Rivista per le Medical Humanities

rMH 34, 2016, 11-16

Observing silence

The article proposes a reflection on the meaning of observing silence from two complementary viewpoints: that of the researcher and that of who is practicing silence. Drawing from some experiences of meditation retreats and a survey on silence in a middle school of the Canton Ticino, the paper thematizes the relationship that the experience of silence has with the specific contexts in which it emerges and develops. Each context of observation is related to a specific way of practicing silence, of living one’s own emotions, and of managing the delicate balance between silence and speech. With reference to the practice of silence in meditation retreats, and illustrating the survey conducted in middle school, the author hopes to promote reflection on the importance of silence in education. Moreover, the experience of meditation in residential settings, or in more precise forms, constitutes a privileged point-ofview with regard to understanding the importance of the phenomenon of silence in our society. When you are immersed in a silent space, where everything is set up to allow for those who enter to live in silence, one realizes of being in a suspended space where the logic of an “upside-down” world reigns: silence becomes the norm, speech the exception. From here arises the interest that similar experiences have, not only in studying the practice of silence, but also in understanding how silence interacts with a symbolic and cultural order based on the use of speech as the foundation of social living.

Francesca Rigotti
rMH 34, 2016, 17-23

«Breaking» silence?

Beginning with a reflection on the metaphorical value of language, the paper takes into consideration two types of silence: an ice-stone silence (solid, still, firm, and enclosed in itself) and a liquid-magmatic silence (marine, deep, mobile, and containing). The first is hard and rational, the second is soft and suffused. Speech intervenes in both, breaking the first with the force of a pointed heavy weapon, and emerging from the abysses of the second as floating lava. The author’s perception is supported not only by linguistic and etymological observations, but also by literary and musical references (Händel, Bach, Boulez, Cicero, Ovid, Rabelais, Pirandello, Vercors, Byatt). The individual authors who speak of silence are distinguished by the essential features of their thought, preferring one or the other metaphorical field as a mental model and, yet, often welcoming them both in their writings. In conclusion, another important distinction is thematized: that between the silence of men and the tranquility of things, between keeping silent and silence, still clearly present in the German language, in two terms: schweigen and stillen

Giovanni Gasparini
rMH 34, 2016, 24-29

Silence in social relations

Despite the importance that the use of silence plays in social relations, the social-anthropological analysis in this regard are infrequent. The author sees this from a sociological viewpoint of everyday life and presents an approach that focuses on interstitial phenomena: these latter represent intermediate and marginal experiences (in-between or entre-deux) among others that are relatively central and well-defined. The interstices of everyday life have been studied from a viewpoint in time (like waiting and staying), space (like a passage and a journey), and communication in its overall sense. In the latter area, the phenomenon of silence finds its expression, appearing as a phase of interval or exceptional interruption within a reality of verbal communication that is almost uninterrupted, and with the constant presence of noise. Silence is divided into three forms, respectively represented by generalized, qualified, and interactive silence, which correspond to different contingencies of everyday life and the processes of institutions and organizations, such as religious institutions, hospitals and nursing homes, and libraries. In the conclusion, change in the perception of silence is discussed as it occurs in our society, and it is claimed that, because it is marginalized and rendered interstitial by overabundant communication and by noise pollution, silence has now taken on the likeness of a rare commodity that is increasingly appreciated and connected to the value of the quality of life.

David Le Breton
rMH 34, 2016, 30-38

Silence as retreat

The text refers to silence as an intimate place, one for internalization, for reflection and a deep immersion in oneself. Silence tied to escaping from the constraints imposed by society. Not for drowning in individualism, but for re-establishing a relationship with the universe around us. In this sense, silence presents itself as a form of meditation that allows you to reinterpret reality, without falling into the limbo of clichés to which we are subjected on a daily basis. Silence is also a form of contemplation, a tribute that we give to the beauty of the world. It is our will to temporarily separate us from oral language and to give us a full and sincere feeling of belonging to the universe. A privileged access to this form of experience: walking through landscapes where their penetrating tranquility offers itself like a path that leads to the depths of one’s own self. In ordinary communication, silence is just as important as speech. Keeping silent before another individual implies an intimate knowledge, if one wants to avoid feeling observed and judged. Complicity in friendship and love dispenses with the need to speak more and allows moments of abandoned silence. Moreover, even strangers can enjoy the serenity of sharing long silences without being uncomfortable. Finally, silence proves itself to be a fundamental dimension, of unprecedented intensity, when death is involved, where speech becomes ever more hesitant, absent.

Sergio Cingolani
rMH 34, 2016, 39-45

Silence in the universe

The paper deals with the question of silence in the universe, starting from several important questions. Is the universe silent or noisy? Can we create an idea for ourselves of its producing energy through a sensation of sound? Is the air that surrounds us responsible for the propagation of waves from any sound source, as long as it is perceptible as part of the frequency sensitivity that our auditory system guarantees? To this regard, the issue of a silent universe can be developed from an anthropocentric point-of-view. In fact, in order to be heard, sound requires a medium that is suitable for propagation and an auditory device that is sensitive to the slightest vibration. The evanescent matter that fills the universe has us believe that we can still witness an event that can be associated to the transmission of sound. Nevertheless, the sound of an event associated with a cosmic cataclysm is confined within the narrow space where the phenomenon occurs. Ever more rarefied and very high temperature gases persist outside of the sphere of a star. Rarefaction is something that slowly leads to silence. Silence in the universe.

rMH 34, 2016, 50-59

The silence cure

The paper, which consists of an introductory text, followed by testimonies, will explain how to care for silence, as well as the condition for transforming silence into a cure. In light of this insight, the original text raises the question of the relationship between the phenomenon of silence and the management of a hospital: from a meeting with Luca Merlini, Director of the Regional Hospital of Locarno, several points of convergence were put into focus, allowing to thematize silence as a central resource in the operation and organization of the hospital. Then follows the testimony of Nicole De Lorenzi who, for thirteen years, has dealt with death accompaniment in the Hospital in Winterthur and tells how, just by taking advantage of the healing properties of silence, this delicate role is carried out with attention to detail and awareness. In conclusion, Graziano Martignoni’s considerations are developed, beginning with an experience of silence lived during the year as a student attending a Benedictine Boarding School in Ascona. The same Martignoni proposed a reflection on the experience of silence in the field of psychotherapy, on the relationship between silence and alterity, and on silence as temporality, which questions a society that is increasingly dominated by fast times.

Daniele Bruzzone
rMH 34, 2016, 91-96

Does a right to hope exist?

Can hope be considered a patient’s right? Why is it so important to keep hope alive in people who suffer from a serious or incurable disease? Some experimental data demonstrate that hope can be a relevant factor in determining resilience and the quality of the therapeutic process. On the other hand, a lack of hope can lead to failure and despair. Phenomenology and existentialism stress that hope is an essential capacity and the pivotal need of every human being. If healthcare professionals are willing to listen to their patients and recognize their spiritual resources, they will succeed, if not in curing them from their disease, at least in caring for their existence. According to Viktor Frankl’s Logotherapy and Existential Analysis, patients and their families can be supported in searching for a meaning to suffering, by finding and actualizing meaningful goals and purposes in their lives. This seems to be a way of regenerating hope, in spite of each condition.

Paolo Marino Cattorini
rMH 34, 2016, 97-101

The rights of caregivers

The rights of health care professionals should be underlined and understood in the framework of a therapeutic covenant, based upon a mutual exchange of promises between a suffering person and a healer (who is a vulnerable human being, as well). Codes of medical ethics list several kinds of duties, which an expert has the burden and the right to honour, with regard to the patient, the family, and society itself. The commitments revolve around the principle of moral integrity, which deals with both the individual conscience and the scientific expertise of the experts. In the event of an absent, reduced, unsteady, doubtful, or impaired competence (such as in a pediatric setting), physicians and nurses must act in the best interest of the sick individual by restoring or promoting his/her autonomy, respecting wishes and preferences, and representing previously expressed (advance) directives. Valid representatives, ethics committees, and clinical ethics consultants have to be called in and taken into consideration, insofar as they are well-informed, free, and responsible agents and do not bear conflicts of interest. Fictional case stories from motion pictures are examined in the present article.

Reto Medici
rMH 34, 2016, 102-107

Children's rights and autonomy

The history of children’s rights and autonomy is relatively recent. The un Convention on the rights of the child, adopted in 1989, shows the direction that every nation should follow. Children are increasingly considered individuals with a high degree of independent rights. Children have the right for adults to listen to them. The Convention recognizes that the level of participation of children in reaching decisions must be appropriate to the level of mental maturity of the same. The ability for children to form and express their opinions develops with age (becoming judicious), and most adults will naturally give the views of teenagers greater weight than those of a preschooler, whether in family, legal or administrative decisions. For medical therapies, the will of a child is increasingly recognized as important and should be held in full consideration. This means that under-aged individuals who are judicious have the faculty to approve medical treatment without the consent of the parents. Clinical research should be encouraged and performed also in children. Ethical issues surrounding pediatric clinical studies are significantly more complicated, compared to those of adults. The informed consent of parents (proxy consent) is always necessary and should consider the will of the child. At any age, children should be appropriately informed about the research that is planned. Also, they must give assent to the study, along with the consent of the parents. The choice of each child plays a pivotal role.