Rivista per le Medical Humanities

Giovanni Gasparini
rMH 37, 2017, 11-16

The limit, between limes and limen

The article highlights the wide range of meanings related to the term “limit” in daily experience as well as in the analysis of social sciences, referring, first and foremost, to the theoreticalempirical approach of “everyday life interstices”. The author discusses differences and points of contact between limit – meant, alternatively, as limes, i.e. a relatively clear-cut boundary between experiences and situations – and as limen, i.e. a threshold which usually admits reversibility and passages in both directions: in this respect, a significant example is discussed, represented by the story of the Crossing of the Red Sea by the Jews and ancient Egyptians, as reported in the Biblical Book of Exodus. Some exemplifications relating to limitation within the medical and healthcare area are thus outlined, with particular reference to the activity of intensive care departments and the situation of patients in life-threatening conditions.

Marisa Del Ben
Nicoletta Suter
rMH 37, 2017, 17-22

At the limit of the body

Skin, as a sensitive border, is the threshold between the outside world and us. The physical and physiological rules of nerve transmission regulate the passages of information between the body and the environment, the inner world and the outside world. The passageways of interoception are like dialogue windows between outer feeling and inner feeling. Experience and mastery of sensations can help raise awareness of limits. Every experience is knowledge, and every knowledge is experience – insofar as we mean by cognition an incarnate experience. When incarnate experience becomes practice put in place, it turns into mastery, consciousness: awareness of physical, material limit of body, awareness of kinaesthesia, flexibility, extensibility degree, strength, taste, smell, hearing, contact, and visceroception... In order to be aware of limitations, we therefore need both sensory and cognitive integration. Narrative and autobiographical tools can help the process of acquisition and recovery of limit awareness, carrying out a job that goes beyond individual sensitive bodily experience put in place through movement. So, it is not just a question of psycho-physical training to achieve awareness, but also of narrative training to achieve the awareness and ability to be present here and now.

Mosè Cometta
rMH 37, 2017, 23-26

Prudence: an ancient virtue for modern medicine

What role is a doctor called to play today? Just as the human being is defined by a dual polarity between body and soul, his activities are crossed by the tension between theoretical and practical aspects. Medicine, as practical know-how, is one of the areas where this tension becomes more potentially dangerous. Each patient is, in fact, an irreducible singularity, despite sharing similarities and affinities with other clinical cases. In this sense, the physician is called to exercise the ancient virtue of prudence – already considered by ancient and mediaeval philosophers as a keystone of human activities. Rediscovering prudence means, in actual fact, accepting technical and scientific innovations without turning them into a myth, weighing the limits of our knowledge and working on a case-by-case basis in search of concrete good. Ultimately, this implies coming to terms with corporality (i.e. our spatial dimension), the peculiarities of each clinical case, the limits of our knowledge and techniques. Prudent medicine understands the difference between proposing and imposing a treatment, thus learning how to really take care of one’s patients.

Laura Bertini
Enrica Massardi
Paola Solcà
rMH 37, 2017, 27-33

Time in migrant care: needs and limits

In the care of migrant patients, especially asylum seekers, “time” is a key ingredient and, at the same time, the limit care that professionals find themselves confronted with. Starting from the exploratory research carried out on behalf of the Ente Ospedaliero Cantonale (eoc) for the Swiss Hospital for Equity network, the authors propose a reflection on the current and future needs and wants of both caregivers and patients in their mutual encounter with the otherness. The survey – of an exploratory nature – entitled “Intercultural competencies in the Ente Ospedaliero Cantonale. Current practices and possible developments”, conducted by supsi, between 2015 and 2016, was aimed at identifying and describing the good practices and possible critical points related to the acceptance of migrant patients at the eoc. In the framework of this contribution, the time factor is highlighted as a decisive factor for the   quality of care given to migrant and other patients.

Giovanni Pellegri
rMH 37, 2017, 34-39

Anthropology of limit. Tales from exposition

In Switzerland there are about one million people living with disabilities. In front of such important figures, it is imperative to wonder whether it is possible not to relegate this normal human fragility to the backstage of our living, on the margins of our society, in the silence of our person. Is it possible to promote a culture that knows how to look at the vulnerability – both of ourselves and of others – with an open and sincere eye, to then catch in man’s normal and universal limit, not only the lack or deficit, but also the space of the possible, of the livable, and of the human? It was precisely starting from this very question that the exhibition entitled “You! A path on diversity” (www.tu-expo.ch) has come to light, created by the L’ideatorio, University of Lugano (Università della Svizzera Italiana), in cooperation with Pro Infirmis Ticino and Moesano. Thanks to a comprehensive set of testimonies, the project is aimed at feeding thoughts, attitudes, behaviours and words about how people with disabilities are perceived, considered and treated. Given that vulnerability belongs to everyone, the same path is intended to promote a limit anthropology that is able to welcome thoughts, attitudes, behaviours and words about ourselves and all others, regardless of whether or not they have any disability. The path invites us to turn our eyes on the other, to grasp some fragment of our own identity, as well as listening to our own limit and to other peoples’ vulnerability, as a way to think of a more inclusive society.

Davide Crippa
rMH 37, 2017, 40-43

Second name: Huntington

“Second name: Huntington” is an exhibition in which designers, biologists, and fab labs gathered to reflect on Huntington’s disease, which, like a “second name”, is assigned by the fate to the person: a family inheritance that, since then, will always accompany him, eventually becoming an integral part of his identity. By reading the essay, you enter this world, often ignored by a society that is by now fully devoted to beauty and profit, preferring not to be confronted with its “weaknesses”: design becomes a tool to break down preconceptions, to offer unexpected readings, to innovate starting from the “minute”, which never means “lesser”. Design has thus approached this world with planning sensibility and the ambition to provide innovative answers, solutions that are sometimes almost “invisible” or seemingly negligible for those who have no direct experience of disease, and yet with a profound impact on the daily lives of those who constantly experience it. Projects – that explore the affective, symbolic, and functional dimension of living – reflect not only on the needs of the disease, but also on gestures, emotions, disappointments, fears and universal hopes, because – while talking about Huntington’s disease – in fact we always talk about ourselves.

Alice Rivières
rMH 37, 2017, 44-49

Dingdingdong: living with Huntington's disease

Ten years ago, Alice Rivières found out she was a carrier of the Huntington’s disease gene, and therefore that she was destined to develop this incurable, neurodegenerative disease, undergoing a transformation the would affect both her body and soul. From then on, she started a kind of literary adventure, turning “Huntingtonland” into a partly unknown world to be explored. With Valérie Pihet, she founded in 2012 Dingdingdong (www.dingdingdong.org), a group of artists (engaged in activities that range from dance to video, literature, painting, etc.) and researchers in human sciences (e.g. philosophy, history, psychology...), with the purpose of creating a new understanding of this disease. Since then, this “Institute for co-production of knowledge about Huntington’s disease” has been working in tandem with families and doctors in order to create a “lifology” – a kind of art specially designed for living well with Huntington’s disease. In her essay, the author explains the reasons why imagination is essential for understanding one’s own future in terms that are not merely those of tragedy. She draws on the experience of other user groups, such as those suffering from aids, who have found a ways to behave actively – and no longer passively – in front of their illness. She also refers to literature, an indispensable tool – in her eyes – to be up to the existential riddles that this illness   entails.

Sebastiano Caroni
rMH 37, 2017, 50-56

The borderless subject

In his essay, the author proposes a reflection on “The subject without borders”, the topic of the cycle of film projections conducted in Ticino by the author himself in 2013. The cycle presented, from a critical point of view, a series of recent and less films that, in their own way, promote dreams, illusions and alternative realities as central and unavoidable themes of contemporary film production. What does it mean to live, to inhabit, or just to be spectator of altered experiential worlds? This question leads us to consider perception as a central element in defining reality, whether it is considered “subjective” or “objective”. The merit of films that openly focus on the theme of the multidimensional and contradictory nature of reality is to transform – like science has always done (or should do) – our perception in a field of experimentation where the assumptions of what may or may not be, on what is pure illusion and what has, instead, a verifiable foundation, replace the easy certainties based on what is often mistakenly taken for granted, and consequently ends up by being no more visible.

Pietro Grassi
rMH 37, 2017, 57-62

Time and desire: meeting the limit

Limits define us, tell who we are, what we can or cannot do. An objective limit is provided by the space and time in which we live, and that life grants us. The need to give our life a meaning comes from the fact that this is finite. Therefore, it is necessary to approach on tiptoe the threshold of the very mystery of life and death in their becoming. Beset by an unstoppable and harrowing question in an attempt to understand the very meaning of life, we have to get prepared to receive the distant resonances of inexplicable mysteries, whose meaning can only be skimmed, if not in a deathly breath – the latter, death, being meant as a continuous spur to deeper reflections. Western medicine has achieved goals of remarkable excellence thanks to the development of scientific research, biotechnologies, as well as to the lucid and intensive contribution of methodological processes based on efficacy tests. At the same time, a certain idea of unlimited linear progress and a strong reductionism – the latter having its origins in economism – of human life justify the need to reflect again and more carefully on the interpretation and design models capable of re-establish a medical practice that is truly on a human scale. It is therefore necessary to strive to meet things themselves, but also to grasp what cannot be said about things, what cannot be seen, and yet can be invoked and approached in the sense of a limit to go through.

Elena Ercole
rMH 37, 2017, 63-65

Setting limits, according to Daniel Callahan

 The essay by Daniel Callahan reviewed here, Setting limits. Medical goals in an aging society (Georgetown University Press, Washington d.c., 1987-1995), a classic of the American bioethical reflection, which has been the subject of extensive debate within the English-speaking community – though never translated into Italian –, analyzes the relationship between medicine, health and ageing in contemporary society. Epochal changes occurred over the last century have involved, through a cascade effect, the concepts of medicine, health and, ultimately, life. The progress of scientific medicine has shifted the boundaries of good health and average acceptable life, resulting in an increase life expectancy and in a reduction in the potential of some debilitating diseases, eventually leading to the rejection of fatality and illness. Technology, breaking the cause-effect relationship in the context of some biological events, has suggested that the finiteness of body and mind can be overcome. In the elderly, this generates not only new hopes, but also new needs, which despite requiring to be met, cannot actually be supported by the social security contributions available for senior healthcare services. So Callahan wonders whether it is possible to act fairly when it comes to tackling these issues and what criteria can morally satisfy the community in an attempt to balance different needs and rights by allocating the available resources consistently, while combining this with an efficient and sustainable welfare system. He argues that medicine should not be used to further extend the life of the elderly, but only for the full   achievement of a natural and proper life span.

Alberto Bondolfi
rMH 37, 2017, 93-98

Dying through centuries and cultures

This work presents the main stages of collective attitudes towards death throughout the history of Western Europe. In particular, the focus is on outlooks, rather than on habits related to death. The essay also discusses the main assumptions put forward to interpret the present moment, namely: the assumption of death concealment and tabooing and, on the other hand, that of its rationalization. Now, both interpretations have been controversial down to the present day and this essay is not intended to express a specific preference in this regard. At the same time, the essay also serves as a guide to read the most recent historical monographs on the subject. Historical research around death actually knew a strong flourishing during the eighties of the last century, but from that moment on, it has remained in a phase of stasis to this day.

Franco Zambelloni
rMH 37, 2017, 99-104

Just die. A lay reading of death

Considering death from a lay point of view means relying only on what scientific knowledge – in view of the current state of the art – allows us to know. Therefore, ruling out the assumption of an immaterial soul, death is the conclusion of a biological process that, even before birth, alternates the cell decay and their replacement. Death integrates into life itself, or rather, it is part of it: it might even be considered as the ultimate destination that the living organism tends to. Eventually, having reached the goal, the body – and person – will turn off in total annihilation. Of course, considering life as a finite path generates sadness and regret; however, the assumption of endless life could be even more distressing. The finiteness of human existence leads us to take advantage of every single moment, to make every day count. “One day we will die. But not the other days”: in this simple wisdom is summed up the invitation to make every day of our life count, so that the last day can take on the meaning of a fulfilment. Death, therefore, gives meaning to life.

Carla Danani
rMH 37, 2017, 105-111

Death within life: an unwelcome, yet not abusive guest

Today, death is turned into something spectacular and, in these same forms, repressed. No diversion and no repression, however, seem to cause the question about death, about dying, to become senseless, which on the contrary seems to underlie each of them: actually, it seems to say something about life. In the death of a dear person and also, inscribed in the very plot of existence, where vital resources gradually fade out, that question becomes experience. Not like what reduces any possible to impossible, but rather like what makes the possible as such. Death involves life as its cessation; it is the experience of disappearing and, therefore, is the pure and simple manifestation of the nature of the possible. The non-being that death induces us to face may, however, be thought of as a handover and not as a shipwreck. On the one hand, it might be said that one can die for someone: it is not about leaving an inheritance whatsoever, but to be able to leave oneself as a heritance, being welcomed into other people’s life and continuing to live in them. On the other hand, the reflection keeps open the tension between infinite and finite: it acknowledges that we are legitimate to think – though without being able to know it – a final correlation of every finiteness, as a precondition without which the reality of the finite and of the non-being that marks its boundaries would have its origins and, contradictorily, nothing.