Wonder and the clinical encounter

Abstract

Here are three writers not thinking particularly about medicine:Were there no given, wonder could never spring on us its unpredictable surprise, would never be able to sneak up and startle us into realizing that we do not know what lies right here in front of us. Jerome Miller [1] Wonder … always points to something beyond the accepted rules. Because of this, the feeling of being overwhelmed, or the experience of humbleness and even awe could accompany it. But wonder is also consistent with a certain uneasiness towards the given, an inkling that there is more to it than tradition admits, and this more can be investigated. Paul Martin Opdal [2] If this is the way the world is: extraordinary, surprising, beautiful, singular, mysterious and meaningful; then this is how I ought to act in that world: with respect and celebration, with care, and with full acceptance of the responsibilities that come with my role as a human being privileged to be a part of that community of living things. Wonder is the missing premise that can transform what-is into a moral conviction about how one ought to act in that world. Kathleen Dean Moore [3] These writers had in mind, variously, questions in philosophy of religion, in developmental and educational psychology, and ecology and environmental ethics; but I believe their common theme -wonder -is always latent within medicine and at times suffuses it. Indeed, there is a sense in which all medical treatment, whether or not it works, is wonder-ful in terms of its ambition and, for want of a better word, its metaphysical presumption.[4] For many, a major reason for entering the profession of medicine is the mystery of the body and its physiological interconnectedness. [Footnote 1 ] Yet for some reason wonder's role in clinical medicine is rarely spoken about.In this paper I want to propose the value, to doctors and others in routine clinical life, of an active, cultivated, openness to wonder and to the sense of wonder. Wonder is a notion that in recent decades has attracted periodic interest among philosophers and theologians, [5][6][7][8][9][10] historians of science [11][12][13] and educationalists [14] among others (including recently at least one significant funding body [footnote 2 ]) but so far as I know it has not been discussed in detail in relation to the practice of clinical medicine. An invitation to do so was issued in the form of an elegantly engaging short paper by sociologist Arthur W Frank, exhorting doctors and patients alike to 'recognize the wonder of the body rather than try to control it; ' [15] and for my own part I have previously suggested an active sense of a wonder as a personal resource to the professional clinician [16] and its cultivation as an educational good to be aimed at via the integration of humanities within the medical school curriculum. [17] However no-one has attempted any sustained analytic discussion of the clinical relevance of wonder, nor exploration of the ethical or aesthetic aspects of wonder in relation to medical 1 I owe this point to A...

Medical Humanities and The Place of Wonder

“…The attitude of wonder is thus one of altered, compellingly-intensified attention to something that we immediately acknowledge as somehow important -something that might be unexpected, that in its fullest sense we certainly do not yet understand, and towards which we will likely want to turn our faculty of understanding; something whose initial appearance to us engages our imagination before our understanding; something at that moment larger and more significant than ourselves; something in the face of which we momentarily set aside our own concerns (and even our self-conscious awareness, in the most powerful instances). 41 EXT This is admittedly a rather ponderous attempt -and there is a much shorter way of putting the matter that, I think, implies the foregoing and catches something of the poetry of experiences of wonder: in wonder the world is made newly-present to us.…”

Medicine, the body and an invitation to wonder

“…Following Hepburn, I have conjectured wonder as ‘an ethical source’,5 but a source is neither a system nor a theory. Is an openness to wonder a virtue in the clinical context (or anywhere else)?…”

Caring about the clinician who seems uncaring: the ‘as if’ approach

“…The option I am referring to is the ‘as if’ approach, proposed in 1911 by the German philosopher and Kantian scholar, Hans Vaihinger [17,18]. Subsequently developed and applied in individual psychology and especially psychotherapy [19–21], it entails people acting as if the reality they want – and are free – to believe matches the facts as they appear to them [22]. The facts appear to contradict what a person wants, but the assumption that the reality underlying this appearance cannot be known with certainty makes it possible for the person to resolve this contradiction by creating a useful fiction.…”