Mohr et al. (1999) described the psychosocial effects of multiple sclerosis (MS) from the patient's perspective. Three factors emerged: demoralization, benefit-finding, and deteriorated relationships. The benefit-finding factor suggested that some patients with MS benefited from their illness. We investigated the generalizability of these results by replicating the Mohr et al. study using patients with two diseases, cancer (N = 56) and lupus (N = 31). All participants completed the questionnaire developed by Mohr et al. along with the Profile of Mood States. When the data were analyzed, results showed a three-factor solution very similar to the one reported by Mohr et al. Scores on the demoralization factor were positively related to total mood disturbance and average pain ratings and inversely related to benefit-finding. Conversely, patients who perceived more benefits from their illness suffered less. We conclude that benefit-finding is not unique to patients with MS but occurs in patients with other chronic diseases.
This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of illness narrative, an alternative phronesis approach to medical ethics influenced by Charles Taylor's account of the interpretive nature of human agency and language is examined. To this end, the account of interpretive medical responsibility previously described by Schultz and Carnevale as "clinical phronesis" (based upon Taylor's notion of "strong" or "radical evaluation") is reviewed and expanded. The thesis of this paper is that illness narrative has the ability to benefit patients as well as the potential to cause harm or iatrogenic effects. This benefit or harm is contingent upon how the story is told and understood. Consequently, these tales are not simply "nice stories," cathartic gestures, or mere supplements to scientific procedures and decision making, as suggested by the objectivist approach. Rather, they open the agent to meanings that provide a context for explanation and evaluation of illness episodes and therapeutic activities. This understanding provides indicators (guides) for right action. Hence, medical responsibility as clinical phronesis involves, first, the patient and provider's coformulation and cointerpretation of what is going on in the patient's illness narrative, and second, the patient and provider's response to interpretation of the facts of illness and what they signify-not simply a response to the brute facts of illness, alone. The appeal to medical responsibility as clinical phronesis thus underscores the importance of getting the patient's story of illness right. It is anticipated that further elaboration concerning the idea of clinical phronesis as interpretive illness narrative will provide a new foundation for medical ethics and decision making.
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