A midlife crisis

Psychoanalysis, Self and Context, 2017

Journal of Nursing & Care, 2016

Social Science & Medicine, 1984

lived to be 91 years old. When he was 79 he married his second wife, with whom he enjoyed 12 years of married life. During the last 20n years of his life he remained

2009

The physician's task is to make sense of the patient's story in the generally accepted terms and concepts of the scientific world. Yet the two narratives, the physician's account and the patient's story out of which it was made, continue to exist side by side. Although the patient's story is contained in and explicated by the physician's, it has not been replaced by it. Nor are the two narratives simple translations of each other. They are incommensurable: neither can be comprehended in or simply reduced to the other's terms. The medical interpretation of the patient's story bears great power for healing. As the location of the malady in the social universe, a diagnosis relieves suffering in itself, as well as in the guidance it provides for therapeutic action. Like all power, it must be exercised with care. -- Kathryn Montgomery Hunter, Doctors' Stories

New England Journal of Medicine, 2014

A 51-year-old woman was brought to the emergency department by her husband after the development of nonsensical speech, including confused word choices, difficulty naming objects, and perseveration with counting. Her orientation, comprehension, and speech patterns had fluctuated throughout the morning. Her husband noted that the day before presentation, she had reported headache, nausea, vomiting, and fatigue. No fevers were noted. She had no history of similar symptoms. Acute changes in mental status warrant prompt evaluation. The differential diagnosis includes cerebrovascular events (e.g., ischemic stroke and hemorrhagic stroke), trauma, abscess, seizure, vasculitis, drug intoxication, and infectious processes (e.g., meningitis and encephalitis). The preceding headache, nausea, and vomiting raise concern about cerebral edema or a space-occupying lesion, though the rapid onset of symptoms makes a tumor or neurodegenerative process less likely. The patient's medical history included cancer of the distal sigmoid colon diagnosed 4 years previously, which was successfully treated with resection and chemotherapy. She had no history of chronic headaches, weakness, numbness, or incontinence. She had smoked half a pack of cigarettes per day for about 10 years before quitting (at an uncertain time). She took no medications. Her family history was notable for diabetes mellitus type 1 in her sister and hypothyroidism in her mother. She was married, lived in Michigan, and had previously worked in an administrative capacity. She had not recently traveled outside the state and had not had any recent contact with sick persons. She had a healthy pet parrot and a healthy dog at home. This patient's personal history of cancer raises concern about metastatic brain involvement. Prior use of tobacco would increase her risk of stroke. Her family history of type 1 diabetes and hypothyroidism could point to an autoimmune process such as lupus cerebritis or vasculitis. Her symptoms of headache, nausea, and fatigue may suggest an infectious cause. On physical examination, the oral temperature was 37.9°C (100.2°F), the blood pressure 138/62 mm Hg, the pulse 91 beats per minute, the respiratory rate 16 breaths per minute, and the oxygen saturation 99% while the patient was breathing ambient air. The body-mass index (the weight in kilograms divided by the square of the height in meters) was 29.3. The patient was alert but could not consistently follow commands. Her ability to respond to questions fluctuated; at times she could answer simple questions (regarding her name or date of birth) correctly, but within minutes she would reply by naming seemingly random numbers or colors. Her pupils were equal in size,

A 46-year-old married woman presents with insomnia, headaches, muscle tension, and back pain. She describes a long-term pattern of worrying about several life situations , including health, finances, and her job, and she notes increased anxiety associated with her teenager's leaving home to attend college. She drinks alcohol daily to reduce the tension and help her sleep. In reviewing her history, you note that she has visited your office many times over the past year because of physical symptoms.

Scandinavian Journal of Caring Sciences, 2007

Lancet, 1955

Journal of Hospital Medicine, 2013

The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. This icon represents the patient's case. Each paragraph that follows represents the discussant's thoughts.

Medical Education, 2012

This course aims at adding a practical and clinical dimension to the philosophical training of the student, in view of eventually leading one's own private philosophical cabinet. It applies critical thinking to practical and more immediate life concerns than the usual metaphysical and epistemological dimensions of traditional academic philosophy. Under the umbrella of clinical philosophy, this course trains the student to apply philosophical reflection to real life problems. Moving from the analysis of one's own experiential predicament to the critical assessment and discussion of that of others, it initiates one to philosophical counselling and Socratic dialogue, so as to acquire the basic skillset of the philosophical cabinet. In this way, the student learns to listen with reflexive method and to probe the dialogical partner through skillful questions able to problematize assumptions and reveal potentially hidden conceptual correlations, incoherences, and their related emotional knots. The first part of the semester is dedicated to the historical, theoretical, and methodological underpinnings of practical philosophy and leads to a written assignment. The second part of the semester focuses on developing the listening and problematizing skills involved in the kind of Socratic dialogue expected of a philosophy cabinet consultation. The evaluation consists in the performance of a philosophical consultation led by the student. The last segment trains the student hands-on in designing and performing short philosophical workshops for individuals or groups, composed either of adults or of children. The evaluation unfolds in three different workshops designed and performed by the student. The final summative evaluation takes the form chosen by the student. It can either be a theoretical paper based on the first part of the semester, a philosophical consultation as learned in the second part, or a workshop, as practiced in the third part of the semester.

International Journal of Geriatric Psychiatry, 2002

Objectives The aim of this study was to illuminate lived experience of having been in an acute confusional state (ACS) as narrated by elderly patients in orthopaedic care. Method Qualitative study with phenomenological hermeneutic method for analysing the data based on narrative interviews. Fifty patients (67-96 years of age) who developed ACS during hospitalisation and in all cases the ACS ceased during their stay on the ward were interviewed once lucid again regarding the course of the event, their experiences, memories and interpretation of what had happened during the ACS. Results The meaning of the patients' lived experiences of being and having been confused was interpreted as 'Being trapped in incomprehensible experiences and a turmoil of past and present and here and there', comprising the themes trying to get a grip on the experience of the confusion, encountering past, present and the realm of the imagination as reality during the period of confusion and confronting the idea of having been confused. Contradictory to earlier research the patients remembered and could tell in great detail about their ACS. While confused, the confusional state means that impressions of all kinds invade the mind of the person and are experienced as reality, making him/her a victim of these impressions rather than the one who controls what comes into his/her mind. While in the middle of these experiences the person simultaneously senses that the impressions are unreal, thus indicating that he/she is in some sort of borderland between understanding and not understanding. The things that come into the mind of the person can either be frightening or neutral or enjoyable scenarios that seem to be mainly familiar but can also be unknown. These scenarios seem to be a mixture of past and present, of events and people while they seem to float from location to location. Conclusions The findings indicates that what takes place during the ACS is not nonsense but probably a mix of the patient's life history, their present situation and above all a form of communication concerning their emotional state and inner experiences in this new situation. The findings also indicated that one possible approach to the patients is to confirm and support the patients in narrating their experiences both during the confusion and also after the ACS had ceased.

Mayo Clinic Proceedings, 2009

International Journal of Qualitative Studies on Health and Well-Being, 2015

Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of learning to live with MUS as narrated by patients in primary health-care settings. Methods: A phenomenologicalÁhermeneutic method was used. Narrative interviews were performed with ten patients suffering from MUS aged 24Á61 years. Data were analysed in three steps: naive reading, structural analysis, and comprehensive understanding. Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining insights and moving on, was based on subthemes describing the patients' search for explanations, learning to take care of oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky's theory of sense of coherence and Kelly's personal construct theory. Possibilities and obstacles, on an individual as well as a structural level, for promoting patients' capacity and learning were illuminated. Conclusions: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged as a conventional and necessary care activity.