Truth, disease, and prognosis. An historical-anthropological analysis

Annals of the New York Academy of Sciences

Volumn 809, Issue , 1997, Pages 40-55

  Galeazzi, Olivio ^a  

^a UNIVERSITY OF BOLOGNA   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CANCER PATIENT; CULTURAL ANTHROPOLOGY; DOCTOR PATIENT RELATION; HUMAN; PATIENT INFORMATION; PROGNOSIS;

EID: 0030994015     PISSN: 00778923     EISSN: None     Source Type: Book Series    
DOI: 10.1111/j.1749-6632.1997.tb48067.x     Document Type: Article

References (59)

1. "The use of true and false is a bit misleading, because it refers to the idea of 'agreement' or 'correspondence' with the facts (or with reality), which is anything but easy to explain . . . . On the basis of this agreement it is assumed that a statement is true if it agrees with the facts or with reality." (Gaetano Calabró. 1981. Vero/Falso. In Enciclopedia Einaudi, Vol. 14, p. 1035. Einaudi. Turin.) It is assumed, though, that truth (or falsehood) is something that concerns the statement of reality, and not the reality stated. Reality will never be true or false - only the statement about reality.
2. The spoken word and its intrinsic power of truth, as the power of relationship, has relevance in the Western classical and Christian traditions, with smaller and less diverse relevance in other traditions. ". . . I assert that God does not know because He is, but that He exists because He knows; because God is intellect and knowledge and His knowledge is the very essence of His being." Then John 1.1 says: "In the beginning was the Word, and the Word was with God, and the Word was God." The Evangelist did not say: In the beginning there was being, and God was being. The Word refers totally to the intellect, as the act of telling and as the spoken word that holds within itself being and nonbeing. That is why the Savior says in John 16.6, 'I am the truth.' Reality watches over the intellect. This relationship receives its whole being from the soul . . . ." (Meister Eckhart. 1953. La nascita eterna. In Antologia sistematica delle opere latine e tedesche. G. Faggin, Ed.: 5. Sansoni. Florence. Quaestio "Utrum in Deo sit idem esse et intelligere," 1302-1304). What assures the existence of a bond between language and the world? The act of naming or baptizing things in the world is always a conventional act, but it always establishes a relatively stable reference between a name and the thing that it indicates; the act of showing that a certain thing has been baptized with a certain name is the basic causal mechanism that stabilizes the relationship between the signifier and the signified. Cf. Thomas Kuhn, 1985, La metafora della scienza - Il riferimento dei termini scientifici e il cambiamento delle teorie., Pegaso 1(1): 46.
3. The spoken word and its intrinsic power of truth, as the power of relationship, has relevance in the Western classical and Christian traditions, with smaller and less diverse relevance in other traditions. ". . . I assert that God does not know because He is, but that He exists because He knows; because God is intellect and knowledge and His knowledge is the very essence of His being." Then John 1.1 says: "In the beginning was the Word, and the Word was with God, and the Word was God." The Evangelist did not say: In the beginning there was being, and God was being. The Word refers totally to the intellect, as the act of telling and as the spoken word that holds within itself being and nonbeing. That is why the Savior says in John 16.6, 'I am the truth.' Reality watches over the intellect. This relationship receives its whole being from the soul . . . ." (Meister Eckhart. 1953. La nascita eterna. In Antologia sistematica delle opere latine e tedesche. G. Faggin, Ed.: 5. Sansoni. Florence. Quaestio "Utrum in Deo sit idem esse et intelligere," 1302-1304). What assures the existence of a bond between language and the world? The act of naming or baptizing things in the world is always a conventional act, but it always establishes a relatively stable reference between a name and the thing that it indicates; the act of showing that a certain thing has been baptized with a certain name is the basic causal mechanism that stabilizes the relationship between the signifier and the signified. Cf. Thomas Kuhn, 1985, La metafora della scienza - Il riferimento dei termini scientifici e il cambiamento delle teorie., Pegaso 1(1): 46.
4. It should be remembered that the act of saying that makes reality true is always an act of selective saying, which sees and underlines only the essential part of reality. Only this part of reality is seen and expressed; only it matters. The truth or the idea that we have about what the truth is is such only when it presents a particular element, a signature, a sign of reality. It is obvious that a complex reality requires, in order to be identified, a complex variety of signs. The same is true in the case of the truth about cancer as for the identification of every level of truth. There are strong analogies with anatomical-clinical iconography: ". . . we are not so much dealing with a single mark of truth in anatomical illustration, but with complex varieties of truths which carry the marks or imprints of a wide range of factors - intellectual, visual and social . . . ." (Martin Kemp. 1993. The mark of truth: Looking and learning in some anatomical illustrations from the Renaissance and the eighteenth century. In Medicine and the Five Senses. W. F. Bynum & Roy Porter, Eds.: 121. Cambridge University Press. Cambridge.)
5. Cf. Antonella Surbone, 1993, Dire la verità ai pazienti, JAMA Ital. edit. 5(1): 33-35; Edmund D. Pellegrino, 1993, Dire la verità al paziente è un artefatto culturale? JAMA Ital. edit. 5(1): 36-37; Howard D. Silverman, L'arte di comunicare cattive notizie, in Medico e Paziente (Trad. da Senior Patient), McGraw-Hill, New York, NY; Antonella Surbone, 1993, Which truth to the patient? in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.).
6. Cf. Antonella Surbone, 1993, Dire la verità ai pazienti, JAMA Ital. edit. 5(1): 33-35; Edmund D. Pellegrino, 1993, Dire la verità al paziente è un artefatto culturale? JAMA Ital. edit. 5(1): 36-37; Howard D. Silverman, L'arte di comunicare cattive notizie, in Medico e Paziente (Trad. da Senior Patient), McGraw-Hill, New York, NY; Antonella Surbone, 1993, Which truth to the patient? in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.).
7. Cf. Antonella Surbone, 1993, Dire la verità ai pazienti, JAMA Ital. edit. 5(1): 33-35; Edmund D. Pellegrino, 1993, Dire la verità al paziente è un artefatto culturale? JAMA Ital. edit. 5(1): 36-37; Howard D. Silverman, L'arte di comunicare cattive notizie, in Medico e Paziente (Trad. da Senior Patient), McGraw-Hill, New York, NY; Antonella Surbone, 1993, Which truth to the patient? in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.).
8. Cf. Antonella Surbone, 1993, Dire la verità ai pazienti, JAMA Ital. edit. 5(1): 33-35; Edmund D. Pellegrino, 1993, Dire la verità al paziente è un artefatto culturale? JAMA Ital. edit. 5(1): 36-37; Howard D. Silverman, L'arte di comunicare cattive notizie, in Medico e Paziente (Trad. da Senior Patient), McGraw-Hill, New York, NY; Antonella Surbone, 1993, Which truth to the patient? in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.).
9. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
10. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
11. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
12. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
13. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
14. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
15. Therapy becomes effective only if the doctor gets profoundly and intensely, although maybe unconsciously, involved in his relationship with his patient. An involvement that could only lead to change is essential to all healing dynamics. (Girgio Bert & Silvana Quadrino. 1993. Il medico e il counseling. Il Pensiero Scientifico Ed. Rome.) A relationship of reciprocal availability between both poles of the therapeutic dyad (doctor and patient) could be delineated from the model formulated in T. S. Szasz & M. H. Hollender, 1956, A contribution to the philosophy of medicine: The basic models of doctor-patient relationship, Arch. Intern. Med. 97: 585 (cited in Costantino Jandolo, 1985, Il malato inosservante, p. 60, Armando, Rome). To the three models - parent-child ("activity/passivity"), parent-adolescent ("guidance/cooperation"), adult-adult ("mutual participation") - should be added a fourth: child-child, which exists at the moment of change or growth that is essential in all types of healing dynamics. See also Rosaria Conte & Mauro de Angelis, 1984, Scopi e conflitti di ruolo del medico nel rapporto col paziente, in Esplorare la vita quotidiano, Carlo Gerbaldo, Ed., p. 237, CNR-Il Pensiero Scientifico Ed, Rome. In the history of the professions, and especially of the medical profession, two opposing tensions coexist: the capacity to remain objective in the exercise of a role (T. Parsons, 1939, The professions and social structure, in Essays in Sociological Theory, Pure and Applied, T. Parsons, Ed., The Free Press, Glencoe, IL) and the availability for intimate involvement in the therapeutic relationship (Olivio Galeazzi, 1992, Rapporto terapeutico e antropologia della sessualità, in Atti 34 Congr. Naz. Storia Med., Messina, November 27-29, 1989, pp. 583-603.) It is not by chance that the element of secrecy is of the essence of the development of the very concept of profession, though in some cases the secret is activated in the opposite direction. "It should be observed that under the guise of the affirmation of truth and the professional secret, the position of a doctor is clearly different from that of a lawyer. The client confides to the lawyer a secret that he himself (the client) knows, while the patient confides to the doctor a secret concerning the condition of his health that he himself does not know and that he wishes to learn about from the doctor . . . ." (Francesco Carelli, 1993, Verità o bugie al malato? Meditime 25(11): 16.)
16. Cf. C. Melodia & C. de Beretolini, 1990, L'immagine del cancro: Dalla morte alla rinascita, Psichiatria e medicina, October: 22-24.
17. "How much a patient should know depends on his desire and on his character, on the wishes of his family, on the state of his affairs, and maybe on his religious convictions . . ."; ". . . one thing is sure, it is not your job to put on a black hood and assume the role of a judge who pronounces a death sentence, to dash all hope of the patient . . . hope that counts so much for all of us (William Osler) . . . ." (1975-1976. Harrison's Principi di medicina interna e terapia, various authors, vol. 1, p. 12, Vallardi, Milan.) Even though all these elements - the desire of the patient, his/her character, the wishes of the family, the state of affairs, religious convictions, keeping hope alive, etc. - are facts of reality that should enter into the clinical evaluation, they are also clinical facts essential in the communication of reality. The Oslerian concept of judge and sentence evidently evolved in the last century. A judge should show wisdom in passing a sentence the way a doctor should show wisdom in forming and communicating a diagnosis. See Maria Giovanna della Vecchia, 1993, Verità vo cercando, Tempo Medico, 11(12): 11.
18. "How much a patient should know depends on his desire and on his character, on the wishes of his family, on the state of his affairs, and maybe on his religious convictions . . ."; ". . . one thing is sure, it is not your job to put on a black hood and assume the role of a judge who pronounces a death sentence, to dash all hope of the patient . . . hope that counts so much for all of us (William Osler) . . . ." (1975-1976. Harrison's Principi di medicina interna e terapia, various authors, vol. 1, p. 12, Vallardi, Milan.) Even though all these elements - the desire of the patient, his/her character, the wishes of the family, the state of affairs, religious convictions, keeping hope alive, etc. - are facts of reality that should enter into the clinical evaluation, they are also clinical facts essential in the communication of reality. The Oslerian concept of judge and sentence evidently evolved in the last century. A judge should show wisdom in passing a sentence the way a doctor should show wisdom in forming and communicating a diagnosis. See Maria Giovanna della Vecchia, 1993, Verità vo cercando, Tempo Medico, 11(12): 11.
19. Aurelio Mauri Paolini. 1987. Evoluzione tecnico-scientifica. Costi sanitari crescenti. Ritardi culturali nelle strutture amministrative-decisionali del S. S. N. attuale. In International Workshop on the History, Anthropology and Epistemology of Medicine, Senigallia, Italy, November 27-28, 1987 (Abstr.).
20. Cf. in Tito Pignedoli, n.d., Fede e malattia, in "Doctor": ". . . only human consciousness has been the cause of the fact that suffering itself has not become isolated and ignored by the community. On the contrary, this very consciousness of the existence of suffering has caused the development of studies and research, the development of medication and countermeasures to prevent it. This has happened because the sick have made the healthy conscious that pain exists, even though the healthy do not have it at the moment." To give meaning to suffering by means of converting it into a universal, communal, shared hope - in other words, a cultural hope - is a primary historical requirement of sick humanity.
21. About the social and cultural (and specifically urban) origin of the entire modern pandemic of chronic degenerative diseases (cardiovascular, neoplastic, psychopathological, etc.) see Sandro Spinsanti, 1993, Il peso della dimensione sociale nel determinarsi della malattia, in Il Medico d'Italia 42: 8; and Olivio Galeazzi, 1994, Ethnopathology in urban contexts: Anthropologtical and historical notes, in Actas 32 Congr. Intern. Historia Medicina, J. L. Carillo & G. Olague de Ros, Eds., pp. 543-551, Seville.
22. About the social and cultural (and specifically urban) origin of the entire modern pandemic of chronic degenerative diseases (cardiovascular, neoplastic, psychopathological, etc.) see Sandro Spinsanti, 1993, Il peso della dimensione sociale nel determinarsi della malattia, in Il Medico d'Italia 42: 8; and Olivio Galeazzi, 1994, Ethnopathology in urban contexts: Anthropologtical and historical notes, in Actas 32 Congr. Intern. Historia Medicina, J. L. Carillo & G. Olague de Ros, Eds., pp. 543-551, Seville.
23. The hypothesis that illness is a message of the invisible exists in every historical and cultural context. It could represent divine or diabolical punishment or revenge, caused by a spell, a prophecy come true, the eruption into everyday reality of deep yearnings, not necessarily negative but endowed by a creative potency, unexpressible any other way, of the individual or collective unconscious (cancer as "symbolic pregnancy," ethnic and "paranormal" pathologies, etc.). Cf. Alessandra dal Ri, .n.d., Voglio guarire, quindi guarisco, in "Doctor": ". . . All emotion that is not lived is lived by the body. This is a very old idea. For ancient Egyptians illnesses are 'confessions' of the soul. In renaissance medicine Paracelsus says: The invisible becomes visible through analogy.' About illness as creativity, i.e., as an "esthetic moment," see Arnaldo Cherubini & Francesca Vannozzi, 1993, Note bibliografiche sull'uso (e l'abuso) del patologico nel Romanticismo, in Healing - Storia e strategie del guarire, Olivio Galeazzi, Ed, pp. 75-92, Olschki, Florence. On the capacity of illness to reveal a level of the invisible and otherwise inaccessible "other" reality, see Renato di Michele, 1993, Il corpo ammalato come emittante di segni, in Healing (op. cit.), pp. 65-73. Illness is something that should be harnessed, tamed, and translated into a different language; suffering requires an interpretation. See Marc Augé, 1982, Simbolo, Funzione, Storia, Liguori, Naples.
24. The hypothesis that illness is a message of the invisible exists in every historical and cultural context. It could represent divine or diabolical punishment or revenge, caused by a spell, a prophecy come true, the eruption into everyday reality of deep yearnings, not necessarily negative but endowed by a creative potency, unexpressible any other way, of the individual or collective unconscious (cancer as "symbolic pregnancy," ethnic and "paranormal" pathologies, etc.). Cf. Alessandra dal Ri, .n.d., Voglio guarire, quindi guarisco, in "Doctor": ". . . All emotion that is not lived is lived by the body. This is a very old idea. For ancient Egyptians illnesses are 'confessions' of the soul. In renaissance medicine Paracelsus says: The invisible becomes visible through analogy.' About illness as creativity, i.e., as an "esthetic moment," see Arnaldo Cherubini & Francesca Vannozzi, 1993, Note bibliografiche sull'uso (e l'abuso) del patologico nel Romanticismo, in Healing - Storia e strategie del guarire, Olivio Galeazzi, Ed, pp. 75-92, Olschki, Florence. On the capacity of illness to reveal a level of the invisible and otherwise inaccessible "other" reality, see Renato di Michele, 1993, Il corpo ammalato come emittante di segni, in Healing (op. cit.), pp. 65-73. Illness is something that should be harnessed, tamed, and translated into a different language; suffering requires an interpretation. See Marc Augé, 1982, Simbolo, Funzione, Storia, Liguori, Naples.
25. The hypothesis that illness is a message of the invisible exists in every historical and cultural context. It could represent divine or diabolical punishment or revenge, caused by a spell, a prophecy come true, the eruption into everyday reality of deep yearnings, not necessarily negative but endowed by a creative potency, unexpressible any other way, of the individual or collective unconscious (cancer as "symbolic pregnancy," ethnic and "paranormal" pathologies, etc.). Cf. Alessandra dal Ri, .n.d., Voglio guarire, quindi guarisco, in "Doctor": ". . . All emotion that is not lived is lived by the body. This is a very old idea. For ancient Egyptians illnesses are 'confessions' of the soul. In renaissance medicine Paracelsus says: The invisible becomes visible through analogy.' About illness as creativity, i.e., as an "esthetic moment," see Arnaldo Cherubini & Francesca Vannozzi, 1993, Note bibliografiche sull'uso (e l'abuso) del patologico nel Romanticismo, in Healing - Storia e strategie del guarire, Olivio Galeazzi, Ed, pp. 75-92, Olschki, Florence. On the capacity of illness to reveal a level of the invisible and otherwise inaccessible "other" reality, see Renato di Michele, 1993, Il corpo ammalato come emittante di segni, in Healing (op. cit.), pp. 65-73. Illness is something that should be harnessed, tamed, and translated into a different language; suffering requires an interpretation. See Marc Augé, 1982, Simbolo, Funzione, Storia, Liguori, Naples.
26. "Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick." (Susan Sontag. 1978. Illness as Metaphor. Farrar, Straus and Giroux. New York, NY.)
27. A hermeneutic of illness cannot exist without anthropological categories, because just as anthropology is a science of "elsewhere" (of others different from oneself, of the other that is in us), in the same way illness, in its very presence, requires the existence of "others" and of an "elsewhere," where the suffering can find the cause as well as its alleviation. See Ferdinando de Marco & Anselmo Palma, 1993, Condividere il disturbo è una terapia? Comunicazione ed espressione del disagio nella dimensione della antropologia quotidiana, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.).
28. Illness is perhaps the most tellable and most memorable event of human existence. There are structural analogies between the story of illness and the other types of stories present in the different literary genres. In all of them the tension escalates until the climax, in which all the moments of narration lead toward the final resolution. In such stories every passage gradually prepares us for the final catastrophe, of which the audience is aware, yet without knowing until the very end the actual outcome of the story. War stories, travel stories (a kind of story of homecoming), comic stories (jokes and gags), and, above all, detective stories: How will it end? Who will recognize the killer? Who will win the war? What will be the outcome of the illness? How will the joke end? These genres of story finds their meaning only at the end. Cf. Walter J. Ong, 1986, Oralité e scrittura - Le tecnologie della parola, Il Mulino, Bologna.
29. There exists a rhetorical hypertrophy in medicine, caused by the great linguistic intensity that characterizes the relationship between doctor and patient. The need to resolve a semiotic and emotional block has always made the therapeutic encounter relatively rigid and constrained. The encounter with the doctor is always changeable, yet stable and with a rigid protocol, like a repetitive ritual. However, in scientific medicine, a standard encounter with the doctor combines the maximum of methodological rigidity with the maximum of flexibility, of expressive spontaneity. In an optimal doctor's visit, a doctor should know how to be spontaneous (to go beyond the pure protocol), while the patient should know how to be rigorous (in order to conform to the rigor of clinical work). See Olivio Galeazzi & Gianni Jacovelli, 1986, Medicina come linguaggio e linguaggio degli srrumenti clinici, in Medicina e Storia, O. Galeazzi, Ed., Il Lavoro Edit., Ancona; Josep Lluis Barona, Communication obstacles in the doctor-patient relation, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). The concept of "volcanic eruption" is applicable to the primal, physiological stage of basic emotions and behavior, which only in the second stage acquires a certain cultural transformation, as happens with mourning, sexuality, nourishment and help-seeking, etc. See Wulf Shiefenhovel, 1985, Sterben und Tod bei den Eipo im Hochland von West-Neuguinea, Curare 4: 191-208.
30. There exists a rhetorical hypertrophy in medicine, caused by the great linguistic intensity that characterizes the relationship between doctor and patient. The need to resolve a semiotic and emotional block has always made the therapeutic encounter relatively rigid and constrained. The encounter with the doctor is always changeable, yet stable and with a rigid protocol, like a repetitive ritual. However, in scientific medicine, a standard encounter with the doctor combines the maximum of methodological rigidity with the maximum of flexibility, of expressive spontaneity. In an optimal doctor's visit, a doctor should know how to be spontaneous (to go beyond the pure protocol), while the patient should know how to be rigorous (in order to conform to the rigor of clinical work). See Olivio Galeazzi & Gianni Jacovelli, 1986, Medicina come linguaggio e linguaggio degli srrumenti clinici, in Medicina e Storia, O. Galeazzi, Ed., Il Lavoro Edit., Ancona; Josep Lluis Barona, Communication obstacles in the doctor-patient relation, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). The concept of "volcanic eruption" is applicable to the primal, physiological stage of basic emotions and behavior, which only in the second stage acquires a certain cultural transformation, as happens with mourning, sexuality, nourishment and help-seeking, etc. See Wulf Shiefenhovel, 1985, Sterben und Tod bei den Eipo im Hochland von West-Neuguinea, Curare 4: 191-208.
31. There exists a rhetorical hypertrophy in medicine, caused by the great linguistic intensity that characterizes the relationship between doctor and patient. The need to resolve a semiotic and emotional block has always made the therapeutic encounter relatively rigid and constrained. The encounter with the doctor is always changeable, yet stable and with a rigid protocol, like a repetitive ritual. However, in scientific medicine, a standard encounter with the doctor combines the maximum of methodological rigidity with the maximum of flexibility, of expressive spontaneity. In an optimal doctor's visit, a doctor should know how to be spontaneous (to go beyond the pure protocol), while the patient should know how to be rigorous (in order to conform to the rigor of clinical work). See Olivio Galeazzi & Gianni Jacovelli, 1986, Medicina come linguaggio e linguaggio degli srrumenti clinici, in Medicina e Storia, O. Galeazzi, Ed., Il Lavoro Edit., Ancona; Josep Lluis Barona, Communication obstacles in the doctor-patient relation, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). The concept of "volcanic eruption" is applicable to the primal, physiological stage of basic emotions and behavior, which only in the second stage acquires a certain cultural transformation, as happens with mourning, sexuality, nourishment and help-seeking, etc. See Wulf Shiefenhovel, 1985, Sterben und Tod bei den Eipo im Hochland von West-Neuguinea, Curare 4: 191-208.
32. Homer, Iliad, 1: 357-365, translated by Robert Fitzgerald, 1974, Doubleday, Garden City, NY. The goddess, who is a mother and a healer, appears under the guise of fog. This means that the one who is helping needs above all to be a presence. The forms, techniques, and good manners of the doctor mean very little if his presence is weak, or if the sick person does not perceive at the outset the inexpressible healing effectiveness inherent in the presence of the doctor.
33. Cf. D. Mechanic, 1976, Illness, illness behavior and help-seeking. Implications for increasing the responsiveness of health services, in The Growth of Bureaucratic Medicine, D. Mechanic,Ed., Wiley, New York, NY.
34. "Have you seen a case like mine before?" A primary and unconscious desire of the patient for the doctor to have seen a case like his before, a hundred, a thousand cases like his (preknowledge of the doctor). This releases his suffering from the chaos of the unknown and anchors it onto the medical (and magical) knowledge that gives meaning to the pain and resolves it. (J. N. Blau. 1993. Behaviour during a cluster headache. Lancet 342: 723-725.)
35. It should be remembered that communication has a primitive, "vulcanic" worth that cannot be reduced to a purely utilitarian vision. Healing, like sexuality, proceeds originally from a language. See Francesco Voltaggio, 1993, Eidos: Paradigma nosologico e prescrizione del farmaco, in Healing (op. cit.), pp. 241-267.
36. In all cultures there is a need to construct a philosophy of illness and healing capable of making suffering a model, a scheme, a syndrome. Cf. Francesco Voltaggio (op. cit.); La malattia e i suoi modelli, Convegno del Ministero dell'Università e della ricerca scientifica e tecnologica, Forlí, Italia, January 26-28, 1995; Filosofia della medicina, Corsi di medicina e scienze umane dell'Istituto Scientifico H. San Raffaele, Milano, 1988-1989/1989-1990.
37. In all cultures there is a need to construct a philosophy of illness and healing capable of making suffering a model, a scheme, a syndrome. Cf. Francesco Voltaggio (op. cit.); La malattia e i suoi modelli, Convegno del Ministero dell'Università e della ricerca scientifica e tecnologica, Forlí, Italia, January 26-28, 1995; Filosofia della medicina, Corsi di medicina e scienze umane dell'Istituto Scientifico H. San Raffaele, Milano, 1988-1989/1989-1990.
38. In all cultures there is a need to construct a philosophy of illness and healing capable of making suffering a model, a scheme, a syndrome. Cf. Francesco Voltaggio (op. cit.); La malattia e i suoi modelli, Convegno del Ministero dell'Università e della ricerca scientifica e tecnologica, Forlí, Italia, January 26-28, 1995; Filosofia della medicina, Corsi di medicina e scienze umane dell'Istituto Scientifico H. San Raffaele, Milano, 1988-1989/1989-1990.
39. A series of translations is embedded in illness - a naturalistic, pathological manifestation sets off a series of translations. It becomes translated into a precultural, primordial scream for help, which, in turn, is tranlated into a prefolkloric, prescientific common language. This is then translated into the language of the ethnomedical knowledge of illness and healing (prescientific folklore); and this is then finally translated by official medicine into scientific language (learned lore). This cascade of translations leads to the knowledge of illness and allows it to complete its course, to have a life as an "object" to be studied and to be tellable - which means treatable in its time outside of time.
40. Francesco Voltaggio, (op. cit.): "My research has led me to evidence that the School of Cos (fifth century B.C.) has elaborated a peculiar concept of illness in which every illness (nosos) is an eidos.
41. Mirko D. Ormek, 1985, Le malattie all'alba della civiltà occidentale, Il Mulino, Bologna, which cites the momumental J. E. Hebebstreit, 1751, Exegesis nominum graecorum quae morbos definiunt, Lankisch, Leipzig. On this theme see the text of a Babylonian tablet, "The people do not know the names of illnesses"; and the Bambara proverb "Illness is a thing that is searching for a buyer" - i.e., is seeking to be called by its name. (From the lectures of V. De Micco & M. A. Coccanari, respectively, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). On the "baptizing" of things refer to the quotation from Kuhn in Note 2.
42. Mirko D. Ormek, 1985, Le malattie all'alba della civiltà occidentale, Il Mulino, Bologna, which cites the momumental J. E. Hebebstreit, 1751, Exegesis nominum graecorum quae morbos definiunt, Lankisch, Leipzig. On this theme see the text of a Babylonian tablet, "The people do not know the names of illnesses"; and the Bambara proverb "Illness is a thing that is searching for a buyer" - i.e., is seeking to be called by its name. (From the lectures of V. De Micco & M. A. Coccanari, respectively, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). On the "baptizing" of things refer to the quotation from Kuhn in Note 2.
43. Mirko D. Ormek, 1985, Le malattie all'alba della civiltà occidentale, Il Mulino, Bologna, which cites the momumental J. E. Hebebstreit, 1751, Exegesis nominum graecorum quae morbos definiunt, Lankisch, Leipzig. On this theme see the text of a Babylonian tablet, "The people do not know the names of illnesses"; and the Bambara proverb "Illness is a thing that is searching for a buyer" - i.e., is seeking to be called by its name. (From the lectures of V. De Micco & M. A. Coccanari, respectively, in International Workshop on the History, Anthropology, and Epistemology of Medicine, Third Stage, Senigallia, Italy, November 27-28, 1993 (i.p.). On the "baptizing" of things refer to the quotation from Kuhn in Note 2.
44. All cured patients become followers and propagandists of a particular cure, of a particular doctor, of a particular hospital in the field of either official medicine or folk medicine. This phenomen is at the root of the modern health pilgrimage, of the so-called voyages of hope - an unavoidable element of the popular experience of illness. See Olivio Galeazzi, 1988, Ethnoiatrical operators in central Italy, Proc. 30 Intern. Congr. Hist. Medicine, Dusseldorf, 31-8/5-9/1986, Leverkusen, Vicom KG, pp. 701-713.
45. Olivio Galeazzi, 1991, Linguaggio folklorico e malattia in una popolazione ambulatoriale: Funzioni rituali e ascendenze culte, in Atti Conv. Psichiatria Magia Medicina popolare, Ferentino, November 14-16, 1991; Storia e Medicina Popolare 9-2,3(1991): 98-109; Lido Valdré, 1988, Medicina scientifica e Linguaggio del senso comune, in Nuova Civiltà delle Macchine," VI-24: 50-55 (monograph edited by O. Galeazzi: Strategie del quarire).
46. Olivio Galeazzi, 1991, Linguaggio folklorico e malattia in una popolazione ambulatoriale: Funzioni rituali e ascendenze culte, in Atti Conv. Psichiatria Magia Medicina popolare, Ferentino, November 14-16, 1991; Storia e Medicina Popolare 9-2,3(1991): 98-109; Lido Valdré, 1988, Medicina scientifica e Linguaggio del senso comune, in Nuova Civiltà delle Macchine," VI-24: 50-55 (monograph edited by O. Galeazzi: Strategie del quarire).
47. Olivio Galeazzi, 1991, Linguaggio folklorico e malattia in una popolazione ambulatoriale: Funzioni rituali e ascendenze culte, in Atti Conv. Psichiatria Magia Medicina popolare, Ferentino, November 14-16, 1991; Storia e Medicina Popolare 9-2,3(1991): 98-109; Lido Valdré, 1988, Medicina scientifica e Linguaggio del senso comune, in Nuova Civiltà delle Macchine," VI-24: 50-55 (monograph edited by O. Galeazzi: Strategie del quarire).
48. "Prognosis is composed of pro- (before) and -gnosis (knowledge) - foreknowledge, foresight. In the Hippocratic language it has a slightly different meaning: it designates the totality of an illness, past, present, and future, because the prefix pro- assumes an extensive-intensive meaning. Knowledge of the future was expressed by the word prognostikon, as part of the prognosis . . . ." (Enrico Marcovecchio. 1993. Dizionario etimologico storico dei termini medici. Festina Lende Ed. Impruneta, Italy.) See also Innocenzo Mazzini, 1989, Introduzione alia terminologia medica, Patron, Bologna.
49. "Prognosis is composed of pro- (before) and -gnosis (knowledge) - foreknowledge, foresight. In the Hippocratic language it has a slightly different meaning: it designates the totality of an illness, past, present, and future, because the prefix pro- assumes an extensive-intensive meaning. Knowledge of the future was expressed by the word prognostikon, as part of the prognosis . . . ." (Enrico Marcovecchio. 1993. Dizionario etimologico storico dei termini medici. Festina Lende Ed. Impruneta, Italy.) See also Innocenzo Mazzini, 1989, Introduzione alia terminologia medica, Patron, Bologna.
50. On the illustrious topic of the use of intuition (rational clairvoyance) in medicine, see the following: Mauro Di Giandomenico, L'occhio clinico tra teoria e storia; Giovanni Federspil, L'occhio clinico: Occhio magico o occhio logico? Cesare Scandellari, L'occhio clinico: Occhio magico o occhio logico? Emanuele Riverso, Strategie dell'occhio clinico; Enrico Garulli, Occhio clinico: Arte o scienza? All are in Epistemologia, metodologia clinica e storia della scienza medica, various authors, pp. 129-172.
51. On the illustrious topic of the use of intuition (rational clairvoyance) in medicine, see the following: Mauro Di Giandomenico, L'occhio clinico tra teoria e storia; Giovanni Federspil, L'occhio clinico: Occhio magico o occhio logico? Cesare Scandellari, L'occhio clinico: Occhio magico o occhio logico? Emanuele Riverso, Strategie dell'occhio clinico; Enrico Garulli, Occhio clinico: Arte o scienza? All are in Epistemologia, metodologia clinica e storia della scienza medica, various authors, pp. 129-172.
52. Storia della medicina, della farmacia, dell'odontoiatria e della veterinaria, various authors, Vol. 1, p. 335, Walk Over, Bergamo, 1982.
53. See Albert S. Lyons & Joseph R. Petrucelli II, 1992, La storia della medicina, Vol. 2, p. 218, Momento Medico, Salerno.
54. "It is not important what is said or how it is said, but to whom it is said. Before establishing what to say and before talking, it is important to foresee the psychological response of the patient to the news. Difficult!" Carelli, op. cit. See also Maurizio Imperiali, 1991, Negli ambulatori non si sa che dire, Tempo medico 15(5): 11.
55. "It is not important what is said or how it is said, but to whom it is said. Before establishing what to say and before talking, it is important to foresee the psychological response of the patient to the news. Difficult!" Carelli, op. cit. See also Maurizio Imperiali, 1991, Negli ambulatori non si sa che dire, Tempo medico 15(5): 11.
56. See 1990, La relazione medico-paziente: I seminario sulla comunicazione, various authors, Snamid, Milan; Constantino Iandolo, 1984, Parlare col malato: Tecnica, arte ed errori della comunicazione, Armano, Rome; Franca Laudi, 1978, Il dire implicate, Il polso, January 15, 1978; Majla Paci, 1985, La comunicazione della diagnosi, Medico e bambino 7: 539-542.
57. See 1990, La relazione medico-paziente: I seminario sulla comunicazione, various authors, Snamid, Milan; Constantino Iandolo, 1984, Parlare col malato: Tecnica, arte ed errori della comunicazione, Armano, Rome; Franca Laudi, 1978, Il dire implicate, Il polso, January 15, 1978; Majla Paci, 1985, La comunicazione della diagnosi, Medico e bambino 7: 539-542.
58. See 1990, La relazione medico-paziente: I seminario sulla comunicazione, various authors, Snamid, Milan; Constantino Iandolo, 1984, Parlare col malato: Tecnica, arte ed errori della comunicazione, Armano, Rome; Franca Laudi, 1978, Il dire implicate, Il polso, January 15, 1978; Majla Paci, 1985, La comunicazione della diagnosi, Medico e bambino 7: 539-542.
59. See 1990, La relazione medico-paziente: I seminario sulla comunicazione, various authors, Snamid, Milan; Constantino Iandolo, 1984, Parlare col malato: Tecnica, arte ed errori della comunicazione, Armano, Rome; Franca Laudi, 1978, Il dire implicate, Il polso, January 15, 1978; Majla Paci, 1985, La comunicazione della diagnosi, Medico e bambino 7: 539-542.