The value of CYP2D6 phenotypes and active metabolite concentrations as predictive factors of tamoxifen efficacy ..

In this paper we explore the rise of 'the breast cancer gene' as a field of medical, cultural and personal knowledge. We address its significance in the Norwegian public health care system in relation to so-called biological citizenship in this particular national context. One of our main findings is that, despite its claims as a measure for health and disease prevention, gaining access to medical knowledge of BRCA 1/2 breast cancer gene mutations can also produce severe instability in the individuals and families affected. That is, although gene testing provides modern subjects with an opportunity to foresee their biological destiny and thereby become patients in waiting, it undoubtedly also comes with difficult existential dilemmas and choices, with implications that resonate beyond the individual and into different family and love relations. By elaborating on this finding we address the question of whether the empowerment slogan, which continues to be advocated through various health, BRCA and breast cancer discourses, reinforces a naïve or an idealized notion of the actively responsible patient: resourceful enough to seek out medical expertise and gain sufficient knowledge, on which to base informed decisions, thereby reducing the future risk of developing disease. In contrast to this ideal, our Norwegian informants tell a different story, in which there is no apparent heroic mastery of genetic fates, but rather a pragmatic attitude to dealing with a dire situation over which they have little control, despite having complied with medical advice through national guidelines and follow-up procedures for BRCA 1/2 carriers. In conclusion we claim that the sense of safety that gene testing and its associated medical solutions allegedly promise to provide proved illusory. Although BRCA-testing offers the potential for protection from adverse DNA-heritage, administered through possibilities for self-monitoring and self-management of the body, the feeling of 'being in good health' has hardly been reinforced by the emergence of gene technology.

Background Expressive writing has been shown to improve quality of life, fatigue, and post-traumatic stress among breast cancer patients across cultures. Understanding how and why the method may be beneficial to patients can increase awareness of the psychosocial impact of breast cancer and enhance interventional work within this population. Qualitative research on experiential aspects of interventions may inform the theoretical understanding, and generate hypotheses for future studies. Aim To explore and describe the experience and feasibility of expressive writing among women with breast cancer following mastectomy and immediate or delayed reconstructive surgery. Methods Seven participants enrolled to undertake 4 episodes of expressive writing at home, with semi-structured interviews conducted afterwards and analyzed using experiential thematic analysis. Results Three themes emerged through analysis: writing as process, writing as therapeutic, and writing as a means to help others. Implications for practice This study augments existing evidence to support the appropriateness of expressive writing as an intervention after a breast cancer diagnosis. Further studies should evaluate its feasibility at different time points in survivorship. Conclusions Findings illuminate experiential variations in expressive writing and how storytelling encourages a release of cognitive and emotional strains, surrendering these to reside in the text. The method was said to process feelings and capture experiences tied to a new and overwhelming illness situation, as impressions became expressions through writing. Expressive writing, therefore, is a valuable tool for health care providers to introduce into the plan of care for patients with breast cancer, and potentially other cancer patient groups.

This article explores knowledge about the breast in lived experience, addressing a gap in empirical research on a highly gendered cultural trope and embodied organ. We present findings from a study that used a free-associative psychosocial method-the Visual Matrix-in order to stimulate expressions of tacit aspects of the breast, aiming to generate an understanding of relations between embodied and enculturated experiences. Our data revealed how an aesthetic of the grotesque in one matrix allowed the mainly female group to use humour as a "creative psychic defence" against culturally normative and idealized aspects of the breast. This was expressed through symbolizations, affectively delivered in an exuberant mode, emphasizing the breast's potency and its potential for nurturance and "weaponization". Through this feminine poetic, life and death became inseparable yet ambiguous dimensions of breasts. The breast's life-affirming qualities included the sensual, the visceral, and the joyful-a material-semiotic knowing. This was incontrast to a second matrix, which expressed a more ambivalent and troubled response, and in which associations were weighted towards the spectacular breast of an ocular-centric culture that privileges hetero-masculine looking. We discuss differences between the two matrices in terms of psychosocial tensions between embodied and enculturated experiences.

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The Visual Matrix method is designed to elicit imagistic and associative contributions established collectively amongst participants in a group setting. In this article, a hard-to-reach area of experience-death and dying-illustrates the production of shared cultural images beyond individual experience. Our dual purpose was to assess the suitability of the method for this challenging topic, and to understand the ways in which death figured in the imagination of the participants. Three theorists, Wilfred Bion, Alfred Lorenzer and Gilles Deleuze, enable us to theorise psychosocial processes of symbolisation beyond cognition.

<p>Expressive writing as a self-help tool one year after the breast cancer diagnosis – results from a Norwegian pilot study</p><p>The article presents findings from a pilot study on expressive writing, a therapeutic method undescribed in a Norwegian scientific context. Objective: 1. Gain qualitative data on breast cancer women’s experiences with expressive writing. 2. Evaluate the intervention’s feasibility, based on participants’ experiences of the instruction, procedure, and circumstances for writing. Method &amp; design: The study has an exploratory descriptive design. Data collection was achieved through in-depth interviews, followed by experiential thematic analysis of transcripts. Results: Two women enrolled, participating in writing/interviews. Analysis revealed three themes: "The experience of the writing process", "Writing as working through and work to clear the mind", "Strength and vulnerability in relation to others". Conclusion: Findings reveal that expressive writing was experienced as achievable for two breast cancer women, one year after diagnosis. Writing provided an opportunity to work through, and sort out, feelings and thoughts connected to participants’ lives and illness experiences. The instruction was evaluated as easy to understand and inspiring. The women became absorbed in electronic writing in their own homes. They both recommended expressive writing for other women with breast cancer, especially in the period after initial diagnosis.</p>

Dominant discourses of ageing are often confined to what is less painful to think about and therefore idealise or denigrate ageing and later life. We present findings from an exploratory psychosocial study, in a Nordic context, into three later-life transitions: from working life to retirement, from mental health to dementia and from life to death. Because, for some, these topics are hard to bear and therefore defended against and routinely excluded from everyday awareness, we used a method led by imagery and affect-the Visual Matrix-to elicit participants' free associative personal and collective imagination. Through analysis of data extracts, on the three transitions, we illustrate oscillations between defending against the challenges of ageing and realism in facing the anxieties it can provoke. A recurring theme includes the finality of individual life and the inter-generational continuity, which together link life and death, hope and despair, separation and connectedness.