Depression embodied: an ambiguous striving against fading
Louise Danielsson and Susanne Rosberg
Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative-based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patient’s struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in-between.
The (dis)unity of nursing science
Robyn L. Bluhm
This paper looks at the implications of contemporary work in philosophy of science for nursing science. Early work on the nature of theories in nursing was strongly influenced by logical empiricism, and this influence remains even long after nurse scholars have come to reject logical empiricism as an adequate philosophy of science. Combined with the need to establish nursing as an autonomous profession, nursing theory’s use of logical empiricism has led to serious conceptual problems. Philosophers of science have also rejected many of the central tenets of logical empiricism, including its focus on the logical justification of theories and the idea that science is, or should be, unified. Instead, there has been an increasing focus on the practice of science, which in turn has led to a pluralist understanding of science that emphasizes the construction of scientific models that are appropriate for certain purposes or in certain contexts. I suggest that this approach to philosophy of science may provide better resources for nursing science.
Nursing and the new biology: towards a realist, anti-reductionist approach to nursing knowledge
As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often a contentious topic and employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti-reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology.
Toward a New Theory of Waste: From ‘Matter out of Place’ to Signs of Life
Joshua Ozias Reno
This paper offers a counterpoint to the prevailing account of waste in the human sciences. This account identifies waste, firstly, as the anomalous product of arbitrary social categorizations, or ‘matter out of place’, and, secondly, as a distinctly human way of leaving behind and interpreting traces, or a mirror of culture. Together, these positions reflect a more or less constructivist and anthropocentric approach. Most commonly, waste is placed within a framework that privileges considerations of meaning over materiality and the threat of death over the perpetuity of life processes. For an alternative I turn to bio-semiotics and cross-species scholarship around the question of the animal. Specifically, the paper asks what theories of waste would look like if instead of taking ‘dirt’ as their starting point, they began with trans-species encounters with animal scat. Following bio-semiotics and efforts to deconstruct the animal/human binary, it is suggested that the objectual forms commonly referred to as ‘waste’ are not arbitrarily classified but purposefully expended, and thus symptomatic of life’s spatio-temporal continuation. Waste matter, therefore, is best construed not as anthropocentric but as semi-biotic: a sign of the form of life to which it once belonged. This alternative perspective has implications for how approaches to industrial forms of mass waste can be reconceived.
The Anatomy Lecture Then and Now: A Foucauldian Analysis
Norm Friesena & Wolff-Michael Rothb
Although there are many points of continuity, there are also a number of changes in the pedagogical form of the anatomy lecture over the longue durée, over centuries of epistemic change, rather than over years or decades. The article begins with an analysis of the physical and technical arrangements of the early modern anatomy lecture, showing how these present a general underlying similarity compared to those in place today. It then goes on to consider examples of elements of speech and presentation, description and illustration that are used in the biology lecture from the early modern (sixteenth to seventeenth centuries) and late modern (or contemporary) eras. The anatomy lecture thus demonstrates a basic physical and technical continuity in the classroom or theater, whereas the larger epistemic functions in which it is embedded have changed: from a descriptive, discursive function, focusing on individual organs and their physicality, to one that is more integrative, systemic and also performative in both form and content.
Learning as Existential Engagement With/In Place: Departing from Vandenberg and the Reams
This article takes Vandenberg’s critique of Ream and Ream’s view on the Deweyan learning environment as a departing point to explore the educational meaning of place. The divergence between Vandenberg and the Reams reminds us that the place is not merely a physical site for learners to be located in but also a horizon to be engaged with. Vandenberg and the Reams provide readers with inspirational understandings of Dewey in different aspects. Yet they both seem to give little attention to the point implied in Dewey’s view that learning is a process of existential—embodied and affective—engaging with the place. Drawing on the philosophy of Merleau-Ponty, this article aims to retrieve and to highlight the significance of existential engagement of place as an element in the Deweyan process of learning.
Touching moments: phenomenological sociology and the haptic dimension in the lived experience of motor neurone disease
Jacquelyn Allen-Collinson and Amanda Pavey
Currently, there is a relative research lacuna in phenomenological research into the lived experience of motor neurone disease. Based on a sociological research project in the UK, involving 42 participants diagnosed with MND, this article explores the potential of a phenomenological sociology for analysing experiences of this drastically life-limiting neurological disorder. Calls have been made for sociological researchers to analyse more fully and deeply the sensory dimension of the lived body, and this article also contributes to this newly developing body of literature. While the social sciences have been accused of a high degree of ocularcentrism, here we take forward the literature by specifically focusing upon the haptic dimension, given that touch – and particularly the loss of key elements of the haptic dimension– emerged as salient in MND patients’ accounts. To illustrate the potential of our phenomenologically inspired theoretical perspective, we consider two specific haptic themes: (i) being out of touch: the loss of certain forms of touch within MND and (ii) unwelcome touch by medical staff.
Identifying gaps in knowledge: A map of the qualitative literature concerning life with a neurological condition
ÅsaAudulv, Tanya Packer and Joan Versnel
Objectives: To describe patterns in the qualitative literature regarding the everyday experience of living with a neurological condition; to identify areas of depth as well as gaps in the existing knowledge base.
Methods: An extensive search of the literature yielded 474 articles meeting the inclusion criteria. Data extraction, based on scrutiny of both abstract and full text article included country of origin, diagnosis, stated aim, methodological framework/design, participants, and data collection method(s). Studies were categorized into 27 topics within four broad foci.
Results: Four broad foci describe the field: impact and management, daily activities and occupations, impact on family, and the healthcare experience. Overall the research is unevenly distributed by diagnosis; some are well represented while others are the subject of little research. Even diagnoses well represented in quantity can be limited in breadth.
Discussion: Possible explanations for the patterns of emphasis include: a focus on issues and problems, highlighted points of contact between patients and healthcare providers, and ability of participants to voice their views. The literature is also characterized by limited across diagnoses research or that comparing the experience of people with different diagnoses. There is a need for more research in particular diagnoses; more varied data collection methods and acknowledgement of ethnicity, gender, discrimination, and social inequalities.
Careful science? Bodywork and care practices in randomised clinical trials
Astrid P. Jespersen, Julie Bønnelycke and Hanne H. Eriksen
Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals’ lives without considering the complexities of daily life. We suggest that broadening the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants’ everyday lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for public health initiatives and future efforts should incorporate this aspect.