Leituras holísticas: de Tchékhov à Medicina Narrativa / Lecturas holísticas: de Tchékhov a la Medicina Narrativa / Holistic readings: from Chekhov to narrative medicine

Neste artigo, procura-se evidenciar como, no conto “Um caso da prática médica”, o escritor russo, Anton Tchékhov, ele próprio médico, ficcionaliza e chama a atenção para aspetos da prática clínica hoje tantas vezes descurados, designadamente a observação e avaliação do ambiente em que vivem os doentes; e aspetos de índole familiar, social e até sexual, bem como a importância crucial da relação interpessoal de carácter dialógico entre médico e doente. Relacionar-se-á esta chamada de atenção indireta de Tchékhov com a situação atual no domínio da prática clínica, recorrendo-se ao conceito de Medicina Baseada na Prova (EBM), como paradigma atualmente dominante nas práticas médicas, e à necessidade de o complementar com o da Medicina Baseada na Narrativa (NBM) ou Medicina Narrativa...

The aim of this paper was to show how, in the short story “A Doctor’s Visit,” the Russian writer Anton Chekhov, himself a physician, creates a fictional narrative in which he draws attention to aspects of clinical practice that are rather overlooked today, namely: observation and evaluation of the environment in which patients live and aspects of their family, social and even sexual outlook, along with the crucial importance of the interpersonal dialogue-based relationship between doctor and patient. The attention indirectly drawn to this issue by Chekhov is here correlated with the current situation within the domain of clinical practice by invoking the concept of evidence-based medicine as the currently dominant paradigm in medical practice, and with the need for a complementary approach, namely by narrative-based medicine or narrative medicine...

En este artículo se busca mostrar como en el cuento “Un caso de práctica médica”, el escritor ruso Anton Tchékhov, que era médico, presenta como ficción y llama la atención para aspectos de la práctica clínica tantas veces descuidados, específicamente la observación y la evaluación del ambiente en que viven los enfermos y también sobre aspectos de índole familiar, social e incluso sexual, así como la importancia crucial de la relación inter-personal del carácter dialógico entre médico y paciente. Se relacionará esta llamada de atención indirecta de Tchékhov con la situación actual en el dominio de la práctica clínica, recurriéndose al concepto de EBM (Evidence based medicine) como paradigma dominante en la actualidad en las prácticas médicas y la necesidad de complementarlo con el de NBM (Narrative based medicine) o Medicina narrativa...

Neurology and literature 2.

INTRODUCTION: Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect. OBJECTIVES: Study the synergies between neurology and fictional literature with particular reference to narrative based medicine (NBM). DEVELOPMENT: Doctors establish boundaries between the normal and the abnormal. Taking a clinical history is an act of interpretation in which the doctor integrates the science of objective signs and measurable quantities with the art of subjective clinical judgment. The more discrepancy there is between the patient's experience with the illness and the doctor's interpretation of that disease, the less likely the doctor-patient interaction is to succeed. NBM contributes to a better discernment of the meanings, thus considering disease as a biographical event rather than just a natural fact. Drawing from their own experience with disease, writers of fiction provide universal insights through their narratives, whilst neuroscientists, like Cajal, have occasionally devoted their scientific knowledge to literary narratives. Furthermore, neurologists from Alzheimer to Oliver Sacks remind us of the essential value of NBM in the clinic. CONCLUSIONS: Integrating NBM (the narrative of patients) and the classic holistic approach to patients with our current paradigm of evidence based medicine represents a challenge as relevant to neurologists as keeping up with technological and scientific advances.

Epilepsy in the process of artistic creation of Dostoevsky.

INTRODUCTION: Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his full literary career. The aim here is to understand his condition in light of his novels, correspondence and his contemporaries' accounts as well as by later generations of neurologists. DEVELOPMENT: From Murin and Ordynov (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1879-1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. Apart from making an intelligent use of the disease by incorporating it into his novels, his seminal idea -that a moment of happiness is worth a lifetime- was probably inspired by his epileptic aura. Through epilepsy, Dostoevsky also found a way to freedom from perpetual military servitude. The first symptoms of the epilepsy presented in early adulthood (late 1830s to early 1840s), but he was only diagnosed a decade later. In 1863 he went abroad seeking expert advice from Romberg and Trousseau. In the first retrospective study of Dostoevsky's literary epilepsy, Stephenson and Isotoff noticed the influence of Carus' Psyche (1848) in the preparation of his characters, whilst his epilepsy has inspired later generations of epileptologists. CONCLUSIONS: Dostoevsky offers an insight into the natural history of an epilepsy, which in contemporary scientific terms would be classified as cryptogenic localization-related of probable temporal lobe origin. Above all, Dostoevsky's case illustrates the good use of a common neurological disorder by a remarkable writer who transformed suffering into art and a disadvantage into an advantage.