This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin’s Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the difference (...) that can make. (shrink)

The aim of this article is to explore the ways in which the engagement with Greek tragedy may contribute fruitfully to the unfolding of empathy in medical students and practitioners. To reappraise the general view that classical texts are remote from modern experience because of the long distance between the era they represent and today, I propose an approach to Greek tragedy viewed through the lens of historical empathy, and of the association between past situations and similar contemporary experiences, in (...) particular. After a brief examination of the concept of empathy, its links with literary reading, and the discussion of these interrelations within the training of narrative medicine, and narrative ethics in particular, the focus turns to selected parts of Sophocles’ Philoctetes, such as the disease scene—an ancient example of pathography. Here Neoptolemus’ empathy for Philoctetes’ situation and its consequences are explored with specific interest in the modern readers’ affective response in connection with their own experiences in medical practice. Neoptolemus’ ethical conflict, which is resolved by his decision to care for Philoctetes, and the problematic nature of this attitude are both indicative of the aim of Greek tragedy to problematize universal issues and thus to point towards the instability of human life and the fluidity of human nature. Realizing through historical empathy the precariousness of human existence may lead to a better understanding and hence better care for others and open new perspectives in the development of empathy within the context of contemporary medical education and practice. (shrink)

This study compares two autobiographical descriptions of illness – the seventeenth-century John Donne's Devotions Upon Emergent Occasions and the twentieth-century Cornelius and Kathryn Ryan's A Private Battle . I begin by identifying the basic structure in both narratives as parallel to that of the case history, and then show how each individual's experience is shaped by the conditions of illness appropriate to their respective cultures. Lastly, I discuss the way in which both authors understand and represent sickness, as well as (...) their respective therapies, in terms of a particular metaphoric construct: for Donne, it is the analogy between illness of the body and illness of the soul; for Ryan it is the analogy between Ulness and war. The stance of each towards his illness is conditioned by this metaphoric model: Donne's is one of acceptance, of conforming to the will of God; Ryan's is one of resistance, of fighting heroically until the very end. Thus these metaphors are functional as well as aesthetic: they serve as figural modalities whereby the patient/author hopes to transcend his illness. Keywords: illness, patients, autobiography CiteULike Connotea Del.icio.us What's this? (shrink)

This paper discusses _My Life in the Dromokaiteion_ by the Greek poet Romos Philyras (1898-1942). Reading the text within the scope of the medical humanities, brings out Philyras’ work as an early example of pathography or autopathography. The story revolves around the poet’s admission to the psychiatric hospital and how he experienced his days there. He describes his emotions, the hospital environment, other patients, their treatment and the nursing staff. Philyras’ text is a first-person narrative on how people with (...) mental health problems see their new social setting, but also how doctors and nurses see patients. _My Life in the Dromokaiteion_ is an autobiographical account which eloquently describes not only the distance between the nursing staff and patients, but also the distance between inside society (the patients of the hospital) and outside society. (shrink)

The concept of memory has always been a crucial topic in philosophical discourse. This book re-traces the thought of major philosophers such as Edmund Husserl, Paul Ricoeur, Hannah Arendt, Karl Jaspers, William James, José Luis Borges and Sigmund Freud to provide an in-depth exploration around several aspects of this timely issue. How is a memory formed? How can we bring into existence what has sunk into oblivion? What is the role of our instincts and inner drives in the constitution of (...) memory? What is the connection between memory and forgetfulness, as well as that between mercy and remembrance? Focusing on these fundamental questions, the author presents a rich interconnection of concepts and ideas that build a significant work on the great theme of memory"--Front cover flap. (shrink)

This paper is a revalidation of Oliver Sacks's role in the development of medicine's narrative turn and, as such, a reinterpretation of the history of narrative in medicine. It suggests that, from the late 1960s, Sacks pioneered in his ‘Romantic Science’ a new medical mode that reunited the seemingly incommensurable art and science of medicine while also offering a way for medical humanities to shape clinical reasoning more effectively.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, emphasizes diagnosis and statistically significant commonalities in mental disorders. As stated in the Introduction, “[i]t must be admitted that no definition adequately specifies precise boundaries for the concept of ‘mental disorder’ ” (DSM-IV, 1994, xxi). Further, “[t]he clinician using DSM-IV should ... consider that individuals sharing a diagnosis are likely to be heterogeneous, even in regard to the defining features of the diagnosis, and that boundary cases will be difficult to (...) diagnose in any but a probabilistic fashion” (DSM-IV, 1994, xxii). This article proposes that it may be helpful for clinicians to study narratives of illness which emphasize this heterogeneity over statistically significant symptoms.This paper examines the recorded experiences of unusually articulate sufferers of the disorder classified as Major Depression. Although sharing a diagnosis, Hemingway, Fitzgerald, and Styron demonstrated different understandings of their illness and its symptoms and experienced different resolutions, which may have had something to do with the differing meanings they made of it.I have proposed a word, autopathography, to describe a type of literature in which the author's illness is the primary lens through which the narrative is filtered. This word is an augmentation of an existing word, pathography, which The Oxford English Dictionary, Second Edition, defines as “a) [t]he, or a, description of a disease,” and “b) [t]he, or a, study of the life and character of an individual or community as influenced by a disease.” The second definition is the one that I find relevant and which I feel may be helpful to clinicians in broadening their understanding of the patient's experience. (shrink)

This review essay examines the emergence of the patient narrative or “pathography” in the late eighteenth and early nineteenth century in relation to the great cultural, epistemological, and ethical transformations that enabled the formation of modern medicine. John Wiltshire’s book provides an historical overview of this complex process, as well as laying the basis for a contemporary critique of some of its key assumptions.

Effective doctor patient relationships are predicated on doctors' relational engagement and affective/holistic communication with the patients. On the contrary, the contemporary healthcare and patient-clinician communication are at odds with the desirable professional goals, often resulting in dehumanization and demoralization of patients. Besides denigrating the moral agency of a patient such apathetic interactions and unprofessional approach also affect the treatment and well-being of the sufferer. Foregrounding multifaceted doctor-patient relationships, graphic pathographies are a significant cultural resource which recreate the embodied moment of (...) clinical encounters as they also lay bare qualitative tensions between patient' illness experience with doctor's professional understanding of the same. Taking these cues, the present article drawing theoretical postulates of Rita Charon, Deborah Lupton, and Havi Carel close reads Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's, Brian Fies' Mom's Cancer, and Stan Mack's Janet & Me: An Illustrated Story of Love and Loss to investigate the nature of doctor-patient relationship vis-à-vis communication and the implications of bad doctoring/communicative practices on patient identity and emotions. Furthermore, the article also examines the aesthetic and functional role of comics in bringing into relief the graphically mediated doctor-patient relationship. (shrink)

Comics has always had a critical engagement with socio-political and cultural issues and hence evolved into a medium with a subversive power to challenge the status quo. Staying true to the criticality of the medium, graphic medicine critiques the exploitative and unethical practices in the field of healthcare, thereby creating a critical consciousness in the reader. In close reading select graphic pathographies such as Gabby Schulz's Sick, Emily Steinberg's Broken Eggs, Ellen Forney's Marbles: Mania, Depression, Michelangelo & Me and Marisa (...) Marchetto's Cancer Vixen, the present article delineates how graphic medicine interrogates the larger than life forces in the field of healthcare. Drawing specific instances from the aforementioned graphic texts, the essay demonstrates that graphic medicine scrutinizes the political economy of health under capitalism. In so doing, the article illustrates how the pharmaceutical corporations, insurance companies, medical technology, and healthcare corporations marketize and commoditize health in the neoliberal era. Finally, the article attempts to theorize how graphic pathographies, mediating subjective experiences, generate a new critical literacy through the conflation of the personal and the political in the verbovisual medium of comics. (shrink)

Many forays have been made by psychoanalysts into the aesthetic realm, particularly in the form of interpretations of works of art and discussions of the particular or general pathology that may predispose individuals toward artistic creativity. Likewise, occasional philosophers have commented on the usefulness of psychoanalysis as a way of approaching areas of mutual interest. This study aims to contribute to this ongoing interdisciplinary dialogue, primarily through a focus on pathography, the term and method originated by Freud in his (...) 1910 monograph on Leonardo da Vinci. ;The thesis begins with an attempt to establish grounds for a dialogue between aesthetics and psychoanalysis by offering a selective review of the literature, identifying three fundamental problems in aesthetics and three basic approaches within psychoanalytic theory, and presenting a discussion of the application of these three modes of psychoanalytic thought to problems of form and content in modern art. ;Next, it is established that pathography, which attempts to probe associations between works of art and the minds that created them, derives from the nineteenth century critical tradition to which Freud was heir. Pathography is subjected to a critique in terms of the ongoing debate in aesthetics concerning problems of intention and expression; finally, its special contributions and limitations are explored. Three models of pathography are presented in detail. Each model with its differing context, motive for interpretation and methodology is scrutinized from an interdisciplinary perspective. ;Beyond pathography, we consider finally the contribution of several post-Freudian theorists who have emphasized the importance of preoedipal development and illuminated certain more general problems of aesthetic interest, i.e., issues centering on response to works of art, creativity and the importance of the external object. The possibility of a developmental line for aesthetic experience is considered, and relevant contemporary infant research is summarized. ;The Appendix offers, beyond pathography, yet another approach of psychoanalysis to art in which the work of art is considered sui generis, not, as in pathography, tied inextricably to the mind of its creator. A statement concerning the vicissitudes of interdisciplinary scholarship concludes the study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 35.3 (2002) 208-222 [Access article in PDF] Writing, Illness and Affirmation Jeremiah Dyehouse My formula for greatness in a human being is amor fati: that one wants nothing to be different, not forward, not backward, not in all eternity. Not merely to bear what is necessary, still less conceal it—all idealism is mendaciousness in the face of what is necessary—but love it. —Friedrich Nietzsche In her (...) widely circulated book On Death and Dying, Elisabeth Kübler-Ross, M.D., addresses herself to a changed historical context for work in medicine. In societies with increasingly effective medical care, she argues, doctors and nurses find themselves working with patients whose health problems range from imperceptible yet terminal sicknesses to psychosomatic ailments. Today, especially, it is easy to see the reality of her description of this situation: forms of terminal cancer can be detected earlier and earlier in a patient's life, rendering the disconcerting reality of a terminal illness with few or no symptoms. Equally strange for doctors and patients today are forms of environmental illness like chronic fatigue syndrome, a condition suffered by many but still disputed by doctors and researchers. To this situation of medical risk, personal suffering, and therapeutic care, Kübler-Ross prescribes a communicative engagement with the dying. This engagement, she argues, not only teaches doctors about death and dying, but it also provides respite for those who must experience these events.The problem of communicating with the dying, the main focus of Kübler-Ross's book, is nevertheless eclipsed by the other, more notable aspect of On Death and Dying. For out of this book emerged the now very popular understanding of the stages of death, the normal sequence of an individual's emotional reconciliation to dying: the processes of denial and isolation, anger, bargaining, depression—the whole series of intrapsychic processes leading up to a final acceptance of death and dying. Now we live amongst a whole panoply of staged progresses towards the acceptance of trauma: trauma associated not only with death and dying but also with substance abuse, catastrophe, and forms of violence. It is perhaps worth recalling, however, that the most famous of these stage models, the five stages [End Page 208] of death, emerged out of Kübler-Ross's attempt to learn what the dying can teach the living about communication.In what follows, I assume that writing about illness is another, more popular form of Kübler-Ross's descriptive and communicative project. To write pathography, as Anne Hunsaker Hawkins calls narratives of illness and dying in her survey of these texts, Reconstructing Illness: Studies in Pathography, is to engage with what sickness and dying teach about life and writing. As might be guessed, most pathographies orbit familiar centers of gravity: agency for the dying, reconciliation for the living, the whole leaden project of acceptance. Even so, pathography is not always and everywhere engaged in such projects. Pathography, as Hawkins demonstrates, is a highly variable project. Literary pathography is quite different from popular pathography, and texts within these categories differ with respect to the purpose of their writing. Pathography is conceived as a communicative engagement with sickness and dying, with the sick and the dying, but is hardly unified in its aims or its functions. It is a form of writing that not just potentially but actually admits a diversity of purposes and produces a variety of effects.It is my purpose here to propose a typology for pathographies. Although pathography as a genre of writing takes a bewildering variety of forms, these writings can be grouped according to their effects. I divide pathography into three types, according to the kind of response they offer to sickness and dying, to the sick and the dying. First, I treat pathography as a process of passive acceptance, the bearing of a burden proposed by the necessities of illness and death. Next, I characterize pathographies that approach the writing of illness or dying as a process of active acceptance. This type of pathography uses writing about illness and dying as a process for the... (shrink)

Dear Professor Heller . . . Your paper had started out superbly. It was a great aesthetic and cognitive pleasure to follow you as you guided us through the intellectual history of the main idea of Kleist's essay, from Plato through the biblical Fall of Man, to Schiller, and Kierkegaard, and Kafka. Indeed the perceptive listener's experience was so satisfying that his disappointment was doubled when he came to realize that all this erudition and beauty had been displayed only in (...) order to serve as a contrast-providing background for the sharp delineation of a reductionistic explanation which you consider to be characteristic of psychoanalysis: the interpretation of the disturbance of man's naive, unselfconscious pre-Fall state as nothing more than a portrayal of sexual impotence—the reduction of a deep existential preoccupation to a case of phimosis. I am certain that the relief I felt when you then took up Freud's demonological-neurosis paper was not an idiosyncratic response on my part but an experience shared by many open-minded listeners in your psychoanalytic audience. Let us, therefore, disregard the "text" of your sermon and consider the substantial questions that you raised after you turned to Freud; these are to my mind the most central ones that you undertook to examine in your—despite its disappointing aspects—splendid address to us. Put into my own words, your most important question was this: What is the purpose of the psychoanalyst's efforts outside the clinical setting, in particular when his contributions take the form of a pathography? That is, To what end do analysts study the psychopathology of the creators of great works? I, too, have asked myself this question, and since you read my old essay "Beyond the Bounds of the Basic Rule" , you know some of my answers. But important basic questions are hardly ever answered once and for all; and I will, therefore, under the impact of your lecture, respond as if I had heard the question for the first time. Heinz Kohut, M.D., is Professorial Lecturer in Psychiatry at the University of Chicago and a teacher and training analyst at the Chicago Institute for Psychoanalysis. His works include The Restoration of the Self, The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders—which has appeared in German, French, and Italian translations—, The Restoration of the Self and collection of his essays, Scientific Empathy and Empathic Science. His "A Reply to Margret Schaefer"" was published in the Spring 1978 issue of Critical Inquiry. See also: "Psychoanalysis and the Marionette Theater: Interpretation is Not Depreciation" by Margret Schaefer in Vol. 5, No. 1. (shrink)

At the beginning of the twentieth century, when psychoanalysis was just emerging and the tradition of writing psychoanalytic biographies did not yet exist, the genre of pathography was widespread among psychiatrists, who considered the life of a prominent figure through the prism of his or her disease. One of the heroes of the number of pathological investigations was Friedrich Nietzsche, whose figure and philosophical views instigated wide interest. This tendency was manifested among the psychiatrists working in the Russian Empire, (...) including the territory of contemporary Ukraine. The analysis of Nietzsche’s illness and creativity, proposed by a psychiatrist from Odessa Ivan Khmelevskyi, helps to clarify the historical boundaries between the pathography and psychobiography. The current article for the first time attempts to reproduce the basic data on the life and research activities of this now almost forgotten psychiatrist. The specificity of I. Khmelevskyi’s views on F. Nietzsche becomes more obvious due to the consideration of the position of Vladimir Chyzh, another Russian psychiatrist who was also interested in the figure and ideas of the German philosopher. It is shown that the pathographies of F. Nietzsche, proposed by I. Khmelevskyi and V. Chyzh, reflected both some features of the development of the genre and general trends in understanding of Nietzsche’s figure and teachings within the Russian context. It is shown that V. Chyzh and I. Khmelevskyi, like many scientists of their time, shared some ideas about evolution and degeneration, which are now considered outdated. At the same time, it has been shown that both psychiatrists confronted with the philosophy and figure of F. Nietzsche were forced to limit the explanatory ambitions of psychiatry and avoid the usual for pathographers of that time tendency to consider genius as a pathology. It is also noted that the fact of Nietzsche’s illness, if not overemphasized, can be accepted to the philosophical discourse of the present time. (shrink)

Foreward by Pramod K. Nayar -- Prologue -- Acknowledgments -- Introduction -- The dys-abled players of Samuel Beckett's Endgame -- The circumcised body of Franz Kafka's select letters -- 'Connoisseurship ... of disease' and Thomas Mann's Death in Venice -- 'Undiscovered countries' with Virginia Woolf's On being ill -- 'Connect nothing with nothing' in T.S. Eliot's The wasteland -- Epilogue -- Pathography -- Index.

Avec "Pathosophie", Viktor von Weizsäcker construit une nouvelle anthropologie dans laquelle la dimension passionnelle et pathique de l'homme est à la fois la base et l'origine d'une médecine repensée de pied en cap. A partir de la destinée pathosophique de l'homme, il fonde un tout autre système afin de pouvoir penser les rapports entre différentes maladies, qu'il expose dans une double triade: névrose-biose-sclérose, organose-somatose-psychose. Ce système se déploie non à l'intérieur de lui-même mais dans la relation médecin-malade, fondée sur la (...) biographie et qui prend forme dans les pathographies. Le détour par la pathographie, à laquelle Viktor Von Weizsäcker a consacré sa vie, transforme tout ce qui peut devenir système en encyclopédie. Viktor von Weizsäcker invite à faire le tour des thèmes fondamentaux de l'existence pathique (la douleur, la volonté, la sexualité, la conscience, l'Etat, le pouvoir, le mensonge, le vertige, l'ennui et la mort) et, ainsi, fait entendre plusieurs voix dans une cohérence polyphonique. Le mode de pensée encyclopédique avec ses foyers de concepts forme un paysage qui apparaît lorsque nous nous y mouvons et Viktor von Weizsäcker nous le fait sentir au lieu de nous le prouver. Selon Jacques Schotte, nous avons à penser plus avant les formulations de Viktor von Weizsäcker si "nous voulons guérir et nous guérir, c'est-à-dire vivre davantage". Comme le proclame Hölderlin: "C'est celui qui a pensé le plus profond qui aime le plus vivant". (shrink)

Frances Burney is primarily known as a novelist and playwright, but in recent years there has been an increased interest in the medical writings found within her private letters and journals. John Wiltshire advocates Burney as the unconscious pioneer of the modern genre of pathography, or the illness narrative. Through her dramatic accounts of distinct medical events, such as her own infamous operation without anaesthetic, to those she witnessed, including the 'madness' of George III and the inoculation of her (...) son against smallpox, Burney exposes the ethical issues and conflicts between patients and doctors. Her accounts are linked to a range of modern narratives in which similar events occur in the changed conditions of the public hospital. The genre that Burney initiated continues to make an important contribution to our understanding of medical practice in the modern world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Place for Healing:A Hospital Art Class, Writing, and a Researcher's TaskJulia Kellman (bio)Introduction[O]bjects transform the top of our chest into a site of memory. I think of private landscapes like this one as querencias, places that hold the heart. The word has been translated as homing instinct and affection. Expatriate Alastair Reid introduced me to it in 1965, writing about the Spanish bullfight in The New Yorker. After (...) the first wound the bull chooses his querencia, the place in the ring where he returns for a moment to rest before the fight goes on, and where he finally dies. Querencia comes from the common Spanish verb querer; among its many meanings are to love, to want, to hold, and to command. Reid spoke of hometowns and native countries as querencias; exiles cling to their memories of them.1Place, "space that has the capacity to be remembered and to evoke what is most precious,"2 by its nature orients us to a particular perspective, to a way of looking at the world. Each place has its own local accent, its own constellation of habits, its own rhythm of language and thought. We are grounded in landscape in the same manner that we are situated in our social world, imprinted like other creatures on a typography, pattern of weather, cycle of seasons, scents, and colors.3Our hearts, too, are embedded in such places; and in this article, through this "act of personal witness," this "inscription of a self and a description of an object" as the anthropologist and writer Ruth Benhar4 describes it, we will see how the members of an art class for people with HIV/AIDS at a local hospital have similarly become grounded in their art space and in the tiny art community that has grown up around it. Additionally, we will discover the importance of a more descriptive style of writing as means for examining the role of art in the lives of people who are ill, for their various difficult [End Page 106] situations call for particular clarity and empathy that both honors and relates the stories of their lives. It will become clear as this article proceeds that the personal engagement of a researcher/writer in such a situation is critical as well. For not only must she be open—vulnerable, as Behar suggests—to the people with whom she works as a means of spanning the chasm between a life of illness and a life of health, but she must also be sensitive to the reader's needs, for she is the reader's guide and surrogate.5 This role as guide and alter-ego demands that the researcher tell the story of other lives in a manner that enables the reader to empathetically and eagerly undertake a journey with the researcher into a world unlike her own.6Personal Engagement: The Researcher/WriterHoward Brody, doctor and medical ethicist, explains the necessity for stories of illness to be descriptive.7 He asserts that the stories in which we are most interested are not merely factual recitations; they are about what the illness means to the individual—they include how that person understands events. "It is far too simple-minded" he writes, to assume that "the writer of literature presents to us a world of fantasy that never existed whereas the author of a nonfictional pathography has some special insight into the world as it really exists, even if the relevant world is nothing but his own subjective experiences."8 He concludes "in stories of that sort (stories of the meaning of things) the line between so-called truth and fiction becomes more blurred and ceases to affect the uses we make of the stories for the deeper understanding of the human response to illness."9 Further, Brody continues, one must understand stories of sickness in order to truly develop a philosophical understanding of what it means to be ill. Such an understanding, Brody suggests, not only provides ethical guidance for health care workers and others but also will lead to improved care for patients and better education of health professionals.10 This view of... (shrink)

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses on the doubt about (...) the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment as the critics presuppose, but a probabilistic judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences. (shrink)

Suddenly unable to walk, I found resources for facing disability in the works of Aristotle and Nietzsche, even though their respective ethical schemes are incommensurable. Implementing Amélie Rorty's notion of crop rotation, I show how each scheme offers the patient something quite indispensable, having to do with how each has its own judgmentally-motivated psychological underpinnings. Aristotle's notion of empathy, wherein the moral move occurs whenever we take up someone else's good as our own, is empowering, especially to those who face (...) an imperiled embodiment. However, Nietzsche teaches us that pity is demeaning both to the pitier and to the pitied, because it falsely assumes that life should be easy so that we are filled with ressentiment when it isn't. Those facing disability need empathy, not pity. The richness of this distinction is vividly conveyed in narratives that show how empathy and pity play out in lived situations, thereby avoiding the dissociation that too often characterizes ethical theorizing. By honoring narrative accounts of how these relational moves are either snagged or successfully made, the attuned moral agency of medical practitioners can be fostered. (shrink)