Rivista per le Medical Humanities
Jane Macnaughton
Martyn Evans
rMH 12, 2009, 11-23
Intimacy and distance in the clinical examination
The expression «medical body» is commonly referred to the sole body of the patient. During the medical examination, however, also the body of the clinician is subjected to some kind of medicalisation. These two bodies estabilish the peculiar form of intimacy we call «clinical intimacy». But what should this intimacy be like? Echoing Wittgenstein’s notion of the dispassionate conduct of philosophical enquiry as residing in a «cool place», the authors introduce the expression «cool intimacy» as a way to combine the unusually close physical or perceptual proximity of doctor and patient with the necessary psychological detachment and «safe» distance between them in emotional terms. As the authors assert, cool intimacy can be confined to (and hence can serve) a mutually agreed and professionally-proper purpose. It is temporarily disturbing but is intended to be ultimately safe, and to this end it is enacted.
Graziano Martignoni
rMH 12, 2009, 24-31
The intimate, or the elusive return to «home»
This article explores the words referred to our inner world, such as privacy, interiority, intimacy and the intimate. The intimate is the most secrete and elusive space, and at the same time it is very familiar, like the «intimate dimension» described in 1957 by Bachelard in La poétique de l’espace – where everything arises and where everything can disappear – or Hölderlin’s Innigkeit. The intimate is the voice of nostalgia and homesickness. Sometimes, illness and pain can make a return to home urgent and inevitable – to a home which sometimes is far away or even lost. This journey needs some fellow traveller, able to reach the borders of this secret «home» and then retire and wait, leaving the other alone with his/her accompanied loneliness. Caregivers should be such fellow travellers, and never only «officers», but witnesses of our existential itinerary.
Michael Bess
rMH 12, 2009, 32-38
The Future of human brain-machine interfacing
Bioelectronic technologies linking the human brain directly to machines are rapidly moving from the realm of science fiction into concrete reality. It is possible that, in the coming decades, some of these technologies could evolve to high levels of sophistication, perhaps even allowing humans to communicate directly with each other, brain-to-brain. I discuss the scientific and technical obstacles that would need to be overcome before such devices became practical, as well as the potential humanistic implications of such technologies. A direct sharing of thoughts, sense impressions, or memories, as encoded in one brain and transmitted to another, could perhaps provide extremely rich levels of intimacy in communication, allowing persons to reach into the subjectivity of another individual in ways never before witnessed in human history. On the other hand, such potent sharing of subjective experiences could also heavily destabilize the boundaries of individual identity.
Nadia Tortola
rMH 12, 2009, 39-44
Intimacy between two lived worlds
This article deals with the relationship between caregivers and patients, investigating the possible implications of a mere biomedical perspective on their respective intimacy. In the world of institutionalised care, with its strict protocols and regulations, how can personal intimacy and the circular dimension of co-existence be safeguarded while, at the same time, furthering a shared experience? Which are the theoretical bases of a concept of intimacy consistent with both care and co-existence? Which essential dimensions of the subject and of communication can allow us to go beyond the protocols, which necessarly deprive the subject of its unicity and its right to be recognised and understood? Which is the role of the «sufficiently good» caregiver, which her/his (conscious and unconscious) expectations, hopes, fears and representations?
Giorgio Abraham
rMH 12, 2009, 45-50
Nakedness and intimacy
Several conceptual prejudices affect our idea of the relationship between intimacy and nakedness, which can alterate our understanding of what is at stake in the delicate realm of care. This article deals with some of these prejudices. Nakedness and intimacy are not logically superimposable; they even can, especially at an emotional level, unexpectedly and inexplicably diverge and contrast. In order to clarify this complex relationship, the author introduces several major distinctions, such as the difference between physical and moral nakedness, between rational and emotional nakedness and between somatic subjectivity and somatic objectivity. Only by an accurate and constant contextualisation of the nakedness and its relation to our intimate life, could we hope to preserve and to repect our and other’s identity.
Pierluigia Verga
rMH 12, 2009, 69-73
Containment in clinical institutes: clinical and ethical issues
This article aims at summing up the currently ongoing debate among health operators on the legitimacy/illegitimacy of physical, mechanical and pharmacological containment. The complexity of the «containment issue» is highlighted because the restraint methods used are many and depend on cultural, structural, organisational, clinical and professional factors. The answer to this ethical issue cannot be found only in the guidelines of scientific committees or in deontological suggestions. According to the author, individual ethos and the commitment to continuous self-training guarantee that operators will be fully aware of what they are doing and will focus on keeping containment measures to a minimum, using them as little as possible. Self-training – as part of professional training in general – implies working with a method begun in uncertain, poorly defined situations. It also implies analysing those situations more than once and going beyond previous levels of knowledge. The destabilising behaviour of patients can, paradoxically, be a moment of self-awareness for health operators, leading to professional growth.
Silvano Testa
rMH 12, 2009, 74-77
From accepting to welcoming
Seriously considering the problem of using restraining methods in health institutes does not mean only reducing the duration and the number of times said methods are used. It also means dealing with everything regarding this very complex issue. It means considering all the phases of patient history before the containment measures are applied and asking how restraints methods could be avoided. By analysing the situation and the problems in the psychiatric institute of the Canton Ticino (Clinica psichiatrica cantonale, CPC), this article recommends finding new ways of dealing with patients in psychiatric wards, without forgetting the life experience of all the actors involved or the unavoidable price to pay for the suggested solutions.
