key informants of the study. This study also employed qualitative research through cultural mapping, and pertinent data were obtained using participant observation, documentation, and interview guides. Qualitative content analysis was used in analyzing the gathered data. The findings revealed that the traditional healers have diverse background information, reflected in the element types, the geographical location and range of the element, and the related domains of the intangible cultural heritage. Likewise, the description of the intangible cultural heritage gave a wide array of descriptions of the history of practice, occasion/season, processes, and procedures involved, beliefs associated, settings, aims, social functions, and cultural meaning, culture bearer/s and practitioner/s of the element, mode of transmission, list of significant tangible movable heritage used associated with the element and list of significant flora/fauna used associated with the element. Meanwhile, spiritual guides and supernatural claims, healing severe cases, and being accused of malpractice or maltreatment were some of the stories/narratives associated with the element. In addition, traditional healing has historical, aesthetic, scientific, social, socio-economic, socio-political, and spiritual significance. Moreover, the assessment of practice exposed the condition/status of traditional healing, which is in danger because of the elderliness of the traditional healers and because no one is accepting the knowledge and practices. Furthermore, the constraint, threat, issue, or challenge experienced by the traditional healers is making false accusations against them. Nevertheless, traditional healers have identified several safeguarding measures in their traditional healing practice. These are transmission through informal education, identification, documentation, research, promotion, enhancement, and revitalization. Finally, sacred texts, books, pictures, prayers, and saints are the references or supporting documentation used in traditional healing. Based on the findings and conclusions, it is recommended to utilize the two research outputs: “Kaalaman at Kasanayan: Cultural Profile of Traditional Healers,” a booklet, and “Tanging Healing,” a documentary film about traditional healing for the preservation of local heritage, community development, and heritage education. (shrink)

Lockdowns, or modern quarantines, involve the use of novel restrictive non-pharmaceutical interventions (NPIs) to suppress the transmission of COVID-19. In this paper, I aim to critically analyze the emerging history and philosophy of lockdowns, with an emphasis on the communication of health evidence and risk for informing policy decisions. I draw a distinction between evidence-based and modeling-based decision-making. I argue that using the normative framework of evidence-based medicine would have recommended against the use of lockdowns. I first review the (...) World Health Organization’s evidence-based pandemic preparedness plans for respiratory viruses. I then provide a very brief history of COVID-19 modeling, which was cited as justification for the use of lockdowns in the U.K., the U.S., and much of the world. I focus on the so-called Imperial College model designed by Neil Ferguson et al. as well as the so-called Oxford model designed by José Lourenço et al. I analyze the evidence-based pandemic response known as ‘mitigation’, and I compare it with Ferguson et al.’s experimental strategy known as ‘suppression’. I summarize the strengths and weaknesses of these strategies based on their diametric aims and each model’s parametric assumptions. Based on my critical analysis of the suppression strategy, I attempt to expose what has been called the ‘logic of lockdowns’, which Sunetra Gupta of the Oxford model group has suggested is flawed. Finally, I consider Trisha Greenhalgh’s objection to evidence-based policy based on the precautionary principle, and I attempt to offer a response. I conclude with a brief narrative review of the emerging randomized evidence on restrictive NPIs, which seems to support my claim that mitigation was the strategy that would have been recommended by evidence-based medicine. If this is true, then COVID-19 modeling may serve as an important reminder of the enduring lesson of evidence-based medicine: that one should always ‘Trust the Evidence!’ for better health policy. (shrink)

The rapid increase of the old age people imposes the reconsideration of the rehabilitation techniques and procedures and/or the development of the existing ones, at least from two points of view: the limitation use of the pharmaceutical drugs because of their secondary effects in the debilitated organisms and their avoidance; the high risk of the induced anxiety states, depression or other symptoms as a consequence of the main disease, i.e. the neuro-degenerative or mobility dysfunctions, limiting again the use of such (...) excessive drug medication. Moreover, Alzheimer’s or Parknson’s diseases are otherwise incurable, so the application of rehabilitating procedures like music-based therapy becomes preferential. The advances both in the identification of the specific auditory musical-sensitive circuits and of the non- musical neuro-connections but activated indirectly by music, otherwise inaccessible by other techniques, and in the understanding of consciousness, which can be described by seven cognitive centers, allows to improve and develop the music based therapy. A multitask procedure based on the activation of these cognition centers is presented, allowing to increase the personal psychical engagement of the patient in the recommended music based therapeutic program, addressed both to the rehabilitation of the main degenerative disease and to the secondary induced dysfunctions. This procedure combines the evidence based medicine assisted by laboratory expertise for the determination of a correct diagnostic, and narrative based medicine allowing to quantify the personal engaging qualities of the patient with respect to the proposed music based program, reducing in this way the gap between these two basic procedures and bringing in a first plane the patient care, not only the disease, with beneficial consequence for the therapy efficiency and for the patient-medical care relations. (shrink)

Foucault’s argument that a major break occurred in the nature of power in the European Eighteenth century—an unprecedented socialization of medicine and concern for the health of bodies and populations, the birth of biopolitics—has become since the 1990s a dominant narrative among sociologists but is rarely if ever scrutinized in its premises. This article problematizes Foucault’s periodization about the politics of health and the way its story has been solidified into an uncritical account. Building on novel historiographic work, (...) it challenges the modernist bias of histories of biopolitics and public health and considers an earlier and more plural history of collective practices of health of which the story told by Foucault is just one important episode. Finally, it discusses the implications of this revised model for wider sociological debates on the link between modernity, health and the body. (shrink)

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; (...) and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

According to the biomedical model of medicine, the subject of the illness event is the pathology rather than the person diagnosed with the disease. In this view, a body-self becomes a ‘patient’ body-object that can be enrolled in a therapeutic protocol, investigated, assessed, and transformed. How can it be possible for cancer patients to make sense of the opposite dimensions of their body-self and their body-diseased-object? Could a creative embodied approach enable the coping with trauma tied to the experience (...) of illness? By applying a phenomenological approach and auto-ethnographic analysis to the experience of cancer, this visual exploration provides support for rethinking the cancer event through a performative perspective. This work previews images and video material collected over ten years of haematological treatments, video dance performances and physical explorations. This work displays how processes of healing can be set in motion by creative embodied practices, physical explorations and unexpected journeys. By resisting the biomedical model and allowing the emergence of new meanings, it illustrates how dance and performative practices offer ground for transformation. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty and (...) blepharoplasty in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

Modern scientific communication traditionally uses visual narratives, such as comics, for education, presentation of scientific achievements to a mass audience, and as an object of research. The article offers a three-level characterization of the interaction of comic culture and science in a diachronic aspect. Attention is focused not only on the chronological stages of these intersections, the expression of the specifics of the interaction is offered against the background of scientific and public discussions that accompany the comics–science dialogue to this (...) day. Within the framework of the first stage (the appearance and distribution of popular science and educational comics), the characteristics of comics content necessary for the different genesis are highlighted: documentary storytelling, educational practices of learning through drawing, active cooperation with well-known companies and institutions, informativeness and empathic involvement of the young reader in a heroico-romantic narrative of scientific discoveries and mastering nature. With the intensification of interdisciplinary approaches (the second stage), comics are increasingly involved in presenting scientific results within the most diverse fields. Comics-based research is becoming an interdisciplinary method and a widespread practical area with the corresponding formation of scientific tools (applied comics, data comics), forms of interdisciplinary interaction (graphic medicine, ethnography, narrative geography, urban comics, comics journalism, etc.), and scientific publications (“The Comics Grid: Journal of Comics Scholarship”, “Sequentials”). The national format of comics-based research is presented on the example of Ukrainian comics projects (historical, feminist comics). In the genesis of development, Comics Studies have gone from a field of research to disciplinary definitions. In the creation of the metadiscourse of the scientific direction (the third stage), the authors focused on scientific discussions, the formation of academic directions and approaches, and markers of disciplinary self-identification. Emphasis is placed on the unique phenomenon of the simultaneous concordance of various stages of the dialogue between comics and science, on the prolonged replication of successful inventions into modern experience, and the active testing of known narratives at new levels of a scientific presentation. (shrink)

In a "parenthesis of fascinated horror" before "the complete discovery and subjection of the body to science", Renaissance anatomists and poets shared peculiar emotions of dread and desire towards the bodies they dissected and described. Jonathan Sawday's ambitious project is to evoke the common taboos, resistances, and fears which the human body provoked in its various early modern investigators, while telling "stories of terrible cruelty, which are tinged by a form of dark eroticism". He is justifiably proud of the historical (...) range of his study, across medicine, cartography, literature, the law, myth, art, theology, social history, and philosophy. But he seeks more than a synthesis of these disparate domains, hoping also both to sketch a new grand narrative about conceptual, practical, and phenomenological changes regarding the body, and further "if not to dispel, then at least to explain" our own multiple, ambiguous feelings about our innards. Thus he marvellously maintains simultaneous attention to culture and psychology, combining high theory with historical precision in rare and risky fashion. (shrink)

In this essay, I develop the concept of episodic value, which describes a form of value connected to a particular object or individual expressed and delivered through a narrative. Narrative can bestow special kinds of value on objects, as exemplified by auction articles or museum collections. To clarify the nature of episodic value, I show how the notion of episodic value fundamentally differs from the traditional axiological picture. I extend my discussion of episodic value to argue that the (...) notion of episodic value readily incorporates the role of narratives into the construction of identity in personal and social contexts. My main contentions are twofold. First, events or experiences from our personal narratives are episodically valuable insofar as they contribute to shaping our narrative identities. Second, when engaged in a collective action, we write a joint narrative with other participants that confers special meanings on the actions of each participant. (shrink)

The deceptive clues in the impossible puzzle film confirm the viewer’s internal expectations and allow retrospective attributing. In the film, a transcendental object negates an internal expectation, causing a retrospective blockage. Retrospectivity does not stop there; the transcendental object reinterpreting deceptive clues in the associative area leads to repeated attribution. This article consists of three parts. First, it discusses impossible puzzle films in the context of complex narrative classification. The following section introduces the Jungian concept of synchronicity and illustrates (...) how it works. The article concludes with a case study of Long Day’s Journey into Night (2018), which contains more complicated puzzles and explains how mind-game narrative techniques create deceptive clues and induce deceptive retrospective attribution. (shrink)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, (...) that of the common good as a goal in medicine. (shrink)

In this article, I outline various ways in which artifacts are interwoven with autobiographical memory systems and conceptualize what this implies for the self. I first sketch the narrative approach to the self, arguing that who we are as persons is essentially our (unfolding) life story, which, in turn, determines our present beliefs and desires, but also directs our future goals and actions. I then argue that our autobiographical memory is partly anchored in our embodied interactions with an ecology (...) of artifacts in our environment. Lifelogs, photos, videos, journals, diaries, souvenirs, jewelry, books, works of art, and many other meaningful objects trigger and sometimes constitute emotionally-laden autobiographical memories. Autobiographical memory is thus distributed across embodied agents and various environmental structures. To defend this claim, I draw on and integrate distributed cognition theory and empirical research in human-technology interaction. Based on this, I conclude that the self is neither defined by psychological states realized by the brain nor by biological states realized by the organism, but should be seen as a distributed and relational construct. (shrink)

Is the self narratively constructed? There are many who would answer yes to the question. Dennett (1991) is, perhaps, the most famous proponent of the view that the self is narratively constructed, but there are others, such as Velleman (2006), who have followed his lead and developed the view much further. Indeed, the importance of narrative to understanding the mind and the self is currently being lavished with attention across the cognitive sciences (Dautenhahn, 2001; Hutto, 2007; Nelson, 2003). Emerging (...) from this work, there appear to be a variety of ways in which we can think of the narrative construction of the self and the relationship between the narrative self and the embodied agent. I wish to examine two such ways in this paper. The first I shall call the abstract narrative account, this is because its proponents take the narrative self to be an abstraction (Dennett, 1991; Velleman, 2006). Dennett, for example, refers to the self as a centre of narrative gravity, to be thought of as analogous to a mathematical conception of the centre of gravity of an object. The second I shall call the embodied narrative account and this is the view that the self is constituted both by an embodied consciousness whose experiences are available for narration and narratives themselves, which can play a variety of roles in the agent’s psychological life. (shrink)

Several scholars observed that narratives about the human past are evaluated comparatively. Few attempts have been made, however, to explore how such evaluations are actually done. Here I look at a lengthy “contest” among several historiographic narratives, all constructed to make sense of another one—the biblical story of the conquest of Canaan. I conclude that the preference of such narratives can be construed as a rational choice. In particular, an easily comprehensible and emotionally evocative narrative will give way to (...) a complex and mundane one, when the latter provides a more coherent account of the consensually accepted body of evidence. This points to a fundamental difference between historiographic narratives and fiction, contrary to some influential opinions in the philosophy of historiography. Such historiographic narratives have similarities with hypotheses and narrative explanations in natural science. (shrink)

This paper responds to Saul Fisher’s critical note (in the current volume) on Peter Lamarque and Nigel Walter’s ‘The Application of Narrative to the Conservation of Historic Buildings’ (Estetika 1/2019). Walter restates the argument, underlining the context of ‘living' buildings whose identities are still in formation. He then responds to points raised by Fisher, commenting on persistence and identity, Noël Carroll’s views on narrative connection, the usefulness of Carroll's engagement with spatial relations, and addressing some of Fisher’s specific (...) challenges. Lamarque then comments, framing the central question as whether conservation work to a building preserves its character, integrity, and coherence, noting that these are core aspects of narrative, before concluding with some reflections on the application of metaphor, including the metaphorical personification of buildings. (shrink)

Memories of our personal past are the building blocks of our narrative identity. So, when we depend on objects and other people to remember and construct our personal past, our narrative identity is distributed across our embodied brains and an ecology of environmental resources. This paper uses a cognitive niche construction approach to conceptualise how we engineer our memory ecology and construct our distributed narrative identities. It does so by identifying three types of niche construction processes that (...) govern how we interact with our memory ecology, namely creating, editing, and using resources in our memory ecology. It also conceptualises how identity-relevant information in objects and (family) stories is transmitted vertically, i.e., across different generations of people. Identifying these processes allows us to better understand the cultural information trajectories that constitute our memory ecologies. Thus, what I’ll argue is that our memory ecology distributes our narrative identity and that engineering our memory ecology is a form of narrative niche construction. (shrink)

I argue against two popular claims. The first is a descriptive, empirical thesis about the nature of ordinary human experience: ‘each of us constructs and lives a “narrative” . . . this narrative is us, our identities’ (Oliver Sacks); ‘self is a perpetually rewritten story . . . in the end, we become the autobiographical narratives by which we “tell about” our lives’ (Jerry Bruner); ‘we are all virtuoso novelists. . . . We try to make all of (...) our material cohere into a single good story. And that story is our autobiography. The chief fictional char- acter . . . of that autobiography is one’s self’ (Dan Dennett). The second is a normative, ethical claim: we ought to live our lives narratively, or as a story; a ‘basic condition of making sense of ourselves is that we grasp our lives in a narrative’ and have an understanding of our lives ‘as an unfolding story’ (Charles Taylor). A person ‘creates his identity [only] by forming an autobiographical narrative – a story of his life’, and must be in possession of a full and ‘explicit narrative [of his life] to develop fully as a person’ (Marya Schechtman). (shrink)

This volume aimed to highlight narrative identities of European cities or city neighbourhoods that have been overlooked, such as mid-sized cities. These cities are neither small towns nor metropolises, cities that are now unveiling their appeal or specificity. The present special issue thus covers a range of representations of cities. The articles investigate more systematically how different texts deal with various cities from different experiential and fictional perspectives. The issue covers the geographical scope across Europe, from east to west (...) or vice versa, as well as a range of different works of national literature(s), but with a clear emphasis on mid-sized European cities that have until now been deemed as lesser-known, secondary, peripheral, ‘other’ cities that are in the focus of the research of the COST project Writing Urban Places. New Narratives of the European City, within which this journal issue is being published. (shrink)

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients are (...) situated. A second goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

Narrative views of the self argue that we constitute our self in self-narratives. Embodied views hold that our self is shaped through embodied experiences. In that case, what is the relation between embodiment and narrativity in the process of self-constitution? The question demands a clear definition of embodiment, but existing studies remains unclear on this point (section 2). We offer a correction to this situation by drawing on Merleau-Ponty’s analysis of the body that highlights its habituality. On this account, (...) the body has an inherent tendency to cultivate an organization of habits through its history of engagement with the world (section 3). Next, we explore its role in narrative self-constitution by distinguishing between two aspects of the narrative self, the narrated I and the narrating I (section 4). We argue on phenomenological grounds that self-narratives are informed by bodily perspectives in both respects. Furthermore, a focus on the habituality of the body allows for a better explanation of self-constitution than those based on implicit self-narratives (section 5). For these phenomenological and theoretical reasons, we conclude that narrative self-constitution is an embodied and embedded practice (section 6). (shrink)

In this entry, we survey key discussions on the role of narrative in theology and philosophy of religion. We begin with epistemological questions about whether and how narrative offers genuine understanding of reality. We explore how narrative intersects with the problems of evil and divine hiddenness. We discuss narrative's role in theological reflection and practice in general, and in black and feminist theologies specifically. We close by briefly exploring the role of narrative in theorization about (...) life's meaning. (shrink)

The objective of this article is twofold. In the first part, I discuss two issues central to any theoretical inquiry into mental imagery: embodiment and consciousness. I do so against the backdrop of second-generation cognitive science, more specifically the increasingly popular research framework of embodied cognition, and I consider two caveats attached to its current exploitation in narrative theory. In the second part, I attempt to cast new light on readerly mental imagery by offering a typology of what I (...) propose to be its four basic varieties. The typology is grounded in the framework of embodied cognition and it is largely compatible with key neuroscientific and other experimental evidence produced within the framework. For each imagery variety, I make some elementary suggestions as to how it may typically be cued by distinct narrative strategies. (shrink)

This paper examines systematically which features of a life story (or history) make it good for the subject herself - not aesthetically or morally good, but prudentially good. The tentative narrative calculus presented claims that the prudential narrative value of an event is a function of the extent to which it contributes to her concurrent and non-concurrent goals, the value of those goals, and the degree to which success in reaching the goals is deserved in virtue of exercising (...) agency. The narrative value of a life is a simple sum of the values of individual events that comprise it. I claim that this view best explains and support common intuitions about the significance of the shape of a life. (shrink)

Marya Schechtman's The Constitution of Selves presented an impressive attempt to persuade those working on personal identity to give up mainstream positions and take on a narrative view instead. More recently, she has presented new arguments with a closely related aim. She attempts to convince us to give up the view of identity as a matter of psychological continuity, using Derek Parfit's story of the “Nineteenth Century Russian” as a central example in making the case against Parfit's own view, (...) and offers a form of narrative theory as a way out of the problem. In this paper I consider this new case, and argue that we should not be persuaded towards the narrative. (shrink)

Narrative views of agency and identity arise in opposition to reductionism in both domains. While reductionists understand both identity and agency in terms of their components, narrativists respond that life and action are both constituted by narratives, and since the components of a narrative gain their meaning from the whole, life and action not only incorporate their constituent parts but also shape them. I first lay out the difficulties with treating narrative as constitutive of metaphysical identity and (...) turn to its function in practical identity. I then explore the ways narrative shapes our agency—by tapping into our motivational structures, providing an understanding of the social background within which our agency operates, guiding our agency through an understanding of our histories and aspirations, providing the links that structure actions internally, and allowing us to change the meaning of our pasts. I suggest that putting these functions of narrative together may allow us to genuinely shape our past motivational structures through our actions. Finally, if life has the form of a narrative, it may seem as if mortality is necessary for our lives and their contents to be meaningful: a narrative, it might seem, relies on the ending for its meaning. If so, an immortal life would be meaningless. I examine the possibility that even an immortal life may draw meaning from local narratives that constitute projects within such a life, while arguing that, to the contrary, narrative may be a tool exclusively adapted to mortal lives. (shrink)

The condition of postmodernity has been associated with the depreciation of narratives. Here it is argued that stories play a primordial role in human self-creation, underpinning more abstract discourses such as mathematics, logic and science. This thesis is defended telling a story of the evolution of European culture from Ancient Greece to the present, including an account of the rise of the notion of culture and its relation to the development of history, thereby showing how stories function to justify beliefs, (...) situate people as agents within history and orient them to create the future. (shrink)

It is widely held that it is good to conceive of one's life narratively, but why this is the case has not been well established. I argue that conceiving of one's life narratively can contribute to one's flourishing by mediating to oneself a second-person experience of oneself, furnishing one with valuable second-personal productive distance from oneself and as a result self-understanding. Drawing on Eleonore Stump's theory that narratives re-present to their audiences the second-person experiences they depict, I argue that conceiving (...) of one's life narratively facilitates taking on the second-person experience that an audience would have in hearing one's life narrative, mediating how someone from a second-person perspective might perceive oneself and as a result yielding valuable self-understanding. I conclude with some practical implications. (shrink)

By revealing the centrality of stories to action, to social life and to inquiry together with the implicit assumptions in polyphonic stories about the nature of humans, of life and of physical reality, this paper examines the potential of stories to transform civilization. Focussing on the failure of environmentalists so far in the face of the global ecological crisis, it is shown how ethics and political philosophy could be reconceived and radical ecology reformulated and reinvigorated by appreciating and exploiting the (...) potential of stories. This could enable radical ecologists to effect the major social and economic changes necessary to meet the global ecological crisis. What we need, it is argued, is a new, polyphonic grand narrative. (shrink)

The expression "analytic narratives" is used to refer to a range of quite recent studies that lie on the boundaries between history, political science, and economics. These studies purport to explain specific historical events by combining the usual narrative approach of historians with the analytic tools that economists and political scientists draw from formal rational choice theories. Game theory, especially of the extensive form version, is currently prominent among these tools, but there is nothing inevitable about such a technical (...) choice. The chapter explains what analytic narratives are by reviewing the studies of the major book Analytic Narratives (1998), which are concerned with the workings of political institutions broadly speaking, as well as several cases drawn from military and security studies, which form an independent source of the analytic narratives literature. At the same time as it gradually develops a definition of analytic narratives, the chapter investigates how they fulfil one of their main purposes, which is to provide explanations of a better standing than those of traditional history. An important principle that will emerge in the course of the discussion is that narration is called upon not only to provide facts and problems, but also to contribute to the explanation itself. The chapter distinguishes between several expository schemes of analytic narratives according to the way they implement this principle. From all the arguments developed here, it seems clear that the current applications of analytic narratives do not exhaust their potential, and in particular that they deserve the attention of economic historians, if only because they are concerned with microeconomic interactions that are not currently their focus of attention. (shrink)

A common method for warranting the historical adequacy of philosophical claims is that of relying on historical case studies. This paper addresses the question as to what evidential support historical case studies can provide to philosophical claims and doctrines. It argues that in order to assess the evidential functions of historical case studies, we first need to understand the methodology involved in producing them. To this end, an account of historical reconstruction that emphasizes the narrative character of historical accounts (...) and the theory-laden character of historical facts is introduced. The main conclusion of this paper is that historical case studies are able to provide philosophical claims with some evidential support, but that, due to theory-ladenness, their evidential import is restricted. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as (...) its concrete practice, I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

Whether non-human animals can have episodic memories remains the subject of extensive debate. A number of prominent memory researchers defend the view that animals do not have the same kind of episodic memory as humans do, whereas others argue that some animals have episodic-like memory—i.e., they can remember what, where and when an event happened. Defining what constitutes episodic memory has proven to be difficult. In this paper, I propose a dual systems account and provide evidence for a distinction between (...) event memory and episodic memory. Event memory is a perceptual system that evolved to support adaptive short-term goal processing, whereas episodic memory is based on narratives, which bind event memories into a retrievable whole that is temporally and causally organized around subject’s goals. I argue that carefully distinguishing event memory from episodic memory can help resolve the debate. (shrink)

This paper attempts to reconcile two apparently opposed ways of thinking about the imagination and its relationship to literature, one which casts it as essentially concerned with fiction-making and the other with culture-making. The literary imagination’s power to create fictions is what gives it its most obvious claim to “autonomy”, as Kant would have it: its freedom to venture out in often wild and spectacular excess of reality. The argument of this paper is that we can locate the literary imagination’s (...) complementary power of cultural articulation in this fictional activity. The suggestion is that we should conceive of the literary imagination as expressing its interests in culture not mimetically but by producing a certain kind of meaning. This meaning is irreducibly narratological, and understanding it helps us to see the role of narrative in bringing into harmony the literary imagination’s interests in both the imaginary and the real. (shrink)