Give an illustration from one of the literary works we read of the idea that to an extent, the experience of illness is socially constructed and involves learned behavior, and say how the work develops that idea:

It is often argued that the modern notion of illness and its resulting experience is socially constructed, especially in the way that minor aches, pains, or even emotions are written off as symptoms. In this age of categorization and rampant societal labeling, a single example of disease as a social construction is Attention Deficit Hyperactive Disorder, and its pharmaceutical treatments, Ritalin and Adderall. Social conditions, like boredom, can lead to certain behavioral patterns, such as hyperactivity, which can then become boxed and medicalized into disorders and diseases, such as ADHD. From my own experience, the deliverance of a diagnosis is reason enough to alter a persons disposition and behavioral pattern, because the deliverance of a diagnosis adds to a mindset that often characterize patients; the Im stuck with it and Theres something wrong with me dispositions that accompany the labels disease and illness. However, disease and illness are not solely labels; they are the languages of the human body. In Albert Camus The Plague, disease and illness are incarnations are presented as incarnations of divine wrath as a symbolic portrayal of political turmoil and the human condition. Within the novel, the reader is plunged into its dominating philosophy: existential revolt, in which the absurdity of life is affirmed, and we continue in spite of it. The residents of Oran, afflicted with the bubonic plague, are representative of a population suffering from the social disease of fascism. By emphasizing that human beings, at their collective core, are linked by liberty and morality. These two ideals are also responsible for linking us in vital junction to one another. Camus constructs the social characters of Oran in such a way that either they, themselves, are pestilences, or victims of the great pestilence. This dichotomy amongst the people sets the stage for a course to healing and unity that allows them to create a true revolt against illness, injustice, fear, despotism, and even death. Illness is a difficult subject to approach, primarily due to the broad nature of its definition. Generically, illness refers to an unhealthy condition; poor health; sickness. In Oran, illness is socially constructed by how it is defined. As we prescribe formal titles to bodily conditions, a societal diagnosis is consequently born. A societal diagnosis is a label, stereotype, or connotations associated with certain bodily symptoms. Such a societal diagnosis can spur fear in the minds of people; people who long to remain unassociated with the that the disease carries with it. Although the gruesome conditions of the plague are not socially constructed, the fear, anxiety, ignorance, and typecasts associated with it most certainly are. As the plague took more and more lives in Oran, the men of the church coordinated a Week of Prayer that would end with a High Mass and sermon delivered by Father Paneloux. In his sermon, he declared, If today the plague is in your midst, that is because the hour has struck for taking thought. The just man need have no fear, but the evildoer has good cause to tremble. Later in the sermon, Father Paneloux asserted that God has unleashed his wrath upon Oran because He grew tired of waiting for the people to acknowledge him, and now the people must understand that they have wronged, as did Cain and his children, and all that hardened their hearts against Him. With these words, he instilled fear within the minds of the townspeople. If evildoers were the only ones to be afflicted by the plague, then individuals would be ashamed to be sick, to solicit aid in fear of the reputation that they would acquire. This negative social stigma that Father Paneloux affixed to the plague mulled in the minds of the residents, and subsequently furthered their fear and aversion toward sickness. This evidence supports the claim that the experience of illness is socially constructed.

Cite three ways in which particular works in this course have reframed or challenged your understanding of caregiving or health care.

Hospitals, state hospitals, are often seen as total institutions geared mainly to the degradation of patients. Doubtless this happens, and on a vast scale. But they may also be asylums in the best sense of the word: places that provide a refuge for the tormented, storm tossed soul, provide it with just that mixture of order and freedom of which it stands in such need. With this statement, Oliver Sacks reframed my understanding of healthcare in the sense that it shed light on aspects of the health care institution that I had never thought to question prior to reading The Autist Artist. In this quote, I believe that Sacks means to critique the entire medical institution: that it just is not designed for efficient communication with the patient. Doctors have innumerable attendings, residents, students, nurses, nurse practitioners, clinical pharmacologists, and the list is seemingly endless. When a patient finally deciphers which scrub-color means what, they are often left even more confused. Only certain members of the staff can prescribe meds, while others take care of private needs. While the attending is technically in charge, the hierarchy not often particularly well-delineated. If even medical students on their first few rotations have difficulty navigating the intricate politics of a hospital, how are we, the patients, expected to figure it out? It does not help that doctors typically use their jargon to communicate with their patients. They are supposed to with colleagues, because right upperquadrant tenderness plus guarding in the area is far more informative and helpful than tummy ache in the prescription of treatments. But when doctors have to address patients and their families who do not understand the jargon, especially when they are relaying complicated matters, their words are not often simply comprehended. In addition, hospitals are busy and it can be frustrating for doctors to actually sit down and offer their undivided attention to patients. Another way in which Sacks reframed my view on health care is how he artfully portrayed that hospitals do not always foster full recovery in a patient. That being said, all I wrote is based on my own experience, that of a non-autistic person. I have have little insight regarding what Jose might feel about hospitals. However, based on his hesitancy with Sacks during their first encounter, it can be inferred that had a bad experience at a hospital. Perhaps the previous doctors who were assigned to his case did not take any personal interest in him and were impersonal in their treatment. There is a vast scale of reasons that a hospital may fall short, but I ought to revert to the original quote. Sacks goes on to say that hospitals may be asylums in the best sense of the word: places that provide a refuge for the tormented, storm tossed soul, provide it with just that mixture of order and freedom of which it stands in such need. Of course, that is dependent on the hospitals conditions, as Sacks iterated. A hospital can certainly be an asylum. It is ironic that the word asylum possesses a negative connotation nowadays. Sacks even felt the need to specify that he was referring to asylum in the best sense of the word. This demonstrates the general lack of ethical treatment of patients in places that were meant to be positive, trustful rehabilitation centers responsible for the distribution of altruistic care (as opposed to what they became - evidenced by nothing less disconcerting than the setting of One Flew Over the Cuckoos Nest). The movie, Wit, originally a play penned by Margaret Edson, had a lasting effect on my perception of health care, as well, in the sense that it reframed my thoughts on doctor-patient relationships. When Dr. Harvey Kelekian pointedly remarked,You have cancer to his patient, Vivian Bearing, it struck me that those three words are not confined to the pages of this play. They constitute a diagnosis that is quite possibly the most feared of them all. In the United States, the American Cancer Society estimates that about 1.5 million people in the United States will hear those very words this year. The worst part is that far too many of those patients will begin their tough, dismal journeys hearing that fateful sentence in a less-than-appropriate manner in a less-than-comfortable environment. Dr. Kelekians cold and brief conveyances are not uncommon in modernity. Such apparent lack of empathy on the doctors end could be explained by the biomedical model that dictates modern Western medicine. It places greater value on technical proficiency and lesser value in communication skills. Because of this historical precedent, physicians might feel unprepared for the intensity that comes with breaking bad news. They may unjustifiably feel that they have failed the patient, uncertain about the patients expectations, or fearful of destroying their patients hopes. They may not feel prepared enough to deal with the patients potential emotional crisis or fear their own incapacity when confronted by the recalcitrant disease that is cancer. The consequence of any one of these feelings or a combination of them is incertitude and distress, which leads to disengagement from situations in which the doctor is called upon to disclose difficult a difficult diagnosis to the patient. If doctors are not able to or choose not to tell their patients of their respective diagnoses with apt sensitivity, then they are at risk of losing their human touch. That loss of humanity is a stab to the heart of what it means to be a doctor.In Dr. David Hilfikers heartfelt, yet unconventional confessional, Facing our Mistakes, he describes how difficult it is to make mistakes as a doctor, despite the fact that mistakes happen all the time. This reframed my understanding of healthcare because of Hilfikers assertion: A physician is even less prepared to deal with his mistakes than is the average person, he writes. Nothing in our training prepares us to respond appropriately. As a student, I was simply not aware that the sort of mistakes that I would eventually make in practice actually happened to competent physicians. Transforming a deeply-embedded set of values is an arduous process currently under way. From my own family members who work in the field of health care, it is evident that doctors, too, are susceptible to feeling guilty, depressed, or fearful after making a mistake, or even after coming close to making one. Those feelings could manifest themselves in the body and the physical world, prompting sleeping difficulty, problematic relations with coworkers, and lessened feelings of self-esteem. Like any other human being, a doctor might be afraid to speak to their colleagues about these troubles, in apprehension of being viewed as inferior, being subject to humiliation, or being fired. Dr. Atul Gawande reinforces the importance of addressing mistakes in his novel, Better: A Surgeons Notes on Performance, published in 2008. Seeing as the majority of people have been patients before and, thus, have placed a great deal of faith into a health care institution that they are unlikely to know much about. There is an invisible curtain that is ever-present between the worlds of the general public and medical professionals. It is a curtain sewn with fabrics of complicated medical terms and auras of superiority on the professionals end, and unguarded, potentially naive outlooks on that of the patients. Gawande pulls that curtain back to reveal a fact that tends to allude the public: like any occupational field, the medical world is not perfect. This is a fact that is best exemplified when he chronicles a simple story about diligence. Every single year, close to three million citizens of the United States of America are infected with a disease following a visit to the hospital. Approximately 100,000 people die from those infections. From where did they originate? After innumerable studies and millions of dollars worth of research being poured into discovering the root cause of high infection rates following hospital visits, the answer was discovered to be as simple and mundane as a lack of hand-washing. Gawande states, People underestimate the importance of diligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as The constant and earnest effort to accomplish what is undertaken. Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior. Thus, it can be concluded that the fear of malpractice is not the only contributing factor to our medical system that is ever-situated on the defense, but also our culture, which fosters a fantasy of unattainable perfection.

Which of the works we read most effectively complicated your understanding of compassion? How and why?

One of the most effective fictional portrayals of suffering and compassion is Ernest Hemingways short story, Indian Camp. Compassion, from the word patior, literally translates to "to suffer with. Thus, the two emotions, suffering and compassion, go hand in hand because compassion is the one that is felt in response to the suffering of others; it prompts ones desire to help. Indian Camp complicates my understanding of compassion because of the types of suffering it addressed, including physical and mental suffering. In the story, the physical suffering is expressed through the outward pain of the Indian womans labor contractions, evidenced by her screams. The mental pain is portrayed by the internal anguish of her husband, evidenced by his suicide. Although the taut, clinical style in which the story is scripted is not telling of the relationship between the woman in labor and her husband, it allows for the reader to imagine the intense nature of their bond. The complication stems from the explicit gendering. The female was able to express her pain through screaming, and the men are expected to internalize it. This internalization may manifest itself dramatically and physically, until it is too late to do anything about it. This prompts the reader to feel for the husband, who laid above his wife, listening to her cries, and unable to help her or desert the sound of her suffering. Out of helplessness, he killed himself. He couldn't stand things any longer, as Nicks father suggested. Dr. Adams lack of compassion for the womans screams and her husbands suicide complicates the readers understanding of compassion because it forces us to consider a particularly difficult fear to come to terms with: that as technology advances, mankinds compassion will dwindle. Does that mean that compassion should be emphasized as a component of healthcare? Our general preoccupation with the current biomedical model of medicine diverts attention from the bio-psycho-social trinity, prompting too many, including Nicks father, to deem it irrelevant. Dr. Adams lack of empathy introduces to me a foreign outlook on healthcare: that compassion does not necessarily need to have a place in the field. A Caesarian section with a jack knife is a task that may be completed competently without any feelings of sympathy, empathy, or pity. In fact, a detached and mechanical approach such as this one is probably appropriate, as long as the end goal is to achieve success in regard to the surgical procedure. If Dr. Adams were to have felt sympathy toward the woman at this time, might it have affected his ability to perform the procedure? It is certainly possible. This twofold cost of compassion complicates my outlook on the subject. I have come to conclude that although compassion is not required to successfully complete all tasks, it is such a potent and crucial force of motivation because the desire to help as a reaction to suffering is the very root of the nobility that underlies any profession in healthcare.

In what specific ways does poetry provide an appropriate means of getting at multiple dimensions of pain and suffering? Give examples.

Although I used to consider poetry as a daunting medium because of its notable practitioners and seemingly-endless rules associated with its forms, I have found it to be one of the most effectual genres in regard to expressing the multiple dimensions of pain and suffering. Jeremy Nobels poem, Pain Work-Up, shed light on several aspects of pain through its unique question format. The speaker posed a multitude of questions that could describe ones pain, defining and framing the act of experiencing pain that only a poem is capable of doing. The speaker seems to be addressing a patient, and the questions remain realistic in a hospital setting until the speaker asks, Do you feel like a small animal is nibbling inside you? From there on in, the questions become personal, shattering the invisible societal boundaries drawn between doctors and patients. When I read this for the first time, I put myself in the place of the interrogator. Upon reading it for a second time, I placed myself in the position of the subject. At first, I was unsure of how certain questions related to symptomatic pains, such as Do you remember a time before birth when the / Rhythm of the universe was your second heartbeat? This is a poetic question, and it redirects the reader to a sense of nothingness, peace. A time before birth was a time before a fully developed consciousness. It was a period of non-existence in the physical world. The next question, Do you remember how green the grass used to be? prompted me to reflect on what is fundamentally human and what should not be: the thought that the grass might have truly been green on my side as opposed to that of the others is not one that crosses my mind often. As the saying goes, the grass always seems greener on the other side. Perhaps that line of thinking effectuates a certain pain in people: that feeling of dissatisfaction and subsequent misery. When you were young did you torture animals? This is disturbing because that is a characteristic often prescribed to serial killers in the making. It makes me wonder if the affliction of pain upon others is reflective of pain within. This is a dimension of pain that is difficult to approach because the psyches of such people are complicated and of no familiarity to myself. Were you faithful to your first lover? I can understand why this might be a source of pain for some. The pain associated with cheating one a partner and the inner turmoil that follows close behind is a dimension that is often left unaddressed, considering the fact that few bother to sympathize with those in the wrong. It is important to address such pain because shame is a horribly volatile and destructive feeling to live with, and that is exactly what one must do - live with it. The subsequent inner turmoil can lead to depression, addiction, or aggression, as shame so often does. The second to last question, Are you afraid of the darkness? intrigued me because darkness, here, can hold two different meanings: a lack of light, or inner turmoil - the anger, pain, desperation, and violence that our superegos primarily effectively conceal from ourselves and the rest of the world. When children claim to be afraid of the dark, they are usually just frightened of all that is associated with the lack of light. Their obscured visions engender their imaginations, and they assume that all the evils of the night, the monsters of the bed and behind the closet, will steal them away when they are most vulnerable. That belief in itself is a sort of fear. As Aristotle once stated, Fear is pain arising from the anticipation of evil. The last question, Tell me about the pain, / Is it sharp or dull? is a reversal to the normative questions posed in the beginning of the poem and used to categorize symptomatic pain. It is a question that is so often asked that people end up believing that pain can be either one of two things. However, as the poem so effectively demonstrated with its in-depth, personal questions, pain cannot be categorized so simply. There is a whole unscripted spectrum of levels and causes and feelings of pain that medical professionals do not take into account when querying a patient.Galway Kinnells Parkinsons Disease is a poem about nostalgia. Simply put, nostalgia is a beautiful suffering. It is the feeling on the first day of Spring when the sun glazes your skin after a long, dark winter and you are reminded of the limitless summer ahead. It is the whiff of a passerbys cologne that is the same as that of an old lover, hauling you back into a thunderstorm of unfiltered emotions you believed you had finally reigned in. It is a crippling and painful inertia that is difficult to avoid at old age. However, it is beautiful in small doses and can spark moments of reflection, inspiration, and reconnection (to ones youthful self and to others). The baby imagery in the Kinnells poem portrays a role-reversal situation between the care-taker and the one who is wanting of care, the relationship between a daughter and her aging father. It commences with the daughter spoon-feeding her ill father and it ends with a parallel drawn between her first steps and his last. That role reversal is a derivative of the narrators nostalgia and it evokes sentiments of pain, woe, and heartache within the reader. The role reversal in this poem is so important because it brings back the topic of dependency shifts, a phenomena also present within the poem, donor by Lucille Clifton. The role of the care-taker and the patient are often switched over the course of a lifetime, and that is made evident by the descriptions of role reversal that the tenderness with which the daughter cares for her father so that the humiliation of aging is lessened and that he is even delighted at the end. This poem complicates the role of the caregiver as well: when is it an appropriate time to reverse the roles (in regard to the roles of the parent and child)? Where is the line drawn between babying and caregiving? One line had a particularly shocking effect on me: Tomorrow will be too late for them to jolt / This supper out of him. She strokes / his head very slowly, as if to cheer up. The abruptness with which the speaker shifts from a somewhat disturbing event to a tender, loving gesture surprises the readers. However, it succeeds in its intended effect: to establish a juxtaposition, one that is reflective of reality. Her inner pain is evident in the gentleness of her stroke. It is undoubtedly a source of pain, for a child to witness a once-able parent to fall prisoner to a disease as harmful and hurtful as Parkinsons. By stealing memories and experiences conjured over a lifetime, the disease is essentially responsible for erasing a lifetime from its victim. Although the patient may not feel pain out of oblivion, the families and friends of the patient suffer from such a loss. This poem reveals its dimensions of suffering through its line breaks the simplicity of word choice. The lack of continuity that readers are so accustomed to. The line breaks cause every single line and, consequently, every image it represents, to be depicted in a more jarring fashion. It feels all that more real. Continuous sentences have a tendency to be so direct that they leave little to the imagination. These line breaks force the reader to stop after each line, and for a fleeting moment, be held in suspense, or to ponder what might come next. It is simply a reminder that in life, one may never know what to expect; one can only trust that the words will fall into sequence. One may hope to experience beautiful and terrible things and then bear witness to the suffering attached to nostalgia when reflecting on ones existence in the end.

How might story be an agent of healing? Of getting stuck in pathological patterns?A story can serve as an agent of healing because the entirety of our lives are personal narratives in construction, from the moment we exit the womb until the moment we enter the sands. When a patient tells his or her story, and is encouraged to do so, it may feel like a stress-alleviating release. Realizing that there is somebody who cares and supports your words and experience is one of the most powerful medicines on this planet. That is because it shatters the notion that we are all disconnected beings. The minute one discovers that there are others out there whose suffering is comparable to his or her own, then that sense of disconnection dwindles, and the truth is revealed: that we are all human beings who vibrate energies that are all interconnected to one another through processes akin to quantum entanglement. There are so many who leave their stories untold, their songs unsung, and that can result in feelings of aloneness or listlessness and a disconnection to ones place and purpose in this world. It can plague them with a chronic and painful perception that something is not quite right. Bottled up stories prompt those feelings which can then manifest themselves in the physical body through illnesses. Studying psychology has informed me of the positive mental and physical effects of telling ones story: when a personal story is relayed and the person on the receiving end is felt to genuinely care, the bodys stress responses are mitigated, turning off toxic stress hormones such as cortisol and epinephrine and turning on relaxation hormones such as oxytocin, nitric oxide, dopamine, and endorphins. In turn, these hormones trigger the bodys self-repair apparatuses. Consequently, storytelling can function as both preventative medicine and a supplement to treatment if one is already sick. Loneliness and detachment are feelings that can torment the mind, and storytelling reminds us that we are not alone. With the growing presence of technology in society, we have seen a growing instance of destorification among the various cultures of the world, because such technology minimizes the need for people to interact with others. Computers and phones reduce the need for human-to-human interactions, and drugs provide quick-fixes like immediate symptom relief to ailments that may settle deeper within the person than merely the external body. Storytelling gives us a way to delve into and extract the ramifications of a deeply-rooted illness within the mind-body-soul trinity. I have found the gateway to my own path toward inner healing within the Bible story, 2 Kings 5:15-19: The Healing of Naaman. The accounts within the Bible are of particular interest to me because, as a recently baptized Christian, the stories serve as both guidelines and analogies that are relevant in my own life. Naaman, by immersing himself seven times in the Jordan river, humbled himself. He was essentially baptized, because he came out of the river as a new person, completely renewed. For Naamans full health to be restored, his pride had to be broken. Thus, it was imperative that he humbled himself by washing in the Jordan seven times, as advised by Elisha, the prophet. Although at first, Naaman viewed this as a personal insult and an act of humiliation, his gracious servants swayed him in the right direction. By addressing him as Father and providing sound advice, he was moved by words of their logic. Naamans willingness to heed the words of his servants was the first instance in which the reader sees his pride to be sacrificed, and So he went down and dipped seven times in the Jordan, according to the saying of the man of God. Despite the fact that it must have been taxing to humble himself to such an extent in the presence of his inferiors, he stripped himself of all egoistic pride and nobility. This is a beautiful and telling portrayal of the way of salvation. It is important to acknowledge and become conscious of our sins and weaknesses which may manifest themselves in our external bodies if not addressed, as exemplified by Naamans leprous condition. Having read this story prior to my own experience, I was made aware of the significance of the immersion metaphor. Hearing this story from my own pastor prior to being baptized healed my spirit and warmed my soul. I saw myself in Naaman, and I could better understand my own renewal by understanding his. In such a way, storytelling is an agent of healing, for we can find our own suffering in the the personal narratives of others and that eases the feelings of lonesomeness. However, in a medical setting, storytelling can also result in the fixation of a pathological pattern. When a doctor asks his or her patients what their stories are, the patients outlooks might prove to be so rigid regarded their pain and suffering that they might actually form a mental block against healing. Rigid in the sense that their repetition of a painful story might have prompted them to wallow in pity, become hopeless, or feel that their illness is beyond repair. Repetitive storytelling has a mantra-like effect in the sense that the more you repeat your story, the more you believe it; the body will respond accordingly. It is a vicious cycle, and thus, it is important to be expressive, yet optimistic about the future. Conclusively, healing is a natural process. Yet, having to deal with, resolving and discovering the meaning of lifes tests can be an elusive, lonely process that storytelling can make that much less painful.