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PubMed2004

Shamans in a Hmong American community.

OBJECTIVE: To increase understanding of the process and meanings of shamanic care from patient complaint through diagnosis, treatment, and outcome. DESIGN: Information collected from 924 patient contact forms completed by 36 shamans over an 18-month period included basic demographic information on the patients, their complaints, treatments suggested by the shamans and the shamans' perceptions of the outcomes of treatment. These data were translated and entered into a computer database. LOCATION: A Hmong American community in California's Central Valley. METHODS: Quantitative descriptions of the sample were generated and integrated with qualitative analysis of the content of the text from the diagnostic, treatment and outcome categories was performed to systematically identify patterns in the data. RESULTS: Patients sought shamanic help for an array of physical, emotional, and psychologic complaints--problems that the shamans frequently diagnosed as being caused by soul loss or bad spirits. CONCLUSIONS: The data suggest the persistence of the need for the spiritual healing provided by the shamans within this immigrant community. Shamans' rituals affirmed and strengthened connections to family, culture, and community.

Adult↗
PubMed2003

Cortex, cognition and the cell: new insights into the pyramidal neuron and prefrontal function.

Arguably the most complex cortical functions are seated in human cognition, the how and why of which have been debated for centuries by theologians, philosophers and scientists alike. In his best-selling book, An Astonishing Hypothesis: A Scientific Search for the Soul, Francis Crick refined the view that these qualities are determined solely by cortical cells and circuitry. Put simply, cognition is nothing more, or less, than a biological function. Accepting this to be the case, it should be possible to identify the mechanisms that subserve cognitive processing. Since the pioneering studies of Lorent de Nó and Hebb, and the more recent studies of Fuster, Miller and Goldman-Rakic, to mention but a few, much attention has been focused on the role of persistent neural activity in cognitive processes. Application of modern technologies and modelling techniques has led to new hypotheses about the mechanisms of persistent activity. Here I focus on how regional variations in the pyramidal cell phenotype may determine the complexity of cortical circuitry and, in turn, influence neural activity. Data obtained from thousands of individually injected pyramidal cells in sensory, motor, association and executive cortex reveal marked differences in the numbers of putative excitatory inputs received by these cells. Pyramidal cells in prefrontal cortex have, on average, up to 23 times more dendritic spines than those in the primary visual area. I propose that without these specializations in the structure of pyramidal cells, and the circuits they form, human cognitive processing would not have evolved to its present state. I also present data from both New World and Old World monkeys that show varying degrees of complexity in the pyramidal cell phenotype in their prefrontal cortices, suggesting that cortical circuitry and, thus, cognitive styles are evolving independently in different species.

Animals↗
PubMed1974

The dilemma of science and morals.

The conflicts between science and morals which still continue to arise despite the apparent hegemony of atheistic scientism over traditional Judeo-Christianity in the twentieth century reflect a basic contradiction in the metaphysical foundation of Western lives. As was set forth by Machiavelli, the contradiction inherent in Western ethics is that it is based on the simultaneous belief in both objectively valid moral truths and purely relative values of communal purpose. The achievements of twentieth century science have intensified these contradictions. Modern physics has put in question the validity of its own metaphysical basis, namely the belief in Natural Law, and modern biology has been unable to come to terms with the Cartesian dualism of body and soul. By contrast, Chinese lives are comparatively free of these contradictions, being founded on the philosophies of Confucianism and Taoism, to which the concepts of objectively valid truth or Natural Law are foreign. Recent developments in Western attitudes regarding science and morals can be interpreted as a movement away from the traditional belief in absolute truths towards a Chinese relativism.

China↗
PubMed1989

One face of beauty, one picture of health: the hidden aesthetic of medical practice.

Unrecognized presuppositions about patient appearance have become increasingly important in medicine, medical ethics and medical law. Symptoms of these historically conditioned assumptions include common ageism, aesthetic surgery, and litigation about 'wrongful life'. These phenomena suggest a societal intolerance for what is considered an 'abnormal' appearance. Among others, eighteenth-century artists and anatomists helped to set these twentieth-century precedents, actually measuring deviations of external traits to analogous deformations of the soul, and drawing moral conclusions from physiognomic measurements. Other eighteenth-century artists countered with pathognomy, recognizing that uneven physical features may indicate humanity, instead of character flaws. We suggest that there is an important and as yet unrecognized role played by visual and perceptual preferences in our judgments concerning normalcy and anomaly. We further suggest a shift away from our current fashion-magazine, youth-oriented aesthetic, and towards an aesthetic of imperfection. Physicians and medical students can be made aware of their historically conditioned reactions to 'abnormal' appearing patients by studying the understandings and methods with which artists have portrayed those who are considered deformed in appearance.

Congenital Abnormalities↗
PubMed1989

Metaphysical accounts of the zygote as a person and the veto power of facts.

That the soul of a human person is infused at conception is a metaphysical claim. But given its traditional articulation, it has the empirical consequence that the zygote must have a substantial continuity with the adult person, a continuity which is already determined at conception. This empirical consequence is contradicted by the fact that the zygote may become a hydatidiform mole, or several persons. The metaphysical claim is falsified by the facts.

Beginning of Human Life↗
PubMed1990

Ars medicina et conditio humana. Edmund D. Pellegrino, M.D., on his 70th birthday.

In his writings, Edmund Pellegrino analyzes four deficiencies in the humanity of those who fall ill: the loss of (1) freedom of action, (2) freedom to make rational choices, (3) freedom from the power of others, and (4) a sense of the integrity of the self. Since Pellegrino's analysis and commitment to virtue-based ethics preceded much of the attention later given by philosophers to the importance of the moral principle of autonomy (in contrast to beneficence) in patient care, it is helpful to trace the source of his commitment to virtue-based ethics and his account of freedom to Aristotle's analysis of the human soul, as an entelechy of an intact and healthy living organism that, unimpeded by illness, moves itself to act, to actualize its intellectual potential in the form of making rational choices, and to free itself from the power of others by remaining independent and without need of continuous assistance, while at the same time retaining the integrity of a unified self that can act, think, and choose for itself autonomously.

Ethics, Medical↗
PubMed1993

The experiential foundations of shamanic healing.

An experience-centered approach reveals empirical foundations for shamanic healing. This article is based on data derived from surveys of Chinese, Japanese, Caucasian-American, and African-American populations and participant observation of over thirty Asian shamans. Respondents reported anomalous events such as apparitions, extrasensory perceptions, contact with the dead, precognitive dreams, clairvoyance, and out-of-body experiences. Based on folk reasoning, these episodes support belief in spirits, souls, and life after death. Shamanic healers have a far greater propensity to experience anomalous events than general populations and to use their beliefs arising from these episodes to produce ceremonies that change clients' perceptions of their illnesses. Although the foundations supporting shamanism differ from those sustaining Western medicine, both traditions provide experiences that convince clients that specific procedural methods alleviate illness.

Black or African American↗
PubMed1995

Medicine as metaphor in Plato.

This article (1) argues that ancient Greek medicine had a significant effect on the way in which Plato conceived of ethics, and (2) explores some ways in which Plato integrated medical concepts such as "health" into his ethics. Specific parallels between ancient medicine and such concepts as eudaimonia, soul, nature and convention, etc., are discussed, as is the relation between conceptions of health and medical treatment.

Ethics, Medical↗
PubMed1984

Two pathographies: a study in illness and literature.

This study compares two autobiographical descriptions of illness--the seventeenth-century John Donne's Devotions Upon Emergent Occasions and the twentieth-century Cornelius and Kathryn Ryan's A Private Battle. I begin by identifying the basic structure in both narratives as parallel to that of the case history, and then show how each individual's experience is shaped by the conditions of illness appropriate to their respective cultures. Lastly, I discuss the way in which both authors understand and represent sickness, as well as their respective therapies, in terms of a particular metaphoric construct: for Donne, it is the analogy between illness of the body and illness of the soul; for Ryan it is the analogy between illness and war. The stance of each towards his illness is conditioned by this metaphoric model: Donne's is one of acceptance, of conforming to the will of God; Ryan's is one of resistance, of fighting heroically until the very end. Thus these metaphors are functional as well as aesthetic: they serve as figural modalities whereby the patient/author hopes to transcend his illness.

England↗
PubMed2001

African American dietary patterns at the beginning of the 20th century.

Early field studies in human nutrition documented the eating habits of African Americans living in a variety of circumstances. We compare the results of these investigations. Our analysis shows systematic differences along a continuum reaching from remote, rural communities in the South toward increasingly metropolitan locations. On the latter end of the continuum, we find diets richer in protein, composed of a wider variety of foods and containing fewer of what we now call "soul foods." Greater market involvement and access to low cost alternatives to more traditional foods help explain these developments.

Black or African American↗
PubMed2000

Oxidase activity in lignifying xylem of a taxonomically diverse range of trees: identification of a conifer laccase.

In a diverse taxonomic range of tree species, including representative species of ancient families of angiosperms (Magnolia x soulangiana Soul.-Bod.) and gymnosperms (Ginkgo biloba L.), oxidase activity was associated with cell walls of developing xylem and was enriched in extracts of cell wall-associated glycoproteins. In all species where oxidase activity was detected histochemically, it was expressed in cell walls of lignifying, differentiating xylem cells and was absent from old wood, cambium and phloem, suggesting that oxidases have a conservative role in lignification of tree xylem. An oxidase from the developing xylem of Picea sitchensis (Bong) Carr. (Sitka spruce) was partially purified by a combination of lectin affinity and immobilized metal ion affinity chromatography. A portion of the total oxidase activity had high affinity for immobilized zinc ions and this feature allowed it to be separated from the bulk of oxidase activity. Two polypeptides that could have been responsible for the bound oxidase activity were enriched by this procedure. The smaller polypeptide of Mr approximately 73 kDa yielded an N-terminal amino-acid sequence that was homologous to laccase-like polyphenol oxidases (E.C. 1.10.3.2) from loblolly pine (Pinus taeda L.), poplar (Populus euramericana (Dode) Guinier) and Arabidopsis. The larger polypeptide (Mr approximately 77 kDa) yielded an N-terminal amino-acid sequence that was homologous with a range of plant subtilisin-like serine proteinases. The roles of oxidase and proteinase activities in developing xylem are discussed.

Cycadopsida↗
PubMed2000

Skin pathology and medical prognosis in medieval Europe: the secrets of Hippocrates.

This article analyzes a medieval text known as The Secrets of Hippocrates. Neither secret (because of its wide circulation in manuscript and print) nor by Hippocrates, the work offered readers a means of offering a prognosis of impending death based on observable signs on the skin. Although the aphorisms that make up the text make little sense in a modern medical understanding, the Secrets of Hippocrates fits well within three medieval traditions: the tradition of secrets literature, the medieval medical tradition, and the tradition of medieval Christian views about the body. First, like other books of secrets, a genre to whose conventions the text closely adheres, the Secrets of Hippocrates offered a shortcut to socially useful knowledge: the ability to offer an accurate medical prognosis. Second, the treatise corresponded to the medieval physician's concern for the so-called nonnaturals, such as diet and exercise. Third, it fit with a medieval Christian notion that sickness and sin were related, as were sin and ugliness. Just as a leper's deformities were a window to his sinful soul, so skin pathologies could clue a medieval physician to the lethal disease hidden inside the body.

Dermatology↗
PubMed2002

Arrogance among physicians.

Arrogance among physicians is, regrettably, common and violates the benevolent spirit of medicine-its very soul -as well the quality of medical care. The need for humility in the physician warrants greater emphasis in medical training, both in the classroom and, more critically, by example. Arrogance persists because of intersecting and mutually enhancing sociologic and psychological pressures. Regarding the sociologic elements, in earlier times, the great respect and prestige accorded physicians could foster arrogance in some. Today, physicians as a group are less likely to be idealized, but the health care system has depersonalized the doctor-patient relationship and created a kind of "system arrogance" in which the patient is seen not as a person but merely as a job to be done cost-effectively. As for psychological aspects, physicians are sometimes drawn to medicine by their unconscious concerns about illness and mortality-they become health experts in the hope of extending their own lives. Such physicians treat death as the enemy, and may practice unwarranted heroic measures. But the most critical variable in the development of arrogance is a physician's knowledge and thereby his or her power over the patient. This can delude some physicians into imagining that they are all-powerful. Seriously ill or injured patients tend to view the physician as an omnipotent parent and savior, and in this way unwittingly tempt physicians to be arrogant. The author concludes by reminding his fellow physicians that "we should not exaggerate our own importance. we are but an instrument of healing and not its source."

Attitude of Health Personnel↗
PubMed1993

Brain death in the pediatric patient: historical, sociological, medical, religious, cultural, legal, and ethical considerations.

OBJECTIVE: To detail the origins of the definition of death, the development of the criterion of whole brain death as fulfilling the definition of death, and the tests used to fulfill that criterion. DATA SOURCES: A review of the literature was performed. No Institutional Review Board approval was necessary. DATA EXTRACTION: In 1959, patients were described as being in "coma dépassé" or beyond coma. In 1967, the first successful heart transplantation took place, with the organ coming from a brain-dead, beating-heart donor. However, anxiety over the definitions of death did not begin with the modern, technological era, and death itself has never been definable in objective terms. It has always been a subjective and value-based construct. During ancient times, most people agreed that death occurred when a person's heartbeat and breathing stopped. For the Greeks, the heart was the center of life; for the ancient Hebrews and Christians, the breath was the center of life. In the 12th century, Maimonides pointed toward the head, and the loss thereof, as the reason for lack of central guidance of the soul. Physicians neither diagnosed nor certified death. During the Enlightenment, the necessity of heartbeat, breath, and consciousness for the definition of life was questioned, leading to questioning regarding the definition of death. Tests to fulfill the criteria of death, and tests to determine the absence of integration between functions of respiration, circulation, and neurology were introduced. Sensorimotor potential was becoming recognized as defining life, rather than heartbeat and respiration. As new tests were devised to fulfill criteria of death, the physician developed a professional monopoly on meeting the criteria of brain death. In the modern era, the boundary between life and death has been blurred, but the intensive care unit straddles this boundary. We may have situations where the patient is alive but in a coma, without functioning heart, lungs, kidneys, or gastrointestinal tract, with a transplanted liver, a reversed coagulation system, a blocked immune system, and a paralyzed musculoskeletal system. DATA SYNTHESIS: A human being is a man, woman, or child who is a composite of two intricately related but conceptually distinguishable components: the biological entity and the person. Therefore, human beings can suffer more than one death: a biological death and decay, and another death. Biological death is a cessation of processes of biological synthesis and replication, and is an irreversible loss of integration of the biological units. The reasons for having criteria for death are to diagnose death and pronounce a person dead. Society can then begin to engage in grief, religious rites, funerals, and burials, and accept biological death. Wills can be read, property distributed, insurance claimed, individuals can remarry, succession can take place, and legal proceedings can begin. Also, organ donation can take place, which entails difficult ethical decisions. The Harvard criteria of 1968 were devised to set forth brain-death criteria with whole brain death in mind. Currently, there are several controversies regarding these criteria: a) whether they apply to infants and children; b) whether ancillary tests are necessary; c) what the intervals of observation and testing are; and d) are there exceptions to the whole brain death criteria. Concerning the use of the adult criteria for infants and children, most researchers now agree that the adult criteria apply to infants and children who are full term and > 7 days of age. Concerning ancillary tests, there has been, in our machine- and technology-oriented profession, a great deal of emphasis on the different tests and their ability to fulfill the criteria of whole brain death. However, clinical examination and the apnea test are usually sufficient to fulfill the criteria. Ancillary tests may be desired in some cases, and a variety of these tests is available. (ABSTRACT TR

Adult↗
PubMed1995

"Being with" a patient who is dying.

Doubting her ability to assume the new manager's role in a specialty unit, the author reflects upon her first day of hospital orientation. The monotony of the day is interrupted by the admission of a patient with a traumatic burn injury. The new manager finds herself perplexed about what to do. Feeling at a loss and somewhat confused about her role as a nurse and manager, she delves into her soul and realizes that her place on the burn team has nothing to do with the type of emergency situation before her. Suddenly, she identifies that her feelings of fear and uncertainty are also experienced by people in their new role as patients. She recognizes that her place stems from the very essence of being a nurse. She wants to care. Basing her actions on her feelings, the nurse is able to comfort a man who is dying. She does not want him to feel lonely and afraid regardless of his imminent death. Clinically, she knows the team's life-saving efforts will be unsuccessful, yet her efforts in caring based on her lived experience of being the "newcomer" enable her to accept the challenge of meeting the needs of her patient and at the same time regain her confidence.

Burns↗
PubMedDate not supplied

Our heels are praying very hard all day.

In this article, prayer is represented not as a single or individual action, but as an entirely integrated part of nursing work. Case examples from American, Irish, and Australian Catholic women's religious congregations who nursed in hospitals in the 19th century are used to analyze the significance of prayer to Catholic sisters' nursing. The issue highlighted in this historical examination of prayer is the power of the sickroom (particularly the deathbed scene) in the battle for souls. Sisters' prayers functioned as invitations to religious experiences and means for patients to meet God. Although based on an ancient religion that embraced medieval notions of penance and Counter-Reformation evangelism through good works, sisters' practices, in the turmoil of 19th-century immigration and social upheaval, contributed greatly to the production of the modern hospital and the modern nurse.

Catholicism↗
PubMedDate not supplied

Examining spirituality among women with breast cancer.

A diagnosis of cancer can conjure up a whole host of emotions. Many women with breast cancer will try to deal with the disease by ascribing meaning for its occurrence and searching for mechanisms by which to cope with its sequelae. Research supports that women who have been diagnosed with breast cancer are employing complementary and alternative medicine use as a means of gaining a sense of control over the disease as well as reducing stress and achieving inner peace. Spirituality is one such mechanism that women with breast cancer utilize in order to achieve that goal; an underlying premise being that taking care of the soul is a necessary element in healing the body.

Adaptation, Psychological↗
PubMedDate not supplied

Caring and healing in the 21st century.

As the 21st century approaches, nurses must be prepared to offer new treatment methods when caring for children. The purpose of this article is to familiarize nurses with human caring theory and complementary and alternative medicine, and to offer a practical way of integrating these methods into nursing care. Nurses can learn to choose simple, conservative, noninvasive, nonintrusive healing methods that are met with little resistance by other health care professionals. Clinical implications of the Nurse's Tool Box suggest methods such as drawing, acupressure, guided imagery, storytelling, therapeutic touch, soft music, and humor as ways to help children heal. By tapping into certain frequency currents through the use of these tools, nurses may build, repattern, or facilitate human energies to replenish children's minds, bodies, and souls, creating wholeness and harmony. By understanding human caring theory and complementary and alternative medicine, and by using a practical approach to healing, nurses in the new century can mend children in ways they never have before.

Complementary Therapies↗