Book Announcement | The Examined Illness: A Philosopher's Confrontation with Deadly Disease

The Examined Illness

Intellect is pleased to share that The Examined Illness: A Philosopher's Confrontation with Deadly Disease, by Darrel Moellendorf, is out in paperback and hardback.

A visceral personal memoir of being seriously unwell – and the consolations of philosophy during sickness. Being a patient is part of being alive. Disease and serious illness often strike randomly, and when they do, we quickly become subject to the impersonal forces of biochemistry and pharmacology. We rarely think about sickness beforehand and are often totally unprepared for it when it happens. Suddenly, there we are, subject to a standard treatment protocol. Darrel Moellendorf learned this by experience during a month confined to a solitary and sterile hospital room where he received a life-saving stem cell transplant. His room was somebody’s workspace, his schedule was somebody’s work routine, his immune system was systematically crushed, and his prognosis was out of his hands. There was no assurance that it would all work out.

Having spent thirty years teaching philosophy to college students, He was facing the biggest test of all—perhaps the final exam. These are his reflections before, during, and after his cancer treatment, written in real time. He writes, “My brain was sometimes addled by the chemotherapy that sapped my energy and destroyed my immune system, but I wrote out of the conviction that living well includes living well with disease, and eventually living well facing death.” This memoir expresses the conviction that the virtues of patience, courage, trust, and hope serve us well. A measure of good humor also can’t hurt.

Part of the Global Health Humanities series.

Table of Contents

Acknowledgements
Introductory Note

Part I: Diagnosis
1. First Thoughts and Second Opinions
2. Healthcare for All Pt. 1
3. Patients and Patience
4. Father to Son and Back
5. Give It Up for Lent!

Part II: Inside
6. Day 7: The Countdown Begins
7. Day 6: Carpe Diem
8. Day 5: Vegetarianism Is Not an Option
9. Day 4: Sweatin’ and Shakin’
10. Day 3: Making Decisions When You Can’t Think
11. Day 2: Nausea and Fatigue
12. Day 1: Courage
13. Day 0: Communion
14. Day +1: Confinement
15. Day +2: Waiting and Anxiety
16. Day +3: Relaxed
17. Day +4: Toiling and Spinning
18. Day +5: Healthcare for All Pt. 2
19. Day +6: Patience and Hope?
20. Day +7: A Letter Arrives
21. Day +8: Anaemia
22. Day +9: Why I Write
23. Day +10: Why I Dyed My Hair Blue
24. Day +11: Shorn
25. Day +12: Tired, Itchy, and Hiccupping
26. Day +13: Waiting
27. Day +14: Signs of Progress
28. Day +15: Turn Me Lose, Set Me Free
29. Day +16: Fresh Air
30. Day +17: Postponement

Part III: Recovery
31. Home Sweet Home
32. Home Update
33. The Social Determinants of My Survival
34. Letting the Days Go By
35. A Thread of Good Fortune
36. Magical Thinking
37. Hope Kept Me Eating
38. Sunshine, Suffering, Rebirth, and Freedom
39. Food Aversions
40. Inching Towards Normalcy
41. Human Fatigue and Canine Anxiety
42. Healthcare for All Pt. 3
43. Still Wearing My Helmet
44. Same as It Ever Was
45. Who Is That Masked Man?
46. Inspiration in the Oncology/Haematology Waiting Room
47. With a Little Help from My Friends
48. Springtime on My Face
49. Feeling the Love … and the Likes
50. Disease, Bodily Alienation, and Transhumanism
51. Dem Fingernails
52. Traversing the Rim of the Valley of the Shadow of Death
53. The Examined Illness

Epilogue: Living with Mortality
References

Please visit our website for more information:

www.intellectbooks.com/the-examined-illness

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Marketing Executive (she/her)

Intellect  | 0117 9589910 | georgia AT intellectbooks.com

Hodges' conceptual framework: A model for Narrative Medicine ...

Abstract

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care. ...

 

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897 

With my emphasis.

#Identity #Group #Individual #Collective #Mind #Body #TheOdysseyHasBegun

'Sociological Theory in Transition' (always ..?)

Conclusion: Sociology as a Skin Trade

In other writings (O'Neill, 1972, 1985) I have set out a rival conception of the embodied subject who suffers the hopes and defeats of what I have called 'sociology as a skin trade'. At the same time I began to renovate the imagery of society as a body-politic, to differentiate the levels of the bio-body, the productive body and the libidinal body as sites where human beings pursue the relevant knowledge and values of health, work and happiness. Each level of discourse requires he formulation of relevant technical knowledge (medicine, political economy, sociology and psychoanalysis) and each level has its own emancipatory discourse about health creativity and self-expression. Because each of these discursive interests is likely to be articulated by professional social scientists and therapists, it is necessary to require the institutionalization of mechanisms of political and ethical accountability to laypersons' common-sense knowledge and values regarding their bodies, their families, their work and their souls. Medical and sociological nemesis is not the result of a therapeutic conspiracy against society. It belongs to the radical technological a priori of Western knowledge whose ambition is fundamentally bio-technological. The sin of Adam and Eve was the best humankind could manage at the time. In today's laboratory Adam and Eve can be bypassed and life can be set in motion according to the best genetic formulas. Huge legal, ethical and sociological problems are simultaneously generated. And thus we step into a new 'crisis of opportunity` for which very few social scientists are prepared - whether by training or morals.' p.35.

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychoanalysis	body as a machine bio-technological body- bio-
sociology	-politic bio-politics of the population

'In concrete terms, starting in the seventeenth century, this power over life evolved in two basic forms ... One of these poles - the first to be formed, it seems - centered on the body as a machine: its disciplining, the optimisation of its capabilities, the extortion of its forces, the parallel increase of its usefulness and docility, its integration into systems of efficient and economic controls, all this was ensured by the procedures of power that characterised the disciplines: an anatomo-politics of the human body.
The second, formed somewhat later, focussed on the species body, the body imbued with the mechanics of life and serving as the basis of the biological processes: propagation, births and mortality, the level of health, life expectancy and longevity, with all the conditions that can cause them to vary. Their supervision was effected through an entire series of interventions and regulatory controls: a bio-politics of the  population. (Foucault, 1980a, p. 139; altered for my emphasis)' p.24.

'Bio-power regulates bodies individually, as in the clinical model. and collectively, as on the model of social medicine. The two strategies are combined to produce the most complete system of discipline ever known in the history of power. Disciplinary power works in hospitals. schools, prisons, armies, factories and bureaucracies. It is compatible with shifting vocabularies of rights, reform and welfare. It is intimate and collective; it is obeyed not because of its power over death but because of its power over life. It is this shift in emphasis that is the source of the expansion of bio-power whose corresponding apparatus we may call the therapeutic state.' p.25.

 

O’Neill, J. Sociological Nemesis: Parsons and Foucault on the Therapeutic Disciplines, Chapter 1 (pp.21-35). In. Wardell, M.L. and Turner, S. (Eds.). (1986) Sociological Theory in Transition. London: Allen & Unwin, Inc. https://digitalcommons.usf.edu/phi_facpub/86

Previously: 'sociology' : 'power' : 'body'

'Health - Illness': Status - presence - absence - Being

A pre-charity shop revisit: 

'So long as we are healthy, we do not notice that we are healthy. Health is one of those phenomena that we do not perceive as anything special because they are a part of everyday life. We discover them by their absence. Only illness enables us to see health as health. That I am healthy, and in what way I am healthy, is something I experience when, and to the extent that, I am or was not healthy, or when I perceive (but this it is difficult to do) that, and to what extent, someone else is or was not healthy. Being healthy is not the only 'being' that escapes our gaze precisely by being, and that appears to us by its absence. One could say the same of being as such.' p.257.

von Weizsäcker, Carl Friedrich (1971 [1980 trans.]). Einheit der Natur [The Unity of Nature] New York: Farrar Straus Giroux.

If we are to demonstrate ('prove') that Hodges' model can be applied, is relevant in:

• illness, disease, trauma (physical and mental);
• health and well-being; 
• human development, ageing, pregnancy;
• social care; 
• preventive medicine, health promotion, health education;
• life sciences, bioengineering; 
• public (community and mental) health;
• self care;
• spiritual health;
• and global - planetary (political) health ...

Then these observations by Friedrich, allied with definitions of health, as per the WHO's Constitution:

'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.'
https://www.who.int/about/governance/constitution

The oft cited (when I was a student nurse) definition of nursing by Virginia Henderson:

“Assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.
https://libguides.twu.edu/c.php?g=270174&p=1803121

We need to 'see' beyond these sources, to take in the global situation. But, being situated this is something Hodges' model is ideally equipped to achieve.

Thoughts ii re. 2026 Lancaster Philosophy of Psychiatry Work in Progress Workshop

For me, applying Hodges' model I tend to place philosophy and psychiatry (mind, thought, belief, truth, intention ...) within the humanistic part of the model. So, Ewa Grzeszczak and - Philosophy of psychiatry and the methodology of social ontology - stood out. This is helpful as Homeostatic Property Clusters (HPC) are a useful structure, spanning bio-mathematics. As suggested previously with 'equality', we can place the philosophical non-trivial question of kinds at the centre of Hodges' model and proceed (if possible?) from there.

The requirement for a holistic, integrative and pluralistic framework is there in literature. A statement supported by Alessandra Civani's talk: 'What kind of concept is ‘incongruence’? I located a paper:

Enactive psychiatry - A pragmatic and pluralistic approach to mental health and disease

- (and now have a copy c/o and thanks to Alessandra) and am grateful to being pointed to de Haan:

An Enactive Approach to Psychiatry

 I will (must) return to these papers. Earlier on Hodges' model, I'd opined (as on 'X') how the -

• medical
• biomedical
• bio-psycho-social models - are insufficient in the 21st century.

There was a thematic feel to the presentations with Anna Golova - Self-illness ambiguity without a self-illness distinction - following nicely. The styling on the slides was an added bonus. I located an informative (co-authored) paper by Golova:

‘Is it me or my illness?’: self-illness ambiguity as a useful conceptual lens for psychiatry'

Part of the power of Hodges' model derives not so much from its duality; as its dual axes. The two axes can encompass and handle the relatedness between/within reductionism, holist perspectives, the self and otherness, illness and health (well-being).

An hours break brought us to an event which was very well attended, clearly open to the public:

6-7pm Prof Miriam Solomon – Royal Institute of Philosophy talk ‘Stigma as an actant in the history of psychiatry’

In setting out the talk's structure I liked Prof. Solomon's reference to the common, implicit "grime" theory of the dynamic of stigma, and "punching down" as a strategy for managing stigma. 'Grime' made me think of sense of smell, the grime in my father's work van, a diesel. Now so many memories are evoked with the merest whiff. More positively, the patina of physical and mental life also came to mind. You would - might think stigma has been dealt with by now, but of course we are socio-politically far from it.

There is a related podcast from 2025, which also covers Prof. Solomon's early studies. A previous paper was also noted in the slides:

Solomon, M. (2025). The Elusiveness of Hermeneutic Injustice in Psychiatric Categorizations. Social Epistemology, 39(2), 166–177. https://doi.org/10.1080/02691728.2024.2400068

 

Discussion of the DSM inevitably followed (and in the above podcast). In questions the 'reality' of severe mental illness, and suggestion of the acute challenge of managing the negative symptoms of psychoses.

 

Prof. Solomon's conclusion was well worth waiting for, including:

Stigma as an "actant" (cf. Bruno Latour's concept of an agent: causal role without intention)... DSM - ICD...

 

If stigma disappeared tomorrow, the DSM would not have the same categories. 

 

Stigma (more specifically, its management) is shaping the conceptual space, with both scientific and moral consequences.

[Added 4th March...] On Friday - Sam Fellowes, took on, or has taken on - the non-trivial issue of - Modelling psychiatric diagnoses when self-diagnosing - how does this work? Complexity was acknowledged on the first slide, with self-diagnosis, and modelling, set against the Duhem-Quine thesis. 

This technical aspect is welcome and no doubt essential given the socio-technical nature of diagnosis, touching as it does the public (society), primary care, psychiatry, service user groups, policymakers, informatics, and HM Treasury, amongst several 'stakeholders'. With the impact of the internet and social media, much (if not all?) of the vocabulary of mental health professionals has been co-opted and re-framed(?) by patient / service-user groups? It does not, for example, appear that the agency behind the DSM will be able to claim it back. Autism and ADHD were also discussed and debated. I located a previous chapter by Sam (pay-wall):

Fellowes S. Self-Diagnosis in Psychiatry and the Distribution of Social Resources. Royal Institute of Philosophy Supplement. 2023;94:55-76. doi:10.1017/S1358246123000218

 

This really is a thicket of thorns, it spreads as and wherever you go.

 

The welfare bill is such that there should have been government Ministers in attendance. I have responded on behalf of clients to PIP assessments. Agencies have invited me to interview for 'Disability Assessor' roles. Not only is this a complex web, but several logics obtain: a perverse temporal logic operates, binary logic and a fixed mindset can develop so that some (vulnerable!?) individuals can get stuck. Perhaps, a social imperative steps in and disrupts, life chances: their being a NEET ('a young person who is no longer in the education system and who is not working or being trained for work'. Ecosia) is better for someone else? 

 

To unpick, make sense of this, you need a foundational universal model.

 

There is a (co-authored) paper from Giulia Russo, who presented - Epistemic and political role of experience: https://philpapers.org/rec/RUSTPO-112 from which:

'As it is widely known, epistemic injustice was introduced by Fricker (2007) to unveil power relations that have negative consequences on people as epistemic agents. She distinguished in particular two different kinds of epistemic injustice: testimonial and hermeneutical. The first kind occurs when a person (usually in a disadvantaged and oppressed role within the epistemic relation) is damaged as a knower because, as the name suggests, their testimony is overlooked, dismissed or invalidated. The second kind of epistemic injustice occurs when a person is deprived of the epistemic resources to even explain or articulate their experience of distress, or of systemic oppression. In connection to this, the concepts of neurodivergence and neurodiversity come from the political and social arena, and are born explicitly to contrast dominant pathologizing narratives in psychiatry.'

In seeking some 'test' cases to try to model relationally, Hodges' model suggests at least four - without letting the care / knowledge domains wag-the-dog. Giulia's talk was very helpful, ranging across forms of epistemic injustice (addressed by others too), identity, neurodivergence, lived experience, self-, counter- and collective narratives with references. A great resource.

 

Frank Denning, reminded me of an important phenomena, in Using Stebbing’s Directional Analysis to Evaluate ‘Mentalizing’. Talking therapies, or more properly referral to talking therapies often presents several criteria that would-be subjects must 'pass'. An ability to mentalize, can represent one. This is understanable, for effectiveness, efficiency, efficacy ... it is to be found in the manual. But, in terms of power relations, gate keeping in various forms is a literal (virtual) key to service access. Hodges' model is no different (sigh!). At what age can people start to use Hodges' model? What mentalization is involved to cognitively engage in use of Hodges' model? 

 

I struggled to obtain a copy of Stebbing's original work from 1930, but see how closely tied the work is to physics. An Internet Archive copy is poor quality. The search will continue, as I suspect there are links to Bill Ross's text on Deleuzian cosmology. It is marvellous that work from 1930 resonates today. There is: 

Janssen-Lauret, F. (Accepted/In press). Directional Analysis in Susan Stebbing’s Philosophy of Physics. In S. Chapman (Ed.), Susan Stebbing on Logic and Analysis Springer Nature. 

https://pure.manchester.ac.uk/ws/portalfiles/portal/338653274/Directional_Analysis_in_Susan_Stebbing_s_Philosophy_of_Physics_Final_.pdf

Gloria Ayob - Flourishing as mental health - was encouraging. 'TASK 1:EQUATION' a slide was titled, including emotional disorder is meta-evaluative; there are negative and positive poles, plus isomorphism between unpleasantness-pleasantness and disorder-health. I think my stomach was protesting I should have paid more attention. There is a blog post by Gloria: https://blog.oup.com/2024/12/the-concept-of-emotional-disorder/

After lunch Richard Hassall - Hermeneutical Injustice and Damaged Intellectual Self-Trust in Psychiatric Service Users, a reminder of the time and effort that needs to be put into public and patient involvement and engagement in mental health service (when this is desired). References included J.L. Austin and J.S. Bruner. A paper:

Hassall R. Sense-making and hermeneutical injustice following a psychiatric diagnosis. J Eval Clin Pract. 2024 Aug;30(5):848-854. doi: 10.1111/jep.13971. Epub 2024 Feb 20. PMID: 38375925.

https://onlinelibrary.wiley.com/doi/10.1111/jep.13971 

Scoping reviews are more common it seems: Lara Calabrese - Exploring epistemic injustice in dementia care: a scoping review and a qualitative study, plus paper [with QR code on the slide]:

Calabrese L, Brigiano M, Quartarone M, Chirico I, Trolese S, Lambiase F, Forte L, Annini A, Bortolotti L, Chattat R. I'm still here and my opinion matters: a scoping review on the experience of epistemic injustice among people living with dementia. Curr Psychol. 2025 Dec 17;45(1):s12144-025-08519-y. doi: 10.1007/s12144-025-08519-y. PMID: 41445984; PMCID: PMC7618523.

 

The paper's title here brought to mind the radio programme "Does He Take Sugar?" Questions followed regards the studies methods. Since leaving I wondered if there has been an evaluation of Dementia Friendly Communities? Are there dots to usefully joined there?

 

The final talk was delivered (with gusto - pepped me up anyway) by Jacob Barlow - Epistemic borders: experts, communities, communication. Jacob's interest in pragmatism was apparent. I look forward to reading future work, and note Liverpool 2025: ‘Problems with Pragmatism in the Philosophy of Psychiatry’.

All in all, a stimulating and enjoyable event.

On Sociology & Becoming a Patient

'The Subject matter of Sociology
& Becoming a Patient'

A primer for my picking up Hodges' model, or being pressed onboard, was early exposure to history and sociology. There was an understandable emphasis in the (then) school of nursing (registered mental nursing) on the role of society, social history, lunacy and the asylums, law, and attitude towards mental illnesses.

Continuing to sort books (inc. secondhand) and papers, there is:

Maclean, Una. (1974) Nursing in contemporary society. London: Routledge & Kegan Paul.

https://wellcomecollection.org/works/qhqc24fv

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

'The sociological viewpoint can be taken on many different subjects. Thus, political sociology has to do with people's voting behaviour and their reactions to the processes of government, while the sociology of education takes into account the influence of various social factors upon educational opportunities and achievements. In addition, social psychology, social psychiatry and social medicine are all related to medical sociology. These terms all imply the use of sociological methods and insights in different areas of human behaviour, and the divisions between them are a convenient way of dealing with what is a very wide territory. Such divisions may suggest that events and things in the real world are already separated in themselves, whereas the divisions are actually in the minds of the people who make them. It is easier to regard sociology generally as being the study of people's behaviour in groups, groups of all kinds, large and small, casual or permanent, groups of which people are very conscious as well as those of which they may scarcely be aware. Thus, much of sociology is concerned with the human family, a group whose form and composition varies from one part of the world to another and from one set of people to another but which does have common features and functions wherever it is studied. The family will be referred to repeatedly in this book, since not only does it affect all our lives but it profoundly influences the way in which people react in relation to illness.' pp.8-9.

Maclean pointed to the 'innumerable other human groupings' (p.9) and how these - family, schools, clubs, professional training, friendships, audiences, tourist crowds, customers, villager, hostel dweller; such groupings, some historic, temporary or transient - also differentiate into populations, that inform epidemiological and demographic studies. 

It is remarkable how societies have changed globally, since Maclean's 1974 text.

As if to presage the one-to-one encounters to follow, chapter 2 'Becoming a patient' after a brief history 'sickness' arrives at the work of the American sociologist Talcott Parsons.

I don't have the date but I remember making a note the four combined conditions at work for an individual to adopt the sick role. What stood out was how something we think is individually determined is social and so often a question of permission.

Maclean's text (with my emphasis) on these factors follows; and is then mapped to the domains of Hodges' model:

'In the first place, the illness must be outside the patient's control, in no sense his own fault. Second, the sick role will allow him exemption from his other roles. with their associated obligations and duties. For example, a man can legitimately give up work and leave his usual family 'responsibilities to his wife. But, third, the sick role requires that the patient should positively desire to get well, he should not relish the relinquishment of responsibility and, fourth, he has the obligation to seek competent medical help.' p.25.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

the sick role requires that the patient should positively desire to get well	the illness must be outside the patient's control, in no sense his own fault.
the sick role will allow him exemption from his other roles. with their associated obligations and duties	he has the obligation to seek competent medical help

Again as an exercise you might care to reflect on this and our experiences since the millennium?

What is most remarkable is the need to view this as a 'future lesson' in terms of how societies must, will change to meet the challenges of tomorrow, and the day after that ...

Martha's mum, dad, guardian ...

Hayward, E. Parents really do know when
their child is sick, The Times,
30 May 2025, p.1.

The previous post highlighted the fact that while practice (and theory) based upon research finding that are 'evidence-based' and scientifically rigorous are a 'gold standard; there are other means by which knowledge is obtained. Cultures, often have systems to transfer knowledge - that which matters to the society, even if is not written in the conventional meaning of the term.

Intution is another source, and within social groups can be a powerful spur to action, and help seeking. This is demonstrated regularly in the knowledge that a parent, or guardian has about what is the normal presentation for a child in their care. 

In the UK Martha's Rule is being tested in NHS hospitals. It is encouraging then to hear and read news of a study in Australia (so in combination a 'multicenter' effort?).

Mills, E., Lin, P., Asghari-Jafarabadi, M., West, A., & Craig, S. (n.d.). Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: A prospective cohort study. The Lancet Child & Adolescent Health. https://doi.org/10.1016/S2352-4642(25)00098-7

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

"Not herself ..." Martha	"Not well" Martha
Mills parents, guardians, friends & family	Martha's Rule*

Hayward, E. Parents really know when their child is sick, The Times, 30 May 2025, p.1.

*Under test in the UK.

Previously: 'intuition'

'Health and Wellbeing Boards' - hiding the obvious

Does the language we use really matter? A public NHS document includes the following:

'PHARMACY

2.1

Background

Health and Wellbeing Boards (HWBs) in England hold statutory responsibility to publish and keep up to date a statement of the needs for pharmaceutical services of the population in its area, referred to as a pharmaceutical needs assessment (PNA). PNAs are used by the NHS to make decisions on which NHS funded services need to be provided by local community pharmacies.'

I'm not asking, or demanding, change to this but the words we employ do matter. One of them above matters greatly. The question of responsibility and its attribution. In the response to mental illness,  responsibility has always been played out on the public stage. Even when society's response was to leave 'care' to religious and charitable agencies. Then the state stepped in with the first legislation. The state assumed responsibility as per the previous post. Not only where the keys thrown away, but many people admitted there, did not need be. The 'reason for referral' was more accurately described as a social ill. In this way, individuals were incarcerated and forgotten.

It is in the gift of Hodges' model, care of its vertical axis [INDIVIDUAL - GROUP], to be able to negotiate the contextual switch from personal to group and population. There is a marked contrast from self-medication, a nurse doing a medicines round - to the design, testing and research effort of production of a specific drug or intervention. The focus then is obviously at the population scale. The pharmocological business, is not just a business. It is a pharmaco-industrial complex, e.g.

Grouse L. Cost-effective medicine vs. the medical-industrial complex. J Thorac Dis. 2014 Sep;6(9):E203-6. doi: 10.3978/j.issn.2072-1439.2014.09.01. PMID: 25276402; PMCID: PMC4178073.

When we think of dependence it is often framed at the individual level. But how can we expect to change health services, health systems to see them as they truly are: Illness and Infirmity Boards masquerading as Health and Wellbeing Boards?

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

	drugs manufactoring testing
	Sybil Shainwald (April 27, 1928 – April 9, 2025)

Sybil Shainwald 

https://en.wikipedia.org/wiki/Sybil_Shainwald

Frayn's - shared 'Home Address'

Frequently I've made the point that 'person-centred' means placing the individual, patient, carer ... whatever the context, at the centre of Hodges' model. At the same time this is of course an idealisation:

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

What is your 'home' address?

'Science, it turns out, is in this respect simply an extension of all the other means we have found of representing the world. As with pictures and narratives, the world is unimaginable without the focus of a viewpoint. To understand the world in any way whatsoever scientifically, historically, artistically, anecdotally, imaginatively we find ourselves compelled to assume a potential point of convergence from which everything is  viewed, measured, and recounted. About the entity that defines this point we know only that it is by definition invisible to us. And since the instruments of science, of logic and mathematics, and of art, are all products of this invisible entity, they will not serve to represent or explain it to us. Anything in the world, or out of it, can be perceived or thought about, or both, and represented in our various codes. The only thing that systematically eludes us, whichever way we turn, is the something upon which everything else depends. The conscious subject that gives meaning to the objective universe cannot give meaning to itself. Without it nothing can be understood; about it nothing can be said.  'The point of convergence . . .' And already we've gone wrong. The self isn't a point, in any remotely geometrical sense, but a complex organisation; and the consciousness that it generates, and by which it is animated, is a complex phenomenon.' pp.401-402. (my emphasis)

Frayn, Michael (2006). The human touch: our part in the creation of a universe. 'Home Address', Chapter 5. London: Faber & Faber. 

A final post from my paperback copy, next - off to a good secondhand home. Previously: 'Frayn'.

'Un Caso Clinico' BUZZATI (I906-I972)

Reading The Theatre of the Absurd earlier this year was a very enjoyable and disconcerting experience. In acknowledgement: I have quoted from the book at length below. I do so to better convey the context, and in the hope other people may similarly obtain and enjoy this classic theatrical text.

Reading, I was reminded of starting my career as a nursing assistant and student nurse, and the 'lock-up' wards: male and female. Listening now to the current Reith Lectures I will post regards: 

Gwen Adshead - Four Questions about Violence

https://www.bbc.co.uk/sounds/play/m0025cmg

As a community mental health nurse in community mental health teams and nursing home liaison, residents on the ground floor (of two or three floors - with 'general') 'knew' there were very poorly people on the top floor. In summer, windows open, they could often be heard shouting and in the night. Inside, for staff, family members, friends became advocates expressing concern for a lack of access to fresh air and sunshine. Something, of course, we can all benefit from. For some residents there was an in-house understanding of NOT wanting to be moved 'upstairs'. At times I gather, if a resident 'played up' such re-location (displacement) was used as a threat: a cue for education.^

DINO BUZZATI (I906-I972)

'In Les Bátisseurs d'Empire the flight from death takes the form of trying to escape upwards. The same image appears in the opposite direction in a remarkable play by Dino Buzzati, the eminent Italian novelist and journalist on the staff of the Corriere della Sera in Milan. This play, first performed by the Piccolo Teatro, Milan, in 1953, and in Paris in an adaptation by Camus in 1955, is Un Caso Clinico. In two parts (thirteen scenes), it shows the death of a middle-aged businessman, Giovanni Corte. Busy, overworked, tyrannized but pampered as the family's breadwinner, whose health must be preserved, he is disturbed by hallucinations of a female voice calling him from the distance and by the spectre of a woman that seems to haunt his house. He is persuaded to consult a famous specialist, and goes to see him at his ultra-modern hospital. Before he knows what has happened, he is an inmate of the hospital, about to be operated on. Everybody reassures him - this hospital is organized in the most efficient modern manner; the people who are not really ill, or merely under observation, are on the top floor, the seventh. Those who are slightly less well are on the sixth; those who are ill, but not really badly, are on the fifth; and so on downwards in a descending order to the first floor, which is the antechamber of death.

In a terrifying sequence of scenes, Buzzati shows his hero's descent. At first he is moved to the sixth floor, merely to make room for someone who needs his private ward more than does. Further down, he still hopes that he is merely going down to be near some specialized medical facilities he needs, and before he has fully realized what has happened, he is so far down that there is no hope of escape. He is buried among the outcasts who have already been given up, the lowest class of human beings - the dying. Corte's mother comes to take him home, but it is too late.

Un Caso Clinico is a remarkable and highly original work, a modern miracle play in the tradition of Everyman. It dramatizes the death of a rich man - his delusion that somehow he is in a special class, exempt from the ravages of illness; his gradual loss of contact with reality; and, above all, the imperceptible manner of his descent and its sudden revelation to him. And in the hospital, with its rigid stratification, Buzzati has found a terrifying image of society itself - an impersonal organization that hustles the individual on his way to death, caring for him, providing services, but at the same time distant, rule-ridden, incomprehensible, and cruel.' 

Esslin, Martin. Parallels and Proselytes, The Theatre of the Absurd. London: Pelican, 1982. (3rd Ed.).pp.277-279.

The Bewitched Bourgeois

^Rest assured, there were and are excellent centers of care too.

Update: 11th January 2025: c/o John Self. Meet the forgotten maestro of the ultra-short story. Saturday Review, The Times, p.15.

'One of his most widely published stories, Seven Floors, is set in a hospital where they put the "mildest cases" on the seventh floor, and so on in increasing order of sickness down to the first floor, which is occupied by those who are "beyond hope"'.

Lawrence Venuti. (2025) The Bewitched Bourgeois, New York: NYRB Classics ISBN: 9781681378671.

Cover image: NYRB.

Take II? Fit for Government . . ?

As a community nurse, driving is obviously pretty essential to your being able to work. I have come across non-driving community nurses (earlier this year) but they are still few(?). As a boy going to work with my father you could see how dependent he and workmates were upon a string of vans, cars and be able to drive both being on the 'right-side' of the law and his health. It was always an 'event' a new van, fitting out with racks, shelves, nooks, hooks and crannies for all sorts.*

Then as a community nurse older adults you come across individuals who still have their driving license, still have their car on the drive / front, and still have the car keys. Perhaps family have suggested to mum, dad, brother, sister, aunt: "Look, isn't it time to call it a day and give up driving?" Ouch! There's a crash - in itself.

Re-working the two-part draft paper on deprivation of liberty safeguarding, threshold concepts, Hodges' model within residential care, some thresholds are difficult, challenging to call. But some are safety critical, and perhaps need a more 'proactive' stance, without giving way to ageism. Is it the local community's job - the public's job to proffer a diagnosis: and what about persons on the world stage? Diagnosis by social media?

I quickly admired those people who, though reticent, gave up the literal fast-lane. Inevitably you wonder how you will react when the time comes. Will you have the humility, the goodness of grace to hand over the keys? To call it a day. With an ageing population, I've warned the children when driving to expect the unexpected. Cars going the wrong way. It was a struggle for my father: but safety as it so often does - did the trick - with the impetus of physical illness.

Sometimes, at work, after a family trying, and a fracas, when they've tried to hide / remove the car keys, suddenly a near-miss has upped-the-ratchet. Neighbours have seen the 'driver' reversing out into the road, with numerous car horns announcing the event. Then perhaps you are intercepted outside, a call comes to the day center (the transport is also going), the community team, or the GP's surgery (the neighbours have helped with medication).

I've had to speak to GPs for them to visit, meeting them on occasion. Do GPs - family physicians still have the same gravitas today?

This is a care transition: what can be a difficult one. A helpful point (diplomatic argument) that often gets through is the matter of car insurance and the status of the existing policy?

Does a political leader carry insurance?

It is difficult for all, a person's human rights, choices, freedom; their life story, former career perhaps, their health career - most definitely.

With events in the USA and the Democrat Party, and seeing the cover of The Economist I had to TAKE II.

Individual

|

      INTERPERSONAL    :     SCIENCES                   

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

cognitive state memory insight Fitness for Office: Mentally & Physically Legally	The Economist
safety of Others community - duty of care - safeguarding  (however realised)

This is global problem that is set to increase and not just for reasons of health.

Ack. The Economist

https://www.economist.com/leaders/2024/07/04/why-biden-must-withdraw

Owen, D. (2009) In Sickness and in Power: Illnesses in Heads of Government during the Last 100 Years, London: Methuen Ltd. ISBN: 978-0-413-77689-1

Listen also ... BBC Radio 4 Moral Maze 

'The Morality of Stepping Down'

Previously:

Hubris syndrome: Daedalus Project [Psycho-Political]

*I suspect he's still driving around somewhere. x

"163 Days"

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC   

SOCIOLOGY  :   POLITICAL 

|

GROUP

	163 Days - Hannah Hodgson
Poetry in [not in] motion

“Hannah Hodgson takes us to the paradoxical heart of poetry itself: to be held inside a pain both intensified and soothed by the sheer brilliant presence of the poet’s mind.” – Caroline Bird

Hannah Hodgon is an award-winning poet and a palliative care patient. In her compelling debut collection 163 Days, she uses a panoply of medical, legal, and personal vocabularies to explore what illness, death and dying does to a person as both patient and witness.  

163 Days is the length of Hannah’s longest period of hospitalisation to date. In this long poem, she probes various truths, personal and medical; truths which clash like a tray of dropped instruments in a silent operating theatre.

The speaker is a teenager on the cusp of adulthood. Doctors struggle to diagnose her complex conditions. Through daily, diary-like poems we see the children’s ward through Hannah’s eyes. It is decked out in primary colours. Volunteer clowns visit. At seventeen she is ‘too old’ to be here, ‘too young’ to move to the adult ward.

The mundanity of hospital life is marbled by a changing landscape of mood, hope and loss. Her symptoms are painful. She has numerous tests and procedures to keep her alive long enough to figure out what’s wrong. A gap yawns between the person she is, and the person in her medical notes.

In ‘Aftercare’, Hannah navigates the worlds of both nightclubs and hospice care as she embarks on a new version of her life as a disabled adult. 163 Days is an important collection, in which Hodgson’s true voice takes poetry into difficult places.

Listen to the BBC radio play adaptation of 163 Days on the New Creatives website here.

163 Days by Hannah Hodgson, Seren Books ISBN-13: 9781781726471
Publication Date: Monday, March 28, 2022

My source:
Hannah's book in Kirkby Lonsdale, The Book Lounge 17th February 2023.

Hubris syndrome: Daedalus Project [Psycho-Political]

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC -----------------------------------  MECHANISTIC    

SOCIOLOGY  :   POLITICAL 

|

GROUP

Hubris Syndrome "Democratic politicians as diverse as Woodrow Wilson, Franklin D. Roosevelt, Churchill, Kennedy, Johnson, Nixon, Pompidou, Mitterrand, Blair, George W. Bush, Chirac, and Sharon all lied about their health. ...

... Between 1906 and 2008 seven Presidents are judged to have been mentally ill while in office: Theodore Roosevelt (bipolar disorder), Taft (breathing-related sleep disorder), Wilson (major depressive disorder), Coolidge (major depressive disorder), Hoover (major depressive disorder), Johnson (bipolar disorder), and Nixon (alcohol abuse). Many despots-such as Hitler, Stalin, Saddam Hussein, Pol Pot, Idi Amin, and Robert Mugabe-have been branded by the press and public opinion as suffering mental illnesses. Lord Owen argues neither Hitler nor Stalin were mad in any sense the medical profession recognizes (whereas Mussolini and Mao had depression, possibly bipolar disorder)."

'Faith' in leadership? 'Choice'?

In Sickness and in Power by Owen David

I remember Lord Owen's book being published, over a decade ago and heard radio interviews at the time (BBC Radio 4, Start the Week?). Not sure why I didn't pick this up as the disciplinary bridges are stark and clear (now!): PSYCHO-POLITICAL and GEO-PSYCHIATRIC. The importance of the issues the Daedalus Project addresses, now within Maudsley Philosophy Group is not just suddenly 'self' evident*, but is of importance for the world's population- impacting upon global safety and security.

Even since Lord Owen's book the rise of AI adds complexity (as ever).

 *irony intended.

Text: https://www.goodreads.com/book/show/3205306-in-sickness-and-in-power

Owen, D. (2009) In Sickness and in Power: Illnesses in Heads of Government during the Last 100 Years, London: Methuen Ltd.  ISBN: 978-0-413-77689-1

Plus via twitter: 

Thanks!

This is great talk from David Owen on Hubris syndrome we organised at @The_BNPA meeting a few years backhttps://t.co/73qGD42oQY

— Tim Nicholson (@Tim_R_Nicholson) March 6, 2022

"Being Horizontal: Vulnerability, Interdependence and Resistance" c/o Confabulations

The title of this event last week struck a cord ...

For those who missed "Being Horizontal: Vulnerability, Interdependence and Resistance" last week - which touched on topics as diverse as austerity, invisibility, repetition and rhythm - a recording of the live event is available until 24th February: https://t.co/WnGFdmkMqF

— Confabulations (@con_fabulations) February 13, 2022

 

From the website with some additions:

 

"Being Horizontal: Vulnerability, Interdependence and Resistance"

  Self - INDIVIDUAL - Person

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC -----------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

Community - Group - Population

sleep* ('in dreams') (found) un-consciousness (beware - risk?) intent non-verbal psychoanalysis patient personal vulnerability	gravity collapse position - posture horizontal - vertical human body, form 3D mobility, movement above - below look up/down angle - inclination clinical positions 'other' positions - sex birth, rest, deceased reclined nude "recline -
The 'games that people play', especially those seeking / in power. social customs dance - history - culture social hierarchies	is often associated with feminised and/or racialised powerlessness." fallen soldier (civilian?) choice*: of position look up/down to "Deliberately assuming a horizontal position in front of others can also, as the complex works grouped in this project reveal, challenge, subvert, and politicise dynamics of vulnerability and power."

 

6th World Congress of the World Association of Cultural Psychiatry (WACP2022)

ROTTERDAM, THE NETHERLANDS 

15 - 17 September 2022 

pre-conference day 14 September 2022

What do we mean by 'culture'?

(draft - ideas...)

 

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

As individuals we are socialised into one or more cultures, depending upon our formative years, parenting and guardianship. Individual capacities and opportunities to learn and life experiences all influence a person's self-identity, their relationship to others and the society in which they reside (when not excluded). A key concept here is salience not just for the person, but the people close to them and the community. Reality can be defined individually, and socially; but it is mediated and ultimately negotiated and determined (often legally) elsewhere. This is why education is so important (to all the literacies?), to all in realising their potential. This begins in infancy and early childhood and must be protected.

A scientific perspective, reference and emphasis on evidence at the expense of personal experience. An approach that might be characterised and described as reductionist. It may see the individual in a mechanistic way, as 'broken' with a deficit, often defined in neurobiochemical and increasingly genetic terms that may not be fully understood by the individual concerned. 'Space' here can be interpreted literally; as ability to respire, to live in - shelter, how much space is 'my space' to live in? Personal recognition, status and hence identity, may be accorded and prioritised by papers I possess, the borders proximate to and bounding my current location and the history (evidence) of my being here.

Sociologically speaking, culture and society are discrete concepts. Cultures vary markedly across the globe, and this richness is to be celebrated. It is here we try to 'sense-make' our own context and that of others and the 'world' - if the opportunities are afforded to us (the social determinants of health are realised). Culture is noisy. Its silence can be deafening. Its vibrancy can be joyous, exemplify humanity at its best. Its modes and mediums of communication can also be subverted and weaponised. COVID-19 continues to reveal the value and values of social capital, local community, belonging and relationships, cooperation and our interdependence.

Culture can also refer to the capacity of an individual and society to not only exercise choice, but the range of choices available, access in a cognitive and physical sense. The political culture can profoundly influence freedom, autonomy and self-expression that an individual may represent through several identities and social roles. The combination of these identities and roles contribute to 'make' them the 'person' they are (or should be). Were an individual is vulnerable the culture 'here' also determines the extent of participation socio-economically,  especially when the individual is alone, in poor health and cannot self-advocate. Societies and cultures need security, law and justice to ensure no one is left behind.

 

My source: twitter @wacp06

Register for ‘Vulnerabilised Individuals and Opaque Institutions’ Feb 10 2022

Professor Havi Carel

 

Join us for the Second Annual Joint Center for Knowledge,
Technology and Society Center for Nursing Philosophy lecture,
“Vulnerabilised Individuals and Opaque Institutions”
with University of Bristol Professor Havi Carel.

 

 

About the lecture

“In this talk I develop the concept of vulnerabilisation to pick out a large and diverse group of people who suffer vulnerabilities caused or exacerbated by their situations. I outline how individuals can be made vulnerable by interpersonal encounters and interactions with social structures. I then discuss vulnerabilisation in relation to what I call ‘institutional opacity.’

An opaque institution is especially problematic for individuals and groups already rendered vulnerable during their interactions with that institution, and a prime example are ill persons in the context of healthcare institutions, which I discuss. I articulate the features of an encounter between a vulnerabilised individual and an opaque institution and end by tracing two ameliorative strategies that could help repair this interaction.” — Havi Carel

About Havi Carel

Havi Carel is professor of philosophy at the University of Bristol, England. She recently completed a Wellcome Trust Senior Investigator Award, the Life of Breath. She was awarded the Health Humanities’ Inspiration Award 2018 for this work.

Her third monograph, Phenomenology of Illness, was published by Oxford University Press in 2016. She was selected as a Best of Bristol lecturer in 2016.

Havi is the author of Illness (2008, 2013, 2018), shortlisted for the Wellcome Trust Book Prize, and of Life and Death in Freud and Heidegger (2006). She is the co-editor of Health, Illness and Disease (2012), New Takes in Film-Philosophy (2010), and of What Philosophy Is (2004).

Event details

Date and time: Feb. 10, 2022 | 10 a.m. Pacific; 1 p.m. Eastern; 5 p.m. UK
Event location: Zoom

Registration

You will receive a link to join the event upon registration.

My source: 

University of California, Irvine Sue & Bill Gross School of Nursing | 252 Berk Hall, Irvine, CA 92697

Previously on W2tQ:

https://hodges-model.blogspot.com/search?q=illness

Links in original source rationalised to reduce any algorithmic penalties.