Helene Scott-Fordsmand

What is lost if we don’t have a diagnosis? This article examines the aims of clinical medicine and the role of understanding in these aims. Starting from a case prompt with a patient suffering from persistent physical symptoms, I argue that understanding is at the clinical core and that the target of such understanding is the patient’s body with symptoms. Synthesizing accounts of medical understanding and phenomenology of illness, I suggest that the understanding sought in the clinic extends beyond mechanistic explanation to include a sense of bodily intelligibility and that diagnoses are useful but not necessary tools to this end.

Mary Hesse’s work on the role of analogical reasoning in science has set the disciplinary standard. Her classic Models and Analogies in Science (1966) spearheaded the emergence of the philosophy of scientific modelling and enjoys lasting prominence in the field. Hesse’s account famously divided analogy into three kinds: positive, negative, and neutral. In this chapter we aim to bring attention to the one element that has been relatively least explored, the negative analogy. We draw on an example from medical practice, namely the use of the Neer Classification system in the medical prognosis and treatment of shoulder fractures. We argue that there are externally and internally functioning negative analogies, and that, importantly, the latter have a ‘positive’ inferential role. We describe three types of externally functioning negative analogies that have already been to some extent discussed in the literature—which we refer to as ‘crucial’, ‘irrelevant’, and ‘requisite’—as well as a new fourth type that we call ‘scope-fixing.’ We then apply Hesse’s distinction between horizontal and vertical relations to the clinical case study and suggest that there are two different ways in which internally functioning negative analogies can serve as premises in analogical inference.

Recent years have seen a rise in the engagement with empirical methods in philosophy. However, explicit discussion of the method and methodology behind such approaches is scarce, in particular for engagement with qualitative ethnographic styles of empirical research. This entry gathers debates from various philosophical subfields where ethnography has found a philosophical use. First, I introduce ethnography and highlight different versions through examples from phenomenology, political philosophy, ethics and philosophy of science. Then, I address three common challenges raised against the relevance and legitimacy of ethnographic philosophy, some specific to ethnography, others shared with experimental philosophy and integrated history and philosophy of science. The entry ends by suggesting some benefits of ethnographic philosophy, including a potential for genuine surprise, the opportunity to fine-tune and enrichen concepts and a better grasp at philosophical significance in human lives. In addition, I note that ethnography encourages more thoroughgoing philosophical self-reflection about contextual and situational features of philosophical theories and about the particularities of the philosophers developing them, introducing the idea of ‘naturalising the philosopher’.

In contemporary debates in philosophy of medicine medical humanities are gaining ground in a discipline that was for many years dominated by bioethics. Phenomenology, with its focus on human experience, and a long history of interest in illness as boundary cases of human existence, turns up as a tradition with a lot to offer in this context. In their introduction to the Edinburgh Companion in Critical Medical Humanities Whitehead & Woods thus mention phenomenology as one of two key traditions within what can be called second wave medical humanities (Whitehead & Woods 2016, 11). In this spirit, the collection of essays in Kevin Aho’s inspiring publication is an invitation to join the exploration of phenomenology and existential medicine and find new potentials for philosophy of medicine within these traditions.

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice.

Fat, in the context of dissection, is a nuisance, an obstruction to anatomical order and orientation. Yet it makes up a large part of the human body, and in the practice of dissection becomes one of the most prominent materials in the room, as it sticks to gloves and spreads through the dissection hall, making chairs greasy and instruments slippery. In this article I explore the role and significance of fat tissue in anatomical dissection for medical students. In anatomy, fat remains largely an excess material; something superfluous, insignificant, left-over when the body is turned into an anatomical body consisting of muscles, nerves, blood vessels, and bones, cleaned and displayable. But fat is also something which appears in experience as excessive, omnipresent, proliferating, and resistant to attempts to keep it in order. Much anthropological work within dissection practices has described the process of ‘cleaning’ the bodies, but often—mirroring medicine—these accounts follow the becoming of the anatomical body and leave the fat behind. In this article, I try to ‘stick with’ the fat and suggest that fat tissue, as an embodiment or material manifestation of the more-than-anatomical-body, may tell us something about bodies, subjectivity, scientific order, and dissection.

The paper offers the concept of reversing the medical humanities. In agreement with the call from Kristeva et al. to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent—but still to be articulated—possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.

This article engages with medical practice to develop a philosophically informed understanding of epistemic engagement in medicine, and epistemic object relations more broadly. I take my point of departure in the clinical encounter and draw on French psychoanalytical theory to develop and expand a taxonomy already proposed by Karin Knorr-Cetina. In so doing, I argue for the addition of an abject-type object relation; that is, the encounter with objects that transgress frameworks and disrupt further investigation, hence preventing dynamic engagement and negatively shaping our epistemic pathways. This article is primarily theoretical, although partly grounded in qualitative fieldwork.

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between ‘clinical detachment’ and empathy. Inspired by observations from my own field work and drawing on Sky Gross’ anthropological work on rituals of practice as well as Henri Lefebvre’s notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine—what I call emotion-entity focused frameworks—are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term ‘attuned concern’—which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement—as a more fitting alternative to ‘clinical detachment’.

The contact hypothesis has dominated work on prejudice reduction and is often described as one of the most successful theories within social psychology. The hypothesis has nevertheless been criticized for not being applicable in real life situations due to unobtainable conditions for direct contact. Several indirect contact suggestions have been developed to solve this “application challenge.” Here, we suggest a hybrid strategy of both direct and indirect contact. Based on the second-person method developed in social psychology and cognition, we suggest working with an engagement strategy as a hybrid hypothesis. We expand on this suggestion through an engagement-based intervention, where we implement the strategy in a theater performance and investigate the effects on prejudicial attitudes toward people with physical disabilities. Based on the results we reformulate our initial engagement strategy into the Enact hypothesis. To deal with the application challenge, this hybrid hypothesis posits two necessary conditions for prejudice reduction. Interventions should: work with engagement to reduce prejudice, and focus on the second-order level of attitudes formation. Here the aim of the prejudice reduction is not attitude correction, but instead the nuancing of attitudes.