Loss adjusting and claims investigation services for Insurance Companies The plaintiff's initial working relationship with the defendant was on contractual basis. the defendant he suffered bouts of ill health of a physical nature, in particular, to claims for psychiatric (or physical) illness or injury arising from the stress of . A sick person can only become a patient when there is a doctor; it is in an illness career; it is a reciprocal relationship between particular instance and chronic course. Kleinman has in mind the meaning of chronic illnesses, which he . The mental and physical tenacity of chronically ill patients having to. To | o olor. onton * JANUARY VOLUME , NO. 1 For 98 out of the years of the 20th century, POPULARMECHANICS has been the chroniclerofthe.
Joel Mokyr has joined their ranks with admirable verve, erudition, and originality. In his account, a change in the beliefs, values, and preferences of Europeans drove them to accumulate, share, and apply knowledge as it had never been done before. Agree or disagree with Mokyr's thesis, you definitely need to take it seriously.
Mokyr's historical laboratory is early modern Europe, when a small mass of highly skilled artisans, entrepreneurs, financiers and merchants laid the roots of what was to become the Industrial Revolution. The Origins of the Modern Economy https: Before the overwhelming majority of humankind was poor; today in the industrialized world, almost nobody lives at the verge of subsistence, and a majority of people in the world enjoy living standards that would have been unimaginable a few centuries ago.
My book asks how and why that happened. The question of the Great Enlightenment is central to economic history; a Nobel prize winning economist, Robert Lucas, once wrote that once we start thinking about it, it is hard to think of anything else. Do we know how and where this started? Yes, it started in Western Europe primarily in Britain in the last third of the eighteenth century through a set of technological innovations we now call the Industrial Revolution.
From there it spread to the four corners of the world, although the success rate varied from place to place, and often the new techniques had to be adapted to local circumstances.
How is this book different from other work looking at this event? The literature looking at the question of why this happened has advanced three types of explanations: My book examines culture: Whose culture mattered most here?
So what was it about these intellectuals that mattered most? In the new book, I explain the origins of the Industrial Enlightenment.
These intellectuals then carried out that program through continuous advances in science that eventually found a myriad of economic applications.
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How and why did this change happen? That is the main question this book is focusing on and tries to answer. The success of these thinkers to persuade others of the validity of their notions of progress and the importance of a research agenda that reflected real economic needs is at the heart of the story of how the Industrial Enlightenment emerged. So why did this take place in this period and in Europe, and not somewhere else?
Europe in this age enjoyed an unusual structure that allowed new and fresh ideas to flourish as never before. Even a modest change can be the difference between acceptable, if frustrating, quiescence, and an eruption of symptoms distressing enough to yield a condition that is unacceptable and not infrequently, dangerous.
He is paradoxically intimate with his body in a way that non-ill people are not, being constantly conscious of changes of his body, and alien to his body, something that he inhabits yet cannot know or control fully.
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Some might take chronic illness to be a quest, as Arthur Frank suggests, on which the ill person seeks transformation, transcendental meaning, or the true self — chronic illness is a long adventure that ends only in death, but can teach lessons along the way.
They suffer invisible pain, undetectable by imaging or tests, that renders them unable to perform the social roles they are assigned. Family and friends become disconcerted and frustrated by the mentions of pain that they cannot name or see, growing detached because the pain prevents the ill person from participating in social life. In the case of Howie Harris, Kleinman describes how persistent back pain has made his job as a police lieutenant difficult to maintain, estranged his wife and children, and completely consumed his life.
While the pain has no clinical meaning of diagnosis, it has many personal and social meanings for Howie. It reflects a sense of failure in being a weak father figure and inadequate husband, a neglected son of an inattentive mother and absent father, with all the shame and guilt at it all. Chronic illness does not stand alone as a disease entity but is entangled in a mesh of relations.
Often in the struggle to break free from pain, the ill person also threatens to break away from social networks. Our pains, like our joys, are small, interior, simple. There is no great moment to the illness or the life. Yet illness, together with other forms of misery, sometimes brings a kind of passion and knowledge of the human condition, giving an edge to life.
And for some patients with chronic illness pain and suffering have more to do with life — and specifically with that aspect of life which is dark and terrible and therefore denied — than with a disease process.
Arthur Kleinman – The Illness Narratives: Suffering, Healing, & the Human Condition
Perhaps the healer and the family, like the historian of human misery, must allow themselves to hear — within the symptoms and behind the illness — especially for the complaints of those of us who are most ordinary — the wail. The mental and physical tenacity of chronically ill patients having to live with such restrictions teaches us important lessons about life.
Ironic illness Kindred to and sometimes indistinguishable from chronic illnesses are illnesses such as neurasthenia, factitious illness, and hypochondriasis. Often chronic illnesses do not have a definite cause; like Howie Harris, the exact reason for the back pain can be untraceable.
When doctors fail to diagnose the somatic reason for pain, psychiatrists like Kleinman step in to see if there is a psychosomatic illness at work. Neurasthenia is a popular nineteenth century term for nervousness, illness resulting from weakness of the nerves and nervous exhaustion. Though rarely diagnosed now in the West, it is still in use in China. Neurasthenia includes chronic fatigue, weakness, myriad of bodily and emotional complaints under the sae neurological cause.
Society was becoming more secular; the helping profession were gaining ascendancy in defining personal problems. I am not sure about this assumption and religion and scientific medicine do not always have to clash. Moreover with the growth of fundamentalism and extremism in recent years I would not easily make the claim that secularism is taking over religion. She lost her position in the Communist party and the opportunity for a university education, therefore now lives in a village where her intellectual abilities are not appreciated; she has a disabled daughter, whom is unlikely to marry because of her deformity; she is separated from her husband.
Though unable to be treated with therapy, at the very least the medical diagnosis of neurasthenia enables her to take medical leave from her job as a teacher by claiming disability status. Although differing in medical term, Chinese neurasthenia functions not that much differently to a diagnosis of say Chronic Fatigue Syndrome; both give the patient a peace of mind in having their illness recognised by a professional, even if other people do not, and having the diagnosis to claim social respite.
Another kind of problem illness is factitious illness. Kleinman uses an extreme case of Gus Echeverra, who had underwent many invasive tests and medical evaluations to find out the reason for his respiratory disorder and anaemia. The release of blood from self-harm was a way of releasing emotional and psychical tension inside, manifesting in somatic problems that received the attention from the mother that otherwise ignored the child. Even though the illness is factitious, it does not mean that Gus was not ill.
He was definitely ill; his illness was both physical and psychological, and without attending to his psychological needs, he could only deflect the problems onto his body. The words depression, anxiety, guilt, and anger, do not do justice to the deeply indwellingself0defeating psychic forces that create and intensify the experience of illness.
The intrinsic irony is that hypochondriasis, defined loosely as the paranoid fear of illnesses, is itself pathologised as an illness.
The hypochondriac is convinced that he is suffering from some unknown illness and is determined to persuade the physician to agree. For hypochondriasis to become chronic, the practitioner must also be unable to convince the patient of this fact, because if the patient comes to accept the medical evidence that he is not suffering from the disease he is experiencing, then he no longer has the disease hypochondriasis.
If you are not ill but you claim to be ill, you are a hypochondriac; if you keep claiming to be ill when you are not ill, you are a hypochondriac therefore you are ill. I am sure the diagnostics are much more complicated than I am able to understand, but it is without a doubt murky waters. Yet these patients are usually quite rational and aware of their paranoia, even as they insist on tests that they know will be negative, so physicians cannot ignore their requests.
Some patients are convinced of some hidden disorders, an undetected cancer tumour, or a rare disease yet to be discovered.
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They are plagued by fears of certain illnesses and when these claims are disputed, even if they are not biologically threatened their social lives are wrecked by accusations of malingering and attention-seeking, which can be equally damaging. With these kinds of psychosomatic illnesses where the nature of the illness is unclear, as well as chronic illnesses, the suffering person is unable to fully perform the sick role without the acknowledgement of family, friends, and physicians.
The significance of therapy is to discover the psychosocial aspects of illnesses and heal sick persons psychologically and emotionally, not just physically. Paul Samuels is a doctor with a diabetic father, and himself has asthma. He views the professional persona as a necessary mask to protect the doctor from suffering, and from making mistakes due to emotions. Some doctors like Benjamin WInterhouse is a cynic who fears lawsuits from dissatisfied patients, or Helen McNaughton who sees medicine as a commodified business where care is provided on the basis of cost and profit rather than welfare.
These doctors are disillusioned about healthcare as a practice in neoliberalism and feels that they cannot fulfil their potentials as healers, only business managers, within the narrow confines of law and economic exchange. It is interesting that Kleinman brings in once again the Chinese traditional doctor as a contrast. The Chinese doctor experiences similar frustrations with the limits of time and resources, but emphasises on the patience of the doctor rather than the patient in dealing with difficult cases like chronic illnesses, where healing is a long process that requires a dialectical relationship.
Chinese medicine builds on clinical experience instead of diagnostic manuals and biomedical tests. It is the subjectivity and rational judgement of the physician that heals the patient. Even where the education of physician inculcates the right attitudes, the organisation of the delivery system may undermine those values, replacing them with ones that complicate care and contribute to chronicity.
They do not specialise but treat the whole person; for them emotional pressures are intimately linked to illnesses and the aim of medicine is to restore balance in the whole body. The specialisation of medicine in favour of division of labour and efficiency loses sight of this holistic aspect of the whole sick suffering person.
It is this humanity of Chinese traditional medicine that Kleinman is advocating. The chronically ill person, like Howie Harris, is isolated by and with pain, from which there is no hope of escape. Kleinman argues that chronically ill patients have psychosocial needs that are not catered for when doctors look only for physical diseases.
What these patients really need is a meaningful relationship with a physician that they can trust, and with whom they can share a faith in whatever treatment they are pursuing. The physician needs to feel a personal connection with the patient that is constructive and instructive on both sides but with the physician leading the way with medical knowledge. Part of successful practices of medicine is in teaching patients about their illnesses and persuading the patient to agree to treatments that they may be afraid of but which the physician feels is necessary.
The psychotherapeutic approach will help physicians and care givers see chronically ill patients not as problem patients who are non-compliant but persons who are suffering in need of support.
As well as caring for the sick person, what is also missing in existing models of medicine is the care for the family. With illness having more than one level of meaning for the individual, the effects of illness ripples across the social and familial circles.
The patient is usually not the only one demoralised; the family feels powerless to help and is alienated by the illness. By involving the family in the psychotherapeutic process, they are brought into the illness experience and once they understand the nature of the illness can provide support for the patient at home. For the family as for the patient there is nothing like the realisation that the practitioner is sensitive to their needs and competent to offer help.
The role of the physician is to control disease process and provide care for the sick person.