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Here, the nurse questions his masculinity should he disregard her standards of cleanliness and openly express pain. Her expectations of manliness represent regulations from eighteenth-century hygiene movements and a Victorian and Edwardian ideal of masculinity defined by military heroism. While medical agendas shaped normative ideals in society, the very same ideals informed the culture of medicine. Medicine had, historically, allied itself, for the most part, with the military as a means to gain recognition as a profession and to preserve medicine as a male domain.
As a result, medical practice followed a masculinized vision of medicine based on values framed in military language—such as active , brave , and courageous. Horton, however, puts two women wearing nursing uniforms into a central position in her painting. Her expertise in electro-mechanical therapy—and her adaptations to electrical appliances that helped optimize their effects—were regarded highly in Bath. Cook, A. The image challenges traditional power relations by contradicting the notion of Victorian masculinity, according to which the attributes active and strong are associated with men, while women are considered passive and weak.
By placing two women at the center of the painting, Horton presents them as having a pivotal role in war medicine, which contradicts more common views of the nursing discipline as a profession of considerably lower social status than the higher male-dominated stratas of medicine. The image can, therefore, be perceived as a feminist painting. The vast number of wounded soldiers in WW1 accelerated the development of new rehabilitation methods.
Common concerns about racial degeneration and the decline of masculinity prepared the ground for a return to ancient Greek beauty ideals of the male body that seemed a promising response to the desire to reconstruct the wholeness of bodies and restore stability in society.
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All the attending professionals are bathed in sunlight coming in from the large windows, as if the war had never happened. The sunlight coming through the windows is perhaps a visual reference to healing attributed to the three natural remedies of air, sunlight, and water—a concept that originated in the Alps and found supporters among the British middle-class in the years leading up to WW1. Applying natural remedies from outside the body, as opposed to relying on the therapeutic effects of intervening inside the body, have been popular in Greece, Rome, and other parts of the world since ancient times.
The focus on the person as a whole made the application of these therapy forms attractive for the treatment of soldiers with permanent injuries, since the medical emphasis on improving the function of individual body parts failed to deliver satisfying outcomes. In European towns where medical doctors had a strong influence on the spa culture, a systematic approach to physical therapies that included a combination of bathing, electrotherapy, exercising, and massage had become part of the treatment provided in hospitals by the end of the 19 th century. In the s, the British Medical Journal BMJ began to publish articles on the clinical effectiveness of massage; hospitals across Great Britain employed an increasing number of masseuses.
The first masseuses were nurses who completed additional training provided by physicians or senior masseuses at mainly London-based training schools. While early members were predominantly nurses, an increasing number of women began to take up massage—including the application of various physical therapies—as a career on its own. Electrotherapy became increasingly popular to treat symptoms attributed to nervous ailments, which were believed to be a side-effect of industrialization and modern life.
During the war years, the scope of its application broadened rapidly to include, for instance, testing and stimulating muscles. Pehr Henrik Ling, who distinguished between active movements encountering resistance and passive movements performed on the body, such as rubbing—a precursor to massage. Swedish physician Dr. He created gymnastic appliances for different movements; his equipment collections became internationally known as Zander Institutes.
Many soldiers came to Bath War Hospital with severe injuries that caused muscle weakness and limited mobility. Zander machines enabled them to gradually improve their physical strength and range of movement, easing the transition to outdoor team sports, which were closely connected to national identity in Britain and believed to reconnect soldiers with their civilian lives.
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The painting helps viewers see early developments in rehabilitation as attempts to restore damaged masculinity through providing opportunities for men to get active and rebuild their physical strength. Horton depicts all soldiers, including those waiting for their turn, as engaged, which contradicts Dr. The similarities between the photos published in the local newspaper and the painting reveal the meticulous care the artist took to achieve a realistic representation of the electrical and mechanical equipment in use at the hospital. While her quest for realism represents classical ideals, the painting itself shows the potential of technology to heal as opposed to causing destruction and violence.
Here, reconstructing the body is aligned with modernity. The image of recovering soldiers actively exercising or having their limbs exercised by masseuses draws attention to their resilience as well as to their weakness and, ultimately, to their continuing sacrifice for the nation. The facial expressions of all figures in the image are shown in an emotionally neutral way, which idealizes the beauty of restoring and re-activating the male body.
The image can be interpreted as an example of attempts at the time to re-evaluate endurance as courageous, softening the concept of heroism without posing a serious challenge to the normative masculine ideal. At the same time, the imagery of heroic sacrifice provides meaning to the suffering not depicted in the painting. Many soldiers admitted to the hospital were, for instance, Australians with little or no previous connection to the residents of Bath. The civilian contribution to Bath War Hospital was, nevertheless, a chance for civilians to become heroes themselves.
The notion of heroic self-sacrifice helped to make the irreparable harm industrial warfare had done to body, mind, and civil life more bearable and meaningful. At the same time, the idealized active and reconstructed male body helped to put an end to the devastation by rendering individual suffering invisible, thereby avoiding the feared decline in masculinity.
Idealized imagery of such bodies intended to help the nation as a whole come to terms with the consequences of the war and reconstruct a civilization thought to be lost. Early developments in rehabilitation, particularly physiotherapy, took place against this background of war and recovery.
It was mainly grounded in a masculinized vision of medicine framed around activity, courage, and bravery, as opposed to domestic values such as peace, compassion, and care. Physical Therapy at Bath War Hospital urges us to take a closer look at how political developments and social expectations have informed rehabilitation practices.
The author wishes to thank Dr.
Francis Duck for being so generous in sharing his historical resources and knowledge about Bath War Hospital. A big thanks is offered as well to Jon Benington, manager at Victoria Art Gallery, for his useful guidance. This work is licensed under a Creative Commons Attribution 4. Heide is Director of Innovation and Training at Bridges Self-Management, where she develops, facilitates and evaluates training and improvement programmes in health and social care.
Your email address will not be published. In this essay, Dr. Nicole Piemonte shares her journey and lived experience that undergirds her research, teaching, and writing.ipdwew0030atl2.public.registeredsite.com/379260-application-to-location.php
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She skillfully paints a portrait of why we need the integration of the humanities in all of our health professions. This essay also provides us with a window into her writing, which is passionate and compelling. She integrates key concepts from philosophy into the analysis of the work of health professions with both clarity and grace. Reading this essay makes you want to be a student in her class! Her book, Afflicted: How Vulnerability Can Heal Medical Education and Practice , while focused on medical education, has much to offer all of us in the health professions. We have much opportunity and work to do!
This journal and scholars like Dr. Piemonte are providing us with a pathway for our continued work. Gail M. Piemonte N. When I started my graduate studies at the Institute for the Medical Humanities, I vowed to stay away from philosophy. I had spent the previous two years as a masters-level student studying continental philosophy, and the work was rigorous, both intellectually and emotionally. I wanted to get out of my head and into the real world of healthcare and healthcare education, as it were. So, with the help of Friedrich Nietzsche, Soren Kierkegaard, Martin Heidegger, and Emmanuel Levinas to name a few , I focused my studies on uncovering the reasons why patients so often feel unseen and unheard in their encounters with healthcare professionals, and why so many healthcare professionals are experiencing what we might call a crisis of meaning in their own work.
I felt compelled to apply existential philosophy to the context of healthcare, since, at least in my view, healthcare is a microcosm of the human experience — birth, death, suffering, loneliness, uncertainty, pain, beauty — all there ready to behold in almost any patient encounter. And for me, the work I was doing was personal, having lost my mother to ovarian cancer in my early twenties and never quite being able to make sense of why her oncologist offered her a fourth-line chemotherapy treatment twelve hours before she died rather than having an honest discussion about what was really happening.
As a result, my mom died the next morning in the hospital instead of at home, and I was left bewildered at her death that seemed so sudden when it was, in hindsight, always just around the corner. As such, the book that emerged from my research aimed to help readers and me better understand this fear and to explore why healthcare education prepares students well for a career taking care of biological bodies while neglecting to teach them how to confront vulnerability or to attend to suffering that extends beyond the physical. What I discovered was that understanding how and why this happens in healthcare education requires a look at medical epistemology — what healthcare professionals know and how they come to know it.
For Heidegger, calculative thinking is too narrow and rigid, given its tendency to ignore that scientific answers can only ever offer partial, and often decontextualized, explanations of the world around us. In healthcare, for instance, the patient is often framed as a diseased body-object in need of medical intervention, thereby overlooking the myriad ways that an illness can affect a person and her everyday way of life. And paradoxically, a patient might expect or even desire such an approach.
This is not to say that such an approach to patient care is inherently wrongheaded. Indeed, part of what makes the dominant epistemology of medicine so attractive is because it works. Test results and visual images of internal pathology can offer verifiable explanations of illness and injury, and scientific research can and does lead to very real and very useful advances in clinical care.
Indeed, when healthcare education is shaped by this epistemology, the occasional expression of the more vulnerable, human elements of patient care is likely unintelligible within the dominant discourse of medical practice that tends to drown out and even dismiss such expressions. I was reminded of this reality recently during a reflective writing session I held with a group of residents at my hospital. One senior resident told the group about a patient he had who presented in our emergency department and was subsequently diagnosed with late-stage breast cancer and given only weeks to live.
The patient was in her forties and had three sons. Unsurprisingly, he and his brothers were shocked, devastated, and terrified, feelings that manifested intensely during a family meeting that the resident helped facilitate. I realized then that this kid was asking all the questions that are constantly swirling around us in medicine that we never stop to ask. It took a teenager yelling them at me for me to realize that these are the same questions we all struggle with and never actually talk about.
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The problem, however, is that patients are so much more than their biological bodies. Phenomenologists like Merleau Ponty and Heidegger, who studied human experience and described the world as we live it, point out that the body is not just a corporeal structure, but rather a lived body — a phenomenon that cannot be measured or studied like the physical body, since the lived body makes living in the world possible in the first place. In his moving and insightful illness narrative about his experiences of having a heart attack at age thirty-nine and a serious cancer diagnosis the following year, sociologist Arthur Frank speaks to the way that a serious illness can shatter any semblance of a coherent life trajectory.
Your relationships, your work, your sense of who you are and who you might become, your sense of what life is and ought not to be — these all change, and the change is terrifying. When healthcare preoccupies itself primarily with the corporeal body and overlooks the various ways that patients suffer, it also overlooks the dynamic illness experience that extends beyond even the lived body.
When illness strikes the lived body, which is inextricably connected to the world and how we make our way in it, our whole being is affected. Others have made this suggestion before, and there is much literature on the need to attend to existential suffering and the bio-psycho-social-emotional aspects of patient care.
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Yet, we continue to participate in a medical culture that fails to address adequately the ways that patients suffer. Why is this so? Thus, reductionist understandings of illness as biological disease or an injury as a functional breakdown allow some healthcare professionals to avoid vulnerability altogether, as they package illness and suffering into discrete pathophysiological processes that might be remedied by medical science.
A patient with a devastating stroke, a traumatic brain injury, or intractable pain who has lost so much of her formal self can be something that is difficult for a practitioner to emotionally hold or intellectually reconcile. For many, then, conceiving of these experiences as functional breakdowns that can be managed is much more palatable than facing the frightening uncertainty of being human. Like my resident and his colleagues, who only faced the existential questions swirling about them after they were cried out loud in a small room, many involved in patient care would rather not dwell on our ever-present potential for death or the vulnerability of the human mind and body, and with good reason: levity and lightness are hard to come by in a world filled with such realities.
In the book, I offer suggestions for how we can begin to shift the culture of medicine, an effort that I believe begins with the way we educate and train our future healthcare professionals.