Incurable suffering from the “hiatus theoreticus”? Some epistemological problems in modern medicine and the clinical relevance of philosophy of medicine.And from the next issue, Volume 19, Number 4 / August, 1998, we have Edmund Pellegrino
What the Philosophy Of Medicine Is.Essential reading when I finally get around to preparing my Philosophy of Medicine course.
Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.and BBC report.
Abstract:They conclude
Certain patterns of anger expression have been associated with maladaptive alterations in cortisol secretion, immune functioning, and surgical recovery. We hypothesized that outward and inward anger expression and lack of anger control would be associated with delayed wound healing. A sample of 98 community-dwelling participants received standardized blister wounds on their non-dominant forearm. After blistering, the wounds were monitored daily for 8 days to assess speed of repair. Logistic regression was used to distinguish fast and slow healers based on their anger expression pattern. Individuals exhibiting lower levels of anger control were more likely to be categorized as slow healers. The anger control variable predicted wound repair over and above differences in hostility, negative affectivity, social support, and health behaviors. Furthermore, participants with lower levels of anger control exhibited higher cortisol reactivity during the blistering procedure. This enhanced cortisol secretion was in turn related to longer time to heal. These findings suggest that the ability to regulate the expression of one’s anger has a clinically relevant impact on wound healing.
...this is the first study showing that difficulty in anger regulation can lead to delayed healing. Furthermore, an exacerbated cortisol response to stress appears to explain the relationship between lower anger control and wound repair, although other physiological pathways may mediate the association between anger regulation and healing.Media report here.
This study adds to the evidence that the work stress–CHD association is causal in nature. We demonstrate, within a population of office staff largely unexposed to physical occupational hazards, a prospective dose–response relation between psychosocial stress at work and CHD over 12 years of follow-up. We confirm, during the same exposure period, the plausibility of the proposed pathways involving behavioural mechanisms, neuroendocrine and autonomic activation, and development of risk factor clustering, represented by the metabolic syndrome. Further, those who are older (and are more likely to be retired and less exposed to work stress) are less susceptible to the work psychosocial effect, presenting a coherent pattern in our findings. This study demonstrates that stress at work can lead to CHD through direct activation of neuroendocrine stress pathways and indirectly through health behaviours.This is part of the Whitehall II study, which I've mentioned before. Long-term, large-scale, prospective studies of this kind are, of course, very welcome. But naturally we'd like to see these balanced by lifelong individual studies, so that we can get beyond the non-specificity of the stress construct.
What happens when we lose someone we love? A death, a separation or the break-up of a relationship are some of the hardest times we have to live through. We may fall into a nightmare of depression, lose the will to live and see no hope for the future. What matters at this crucial point is whether or not we are able to mourn.In this important and groundbreaking book, acclaimed psychoanalyst and writer Darian Leader urges us to look beyond the catch-all concept of depression to explore the deeper, unconscious ways in which we respond to the experience of loss. In so doing, we can loosen the grip it may have upon our lives.
I would go so far with the hedonist as to say that anything good is pleasant. Any activity which I definitely choose to go in for, so far as my experience goes, yields me feelings among which there is pleasure, And I will add that although the pleasure sometimes comes as a surprise, a by-product which I had not expected, this happens more and more rarely as I become more and more experienced and acquire (as I hope I do acquire) more and more savoir vivre. Experience of life teaches me to expect the unexpected; in this case, to expect that I shall get pleasure out of things which, if I had been less experienced, I should not have thought likely to prove pleasant. A child may undergo dental surgery and find little in it except pain; when more advanced in years, he will find that bearing the pain gives him a curious and seemingly perverse but unmistakable pleasure; still later, he may learn to expect and reckon on the pleasure. This is not masochism. It is not a pathological enjoyment of merely being hurt. Being hurt is one thing; fortitude under pain is another. So the masochistic enjoyment of pain is one thing; the pleasure of finding that a certain degree of pain does not destroy one's fortitude is another. (pp. 426-7, 'Goodness, Rightness, Utility', The New Leviathan, Clarenden Press 1992)With modern anaesthetics and pain-killers, in my case little fortitude was required.
“In the days following my surgery, I have a series of unexpected complications and my temperature soars. Eventually I am carted off to the hospital’s Intensive Therapy Unit where I spend several days unconscious on a ventilator. I have a second operation and then suffer massive internal haemorrhaging. Over one tumultuous weekend, I am given 45 units of blood in transfusions. Eventually, the doctors decide to try a rare clotting agent in a desperate attempt to staunch my bleeding, and Anna is told that if this fails to work by the second dose then there is no further hope for me. My children respond to the warning of my imminent death with storm-hardened calm. They are used to grim news by now.”The book also takes a philosophical and questioning journey through chronic illness as Ludlow explores its wider significance. It is the record of a quest - which we all face - for health and wholeness in a fractured, disjointed world.
