Gendered bodies: A graphic medicine commentary.

This final commentary, in comic format, frames this special issue using Graphic Medicine methodologies to explore broader themes and meanings related to the scientific study of gender and health. Comics can be seen as a way to introduce complex human narratives and as an exploratory tool to ask broader social-contextual and ethical questions about health and medicine. This piece is also constructed through the lens of queer scholarship, which, together with the comics format, provides opportunities to build more embodied, complicated narratives about gender, sexuality and health. Most importantly, comics are used as a modality to tell compelling narratives about how individuals, rather than populations, may be impacted by biomedical conceptualizations of gender and health. The commentary includes a series of graphic narratives containing hypothetical stories and cases: stories of how individuals may be harmed within healthcare systems by rigid framings of gender, sex and sexuality, and stories about how gender socialization may impact health in subtle ways. These narratives furthermore examine the inextricable link between gender and power, illustrating how overt and covert manifestations of power may shape a person's health over the life course. Finally, the piece explores how expansive views of gender may contribute to positive health care experiences. The intention of this piece is to nudge scientific researchers and clinicians alike to approach the topic of gender, sexuality and health with nuance and curiosity.

Do pictures' emotional valence and arousal affect younger and older adults' narratives?

Emotional content, specifically negative valence, can differentially influence speech production in younger and older adults' autobiographical narratives, which have been interpreted as reflecting age differences in emotion regulation. However, age differences in emotional reactivity are another possible explanation, as younger and older adults frequently differ in their affective responses to negative and positive pictures. The present experiment investigated whether a picture's valence (pleasantness) and arousal (intensity) influenced older adults' production of narratives about those pictures. Thirty younger and 30 older participants produced narratives about pictures that varied in valence (positive, negative, and neutral) and arousal (high, low). Narratives were recorded via Zoom, transcribed, and analyzed with Linguistic Inquiry and Word Count-22 to get measures of emotional word use, disfluencies, and linguistic distance. Results showed that negative valence increased age differences in speech production independent of picture arousal: Relative to younger adults, older adults used more positive words, fewer negative words, and had more silent pauses when telling narratives about negative pictures. In contrast, high arousal decreased age differences such that older adults used fewer positive words in narratives about positive pictures and more linguistically distant words evidenced by fewer present-tense verbs, relative to narratives about low-arousal pictures. Contrary to an explanation of enhanced regulation or control over emotions in older adulthood, these findings support the idea that older adults' speech production is influenced by their reactivity or affective response to emotional stimuli even when the task is not to communicate one's emotions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The power of animation: encouraging doctors to access support for psychological wellbeing.

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May-July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation 'Jane the GP' was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice.

A personal narrative intervention combined with self-monitoring strategies: Outcomes for Mandarin-speaking adolescents with Down syndrome.

BACKGROUND: Personal narratives play an essential role in children's social and academic development. However, children with Down syndrome have ongoing challenges with constructing and communicating personal narratives. METHODS: Using a single-case multiple-probe across participants design, we examined whether a targeted intervention could improve both micro- and macro-structural aspects of personal narratives from Chinese adolescents with Down syndrome. RESULTS: All three participants demonstrated high treatment effects in two macrostructural narrative outcomes (i.e., narrative element complexity and narrative coherence) in response to the intervention and moderate to high treatment effects in the microstructural narrative outcomes (i.e., the mean length of utterance in words and the number of different words). However, all participants demonstrated limited improvements in narrative cohesion. These effects were maintained and generalised in a different narrative condition. CONCLUSIONS: The preliminary findings support the feasibility and effectiveness of the personal narrative intervention incorporated with self-monitoring strategies for adolescents with Down syndrome.

Moral aspects of filial concern for a parent living with dementia: Social imaginaries in contemporary narratives.

Many adults face the difficulties of a parent living with dementia. Although not always caregiving for a parent living with dementia, they care about and are concerned for the vulnerability of their parent. This concern is invaluable but often an experience with a far-reaching impact. Qualitative research on filial concerns and experiences of caregiving has resulted in a vast body of knowledge about the experience of family carers. Far less research, however, has examined the moral concern of children. The aim of this study is to gain insight into the normative aspects of their concern. An international collection of 24 books written by adult children about their involvement with an ageing parent was analysed using the Dialogical Narrative Analysis method. Our study shows that the stories deal with children's moral questions about independence, identity, and suffering. These questions can be related to social imaginaries of individualism and progress. The two social imaginaries may have both positive and negative impacts on children's ability to cope with their concern for a parent living with dementia. The moral questions that arise from children's concern seem to originate from both the appeal of the vulnerable parent and from the social imaginaries. These moral sources may compete, resulting in moral friction. Children with a parent living with dementia deliberate upon the personal and societal held beliefs and need moral space to embody their concern.

The Waiting.

The following article uses storytelling, poetry, and findings from a humanbecoming inquiry on waiting to describe the arduous universal humanuniverse living experience of waiting.

'Talking lines': the stories of diagnosis and support as told by those with lived experience of rare forms of dementia.

BACKGROUND: People living with, or caring for someone with, rare forms of dementia can encounter issues while obtaining a diagnosis and trying to access appropriate support. This can affect their wellbeing, quality of life, social relationships and employment status. This study makes use of an arts-based narrative approach to explore individual accounts of these experiences whilst also exploring how, in telling their stories, those affected by rare forms of dementia might invoke, and situate their stories in relation to, broader cultural narratives around dementia and illness. METHODS: Semi-structured interviews were conducted via video-conferencing software with participants (N = 27), living with, or caring for someone with, a rare forms of dementia. Participants used line drawings to depict their journey from initial symptoms to the present day, followed by prompts to verbally narrate their experiences. All interview transcripts and line drawings were subjected to narrative analysis. Four sets of transcripts and drawings were then subjected to more in-depth analysis. RESULTS: Analysis shed light on the struggles encountered by both care-partners and people with a diagnosis, while navigating a health and social care system that does not always understand their needs. This often led to individuals feeling isolated and unsupported. Accounts also depicted challenges to identity brought on by the process. The moment of diagnosis was also drawn in a complicated light. Individuals found comfort in gaining understanding, but felt fear at recognising upcoming challenges. Participants situated their own accounts against mainstream cultural narratives around what good support for cognitive impairment and dementia might look like, whilst also demonstrating the influential role they took on in pursuing the right care. CONCLUSIONS: The use of line drawing, alongside narrative interviews, allowed participants to tell complicated, sometimes anachronistic, stories about difficult experiences, whilst also reflecting on, and attaching meaning to, them. These stories highlighted pressing gaps in healthcare services and shone a light on the various pieces of collective action individuals were engaged in in order to improve them. Finally, in modelling some elements of the participants' service provision which were working, the narratives pointed to future directions services might move in.

Faith in frames: unveiling therapeutic narratives in religion-related cinema through computational analysis.

Introduction: This study explores the emotional impact of religion-related films through a "cinematherapy" lens. It aims to analyze the emotional patterns in a curated selection of religion-related films compared to a broader sample of acclaimed movies using facial recognition with YOLOv5 object detection. The study aims to uncover the potential therapeutic application of religion-related films. Methods: Facial recognition with YOLOv5 object detection was utilized in this study to analyze the emotional patterns in religion-related films. A curated selection of these films was compared to a broader sample of acclaimed movies to identify any distinct emotional trajectories. Results: The analysis of the emotional patterns revealed that religion-related films exhibited a subtler range of emotions compared to the broader film spectrum. This finding suggests that these films potentially create a safe space for contemplation, aligning with the profound themes often explored in religion-related films. Interestingly, the emotional arc observed in the films mirrored the spiritual journeys depicted in them. The films started with a low point of separation, transitioned through challenges, and culminated in a peak representing spiritual transformation. Discussion: These findings suggest promise for the therapeutic application of religion-related films. The muted emotional expression in these films creates a safe space for self-reflection, enabling viewers to connect with the struggles of the characters and explore their own values when faced with complex religious ideas. This emotional engagement may contribute to therapeutic goals such as introspection and personal growth. The study unveils the unique emotional power of religion-related films and paves the way for further research on their potential as therapeutic tools. It emphasizes the need for continued exploration of the emotional impact of these films and their capacity to aid in therapeutic goals.

Analyzing relationships between latent topics in autonomous vehicle crash narratives and crash severity using natural language processing techniques and explainable XGBoost.

Safety is one of the most essential considerations when evaluating the performance of autonomous vehicles (AVs). Real-world AV data, including trajectory, detection, and crash data, are becoming increasingly popular as they provide possibilities for a realistic evaluation of AVs' performance. While substantial research was conducted to estimate general crash patterns utilizing structured AV crash data, a comprehensive exploration of AV crash narratives remains limited. These narratives contain latent information about AV crashes that can further the understanding of AV safety. Therefore, this study utilizes the Structural Topic Model (STM), a natural language processing technique, to extract latent topics from unstructured AV crash narratives while incorporating crash metadata (i.e., the severity and year of crashes). In total, 15 topics are identified and are further divided into behavior-related, party-related, location-related, and general topics. Using these topics, AV crashes can be systematically described and clustered. Results from the STM suggest that AVs' abilities to interact with vulnerable road users (VRUs) and react to lane-change behavior need to be further improved. Moreover, an XGBoost model is developed to investigate the relationships between the topics and crash severity. The model significantly outperforms existing studies in terms of accuracy, suggesting that the extracted topics are closely related to crash severity. Results from interpreting the model indicate that topics containing information about crash severity and VRUs have significant impacts on the model's output, which are suggested to be included in future AV crash reporting.

Persuasive Narratives About Osteoporosis: Effects of Protagonist Competence, Narrator Point of View, and Subjective Risk.

Narratives have been widely acknowledged as a powerful persuasion tool in health promotion and education. Recently, great efforts have been devoted to identifying message components and causal pathways that maximize a narrative's persuasion power. Specifically, we investigated how narrator point of view and readers' subjective relative risk moderate the effects of protagonist competence on intentions to adopt osteoporosis-prevention behaviors, and proposed identification with the protagonist, self-referencing, and fear arousal as three mediators explaining the effect. Women aged 35 to 55, still young enough to reduce osteoporosis risk, read a narrative in which the 60-year-old female character reflects on either taking actions to prevent osteoporosis (competent protagonist) or failing to do so, resulting in osteoporosis (incompetent protagonist) (N = 563). The narratives were told from either the first- or third-person point of view. We found that women who perceived themselves to be at lower risk for developing osteoporosis relative to their peers identified more with the competent protagonist. For women at higher perceived risk, the competent and incompetent protagonists elicited similar levels of identification. Identification was higher when the protagonist's story was told from the first-person perspective, but only for the incompetent protagonist narrative. Identification, self-referencing, and fear arousal played important mediating roles. Implications for theory development and practice are examined.

A qualitative exploration of depressed female Iranian adolescents' attachment narratives.

It is assumed that depressed and suicidal adolescents struggle with issues reflecting insecure attachment. However, less is known about which insecure attachment-related themes characterize depression and suicidality in adolescents. To explore this further, semi-structured in-depth interview were conducted with 18 Iranian female adolescents (Mage = 16.6 ± 0.70), with depression and/or suicidal ideation or suicide attempts, who self-reported being insecurely attached. Qualitative data were analysed using thematic analysis. Three main themes were identified from the data: (1) quality of parenting, (2) attachment representation, and (3) attachment behavior. The theme parenting quality included the subthemes "emotionally absent", "emotionally supportive", "psychologically controlling", "overprotective", "punitive", "aggressive", and "passive". The theme attachment representation comprised: "not accepting", "not feeling loved", "not feeling understood", "lack of intimacy", "unreliable", "reliable", "mixed emotions", "hatred", and "dismiss and devaluation". The theme attachment behavior included "aggression", "relational avoidance", and "emotional role reversal". Findings point to the possible usefulness of attachment-based interventions to treat suicidal adolescents and their families in Iran. However, the results also showed culture-specific themes, pointing at the father-daughter relationship's unique importance, which deserves special attention in attachment-based interventions.

Pupils' inclusion as a process of narrative interactions: tackling ADHD typification through MADIT methodology.

BACKGROUND: ADHD is the most common childhood neurodevelopmental disorder. The symptomatology makes the management of ADHD particularly demanding in school, so teachers' training programs have been widely implemented. Nevertheless, these interventions could lead teachers to concentrate on the dysfunctional elements of these students, exposing them to the risk of stigmatisation. Conceptualising stigma and inclusion as narrative processes, the present study observed how teacher ADHD training texts, endorsed by the Italian government, impact on the inclusion process of students. METHODS: The research analysed a corpus of N = 31,261 text occurrences and focused on three areas: (1) ADHD as a clinical condition; (2) the impact of ADHD characteristics in the scholastic setting; (3) interventions to manage ADHD criticalities in school settings. To observe the interactive processes fostered by the narratives under scrutiny, we used Dialogic Science and MADIT methodology, since they allow us to measure the language use modalities through an index: the Dialogical Weight (dW). The value of dW ranges between 0.1 (min) and 0.9 (max) and is linked to the potential outcomes of inclusion for students with ADHD. A low dW accounts for narratives entrenched in personal beliefs presented as absolute truths, undermining inclusion of students with ADHD. In contrast, high dW signals language interaction relying on sharable elements, able to foster social unity and diminish stigma. RESULTS: The results yielded a critical discursive configuration, both in general and for the three distinct areas. We measured an overall Dialogical Weight of 0.4dW and, for the three areas (1) = 0.3dW; (2) = 0.3dW; (3) = 0.4dW. The analysed text does not maximise the triggering of inclusive interactions, as they rely on individual references and present one's narrative as the sole plausible perspective: reinforcing already existing positions and exposing to the risk of stereotyping of the pupils. CONCLUSIONS: The study highlighted how the ADHD training materials analysed, focusing on a purely informational and clinical approach, lose in effectiveness with respect to generating inclusive school settings. Finally, to promote the inclusion of these pupils, elements are offered for outlining an approach based on fostering active participation by all roles involved.

Just a story? Leadership, lived experience and integrated care.

BACKGROUND: Integrated care is based around values of involvement and shared decision-making, but these are not often reflected within planning and implementation. Barriers include continued emphasis on professional and managerial perspectives, skills gaps on how best to engage people and communities and insufficient investment in involvement infrastructure. Despite such challenges, people with lived experience have still led changes in policy and services. DESIGN: Qualitative study involving 25 participants with lived experience from 12 countries. Participants shared their background stories and engaged in semistructured interviews relating to leadership identity, experience of influencing and personal learning. Transcripts were analysed through a framework approach informed by narrative principles. RESULTS: Participants were motivated by their own experiences and a wish to improve care for future individuals and communities. Sharing their story was often the entry point for such influencing. Participants gained skills and confidence in story telling despite a lack of support and development. Many felt comfortable being described as a leader while others rejected this identity and preferred a different title. No common alternative term to leader was identified. Influencing services required considerable personal cost but also led to new networks, skills development and satisfaction when change was achieved. DISCUSSION: Leadership within integrated care is often awarded to those with structural power related to management or clinical seniority. People with lived experience are though uniquely placed to identify what needs to change and can develop inspiring visions based around their personal stories. Claiming identity as leader can be challenging due to traditional notions of who is eligible to lead and unwillingness by professionals and managers to grant such identity. CONCLUSIONS: People with lived experience should be recognised as leaders of integrated care and have access to developmental opportunities and practical support to strengthen their skills, including that of storytelling. PATIENT AND PUBLIC CONTRIBUTION: The research was instigated on the request of a community advisory board of people with lived experience who shaped its design, contributed to the analysis and informed the conclusions and implications.

"I needed something to hook me." A narrative study on adherence to Pilates.

INTRODUCTION: Exercise adherence is necessary for achieving long-term benefits. Along with other elements, stories and narratives can play a role in understanding and promoting adherence. The aim of the present study was to explore how stories and narratives may affect adherence to Pilates. METHOD: 8 Pilates practitioners who had been participating in a Pilates program for 6 or more years were interviewed. Data obtained were analysed using thematic narrative analysis, (focusing on the whats of stories) and holistic narrative analysis (examining how narratives acted on adherence). RESULTS AND DISCUSSION: Results highlight pain, Pilates as a health-related method, and the social relations as characters, plots and scenarios of stories enhancing long-term participation in Pilates. Exercise is medicine and eudaimonic well-being are presented as narratives articulating the coherence to practitioners' adherence. They act for participants subjectivizing their Pilates practice into a serious commitment to health. CONCLUSION: Stories and narratives are relevant to give meaning and sense to the adherence to Pilates. A focus on stories can be added as a strategy to promote adherence to Pilates.

The Risk Perception of the Chinese Diaspora during the COVID-19 Pandemic: Targeting Cognitive Dissonance through Storytelling.

The global COVID-19 pandemic in 2020 required risk communications to mitigate the virus' spread. However, social media not only conveyed health information to minimize the contagion, but also distracted from the threat by linking it to an externalized 'other'-primarily those appearing to be of Chinese descent. This disinformation caused the attribution of blame to Chinese people worldwide. In Canada's Greater Toronto Area, Chinese individuals reported widespread public stigma that compounded their risk of contagion; to the degree that it was driven by cognitive dissonance, it generated experiences of social and cultural vulnerability. In this paper, we draw on the aforementioned study's findings to explain how the risk perception and threat appraisal of Chinese diaspora individuals were impacted by different cognitive dissonance pathways. These findings explore how storytelling is a viable intervention with which to target and mitigate cognitive dissonance. Indeed, the mechanisms of cognitive dissonance can modify risk perception and mitigate social and cultural vulnerability, thereby averting potential long-term negative consequences for one's mental health and well-being. We hope our guidance, training educators to target pathways of cognitive dissonance by drawing on storytelling (with humour), can assist them to better convey information in ways that are more inclusive during public health emergencies.

Songs tell a story: The Arc of narrative for music.

Research suggests that a core lexical structure characterized by words that define plot staging, plot progression, and cognitive tension underlies written narratives. Here, we investigate the extent to which song lyrics follow this underlying narrative structure. Using a text analytic approach and two publicly available datasets of song lyrics including a larger dataset (N = 12,280) and a smaller dataset of greatest hits (N = 2,823), we find that music lyrics tend to exhibit a core Arc of Narrative structure: setting the stage at the beginning, progressing the plot steadily until the end of the song, and peaking in cognitive tension in the middle. We also observe differences in narrative structure based on musical genre, suggesting different genres set the scene in greater detail (Country, Rap) or progress the plot faster and have a higher rate of internal conflict (Pop). These findings add to the evidence that storytelling exhibits predictable language patterns and that storytelling is evident in music lyrics.