Professional patienthood and mortality: Seán Ó Ríordáin's diaries 1974-1977.

Unwieldy by nature, unsolicited diaries and their study, this article contends, have the potential to offer deeper insights into the experience of illness but only if they receive due consideration from scholars. This article uses a series of historic diaries to examine the concept of 'professional patienthood' or being a full-time patient, and, while it found the narrative medicine approach to be very useful, it also found it limiting. The recent methodological trends in biomedicine and social sciences towards structured mechanisms like questionnaires-surveying and evaluating performance, satisfaction and experience-can only go so far. This article makes a case for the unsolicited, the unorthodox and the unstructured.

Patienthood in medieval Tuscany: beliefs and cures.

This paper focuses on intersections of holy and sick bodies in the Tuscan Middle Ages to examine how the faithful accessed miraculous cures from contact with, or belief in, the relics of the saints. Rather than examine the relationship between the long dead martyrs (whose relics were abundant), however, it will look at the relationship between relatively recent saints and their devotees. The miracles discussed are traditional-that is, they are found in the lives of many saints and are not exceptional. It is hoped, however, that by concentrating on Tuscany, some insights can be secured on the relationship between Tuscan individuals of the late middle ages and those of their community who were recognised, either officially or through vox populi, as saints.

[Barbers, charlatans, and the sick: The medical plurality of baroque Spain perceived by the picaresque Estebanillo González]. / Barberos, charlatanes y enfermos: la pluralidad médica de la España barroca percibida por el pícaro Estebanillo González.

In order to know about diseases and their medical treatment from the perspective of the patient in Baroque Spanish society, creative literature, especially the picaresque novel, is a valuable source that offers a representation of ideas on medicine and disease that were widespread among the population and difficult to access from other sources. The first-person narrative in the Vida y hechos de Estebanillo González (1646) offers knowledge on three different aspects of the medical world in Europe during the Thirty Years' War: Estebanillo practises various medical professions, appears in the story as a patient and comments on health practices and disease, providing highly useful material to analyze how different fields of medicine are represented in this literary work.

A "tale of two countries": Narratives of hearts, patients and doctors in the Spanish press.

In this article we explore how the Spanish written press--ABC, La Vanguardia, and Blanco y Negro--and the official newsreel No-Do, created and disseminated a narrative about heart transplantations at the end of the 1960s. We consider how Franco's regime used Christiaan Barnard's heart transplants to legitimize the Spanish dictatorship and as a means of signifying scientific progress, modernization and national pride. The Spanish press created the plot of the first transplantations like that of a television series, presenting daily installments on the patients' progress, dramatizing the stories and ensuring the public's emotional attachment. The three main characters in the story: donors, patients and surgeons, formed a symbolic, indivisible narrative triangle endowed with singular meaning. This Spanish narrative of organ transplant technology was deployed through what we have called "a tale of two countries", that, emulating the South African's success, constructed in Martínez-Bordiú, Franco's son-in-law, a home-grown, masculine scientific personality capable of performing heart surgery and endorsing Franco's investment in scientific modernization.

Actors, patients and agency: a recent history.

This article examines the history of patients' behaviour since the middle of the 20(th) century. It describes a number of strategies that have served to encourage patients to exercise increasingly autonomous behaviour. The effect has been to instil a sense of agency in previously passive patients.

Identifying the patient in George W Lambert's Chesham Street.

This paper takes as its focus one of the Edwardian period's most dramatic and little-understood paintings of a medical examination: George Washington Lambert's Chesham Street (1910). The painting shows an upper-class male patient lifting his shirt to reveal a muscular torso for examination by the doctor in the scene and the viewers outside it. The subject of a medical examination, I argue, legitimised the scrutiny of exposed male flesh and offered an opportunity for sensual pleasure between men. By way of a comparison with other portraits of the artist from around the same period, I interpret Chesham Street as a patient self-portrait, which reveals the artist's dual personalities of bohemian artist and Australian boxer: two personae that did not combine seamlessly, as revealed by the composite nature of the patient in Chesham Street. From a discussion of the artist as patient, I move to an analysis of other self-portraits by Lambert in which the artist is shown flexing his muscles, especially in the context of his passion for boxing. I consider how these portraits serve as complex inscriptions of illness and health and how this relates to the experience of living and working as an Australian expatriate artist in London in the early twentieth century.

Portraits of John Hunter's patients.

Portraits of patients served many clinical functions in eighteenth-century medic John Hunter's medical practice. As incarnations of medical skills and medical knowledge, they helped Hunter understand his patients' problems. They could also bridge the physical absence of his patients, and so help him discuss cases at a distance with other members of the medical faculty. Moreover, portraits complemented text in his day-to-day practice; portraits were in no way an ancillary medium for Hunter, but rather a fundamental way of working. Meanwhile, the role of Hunter's assistants as medically trained artists complicates typical historical models of patient-practitioner interactions, and affects how patients were objectified by modes of looking and by art.

[The patient throughout history since Hippokrates]. / Potilaan historia Hippokrateesta alkaen.

Throughout history, the patient's dependency on the social group in which he or she happens to be born, has remained unchanged. The period in the 19th to the 20th century, during which the authority of physicians over patients grew markedly, seems to have passed. As in the classical period, a wealthy western patient is again able to choose the most suitable one from the healthcare service providers. Since the 18th century medicine and religion have diverged from each other in the life of a western patient. The decisive position of the medical industry towards the end of the 20th century is a new phenomenon in the history of patient.

From medicine to psychotherapy: the placebo effect.

If placebos have been squeezed out of medicine to the point where their official place in in clinical trials designed to identify their own confounding effect, the placebo effect nevertheless thrives in psychotherapy. Not only does psychotherapy dispose of placebo effects that are less available to medicine as it becomes increasingly technological and preoccupied with body parts, but factors of the sort inhibiting the use of placebos in medicine have no equivalent in psychology. Medicine today is disturbed by the placebo effect in a way psychotherapy is not. Psychotherapy does not have to grapple with such a disconcerting paradox as successful sham surgery, and unlike those physicians who once pretended to treat the patient's body while actually attempting to treat the mind, the psychotherapist can treat the mind in all frankness. Perhaps it is because psychotherapy is less burdened by doubts about the placebo effect that it was able to come to its aid when it was orphaned by medicine. It is vain to expect something with so long a history as the placebo effect to disappear from the practices of healing.

The strange case of the Freudian case history: the role of long case histories in the development of psychoanalysis.

Sigmund Freud's five long case histories have been the focus of seemingly endless fascination and criticism. This article examines how the long case-history genre developed and its impact on the professionalization of psychoanalysis. It argues that the long case histories, using a distinctive form that highlighted the peculiarities of psychoanalytic theory, served as exemplars in the discipline. In doing so, the article extends John Forrester's work on "thinking in cases" to show the practical implications of that style of reasoning. The article illustrates how the form disappeared once the theoretical basis of the movement was set. The genre never became institutionalized, although the content of the five long case histories did, because of Freud's accepted role as theoretician of psychoanalysis.

Bad blood: poverty, psychopathy and the politics of transgression in Kenya Colony, 1939-59.

This article examines the inter-relationship between psychiatry and sex, both fertile fields within the recent historiography of colonialism and empire. Using a series of case files pertaining to European patients admitted to the Mathari Mental Hospital in Nairobi during the 1940s and 1950s, this article shows how sexual transgression among colonial Europeans precipitated, and was combined with, mental distress. Considering psychiatric treatment as a form of social control, the article investigates a number of cases in which a European patient had been perceived to have transgressed the normative sexual behaviour codes of settler society in Kenya. What these files suggest is that transgressive sexuality in Kenya was itself framed by indices, as insistent as they were uncertain, of gender, race and class. While psychiatry as social control has some degree of purchase here, more valuable is an attempt to discern the particular ways in which certain forms of sexual behaviour were understood in diagnostic terms. Men who had sex with Africans, we see, tended to be diagnosed as 'depressed' on arrival at the hospital but were judged to be mentally normal consequently. Women, by contrast, were liable to be diagnosed as psychopathic, a diagnosis, I argue, that helped to explain the uniquely transgressive status of impoverished European women living alone in the margins of white society. Unlike white men, moreover, women did not have to have sex with non-Europeans to transgress sexual codes: this is because female poverty was a sexual problem in a way that male poverty decidedly was not. Poor white women were marked by uncertainty over their sexual behaviour­and dubious racial identity in its turn­and the problem of social contamination was described by reference both to the polluted racial ancestry of an individual and to the prospective contamination of healthy racial stocks. This article aims to address current historical debates around sex and empire, 'white subalternity' and the social history of psychiatry and mental health. All names have been changed to protect patient anonymity.

[First initiatives for social integration of the mentally ill in one phase of pre-deinstitutionalization. The example of Saint-Jean-de-Dieu, 1910-1950]. / Premières initiatives d'intégration sociale des malades mentaux dans une phase de pré-désinstitutionnalisation. L'exemple de Saint-Jean-de-Dieu, 1910-1950

This article on the first initiatives of social integration of the mentally ill, using the example of the Hôpital St-Jean-de-Dieu, explores the implementation of a period of deinstitutionalization in the early decades of the 20th century. Our study is situated in the recent historiography that offers a rereading of the period just prior to the Quiet Revolution in Quebec. We intend to contribute by demonstrating that the policies, strategies and practices of the Sisters of Providence and the psychiatrists of St-Jean-de-Dieu developed a system of deinstitutionalization that reintegrated patients into their family as early as the 1910s, half a century before the first wave of deinstitutionalization of the 1960s was orchestrated by the authors of the Bédard report.

A house divided: deinstitutionalization, medicare and the Canadian Mental Health Association in Saskatchewan, 1944-1964.

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.

From closed ranks to open doors: Elaine and John Cummings' mental health education experiment in 1950s Saskatchewan.

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.

Deinstitutionalization and vocational rehabilitation for mental health consumers in Nova Scotia since the 1950s.

In this paper we explore the broader policy determinants of the de-hospitalization of mental patients in Nova Scotia between the 1950s and 1980s and trace the background to the development of occupational rehabilitation programs in the community. For employment programs, the government chose to rely on non-profit NGOs as the suppliers of services. As a case study of such an organization, we examine the evolution of LakeCity Employment Services Association as a resource for people living with mental disabilities.

Visiting the mentally ill: volunteer visitors at Saskatchewan hospital, Weyburn 1950-1965.

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

[The psychiatric revolution in Quebec, 1950-1962. From asylum to community psychiatry and the open door]. / La révolution psychiatrique au Québec, 1950-1962. De l'asile à la psychiatrie communautaire et l'open-door.

Psychiatry opens to the world at a time when the very basis of psychiatric practice, namely the asylum, is called into question. Studies appear in Quebec and Canadian journals concurrent to the introduction of new formulas for care, such as the delivery of psychiatric services in general hospitals and clinics, that allow patients to be treated outside the walls of psychiatric hospitals. In addition, postwar psychiatry takes an optimistic view toward the future of children with impairments through the creation of specialized schools and workshops. From the mid-20th century onward, the thinking in psychiatry centres on the open door.

Life satisfaction in chronic pain patients: the stress-buffering role of the centrality of religion.

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

A curious jumble: the Canadian approach to online consumer health information.

As part of a larger e-health strategy, Canadian governments have invested millions in online health information services for the lay public. These services are intended to reduce demands on the primary health care system by encouraging greater individual responsibility for health and are often promoted using the language of personal empowerment. In this paper, we describe how lay searchers generally look for online health information and discuss the disempowering challenges they are likely to face in (a) locating Canadian government-sponsored health information sites and (b) finding useful information on these sites to address everyday health concerns. We conclude with several recommendations for policy changes.

[Physicians, journalists and patients as public spheres in West Germany. The example of the journal "Der Spiegel" (1947-1955)]. / Arzte, Journalisten und Patienten als Akteure von Teilöffentlichkeiten in Westdeutschland. Eine Analy- se am Beispiel des Nachrichtenmagazins "Der Spie- gel" (1947-1955).

Until today, it is still unexplored, how modern (scientific) medicine in Western Germany could negotiate its social position in the public sphere and how it was represented in the media. This paper will contribute to the analysis of this problem by investigating all entries on "medicine" in the journal "Der Spiegel" during the period 1947 to 1955, when Western Germany was built up. It is possible to show that the journal was a market place where specific public spheres as e.g. physicians, patients or journalists could discuss medical topics. This way, on the one hand, "Der Spiegel" grasped contemporary notions on medicine and the medical market, which made itself felt in later years of Western Germany. On the other hand, the journal itself molded the discussions about a scientific medicine, which was to be not only innovative but also democratic.