Journal of Medical Humanities

, Volume 38, Issue 2, pp 151–172 | Cite as

'Geraniums (red) and Delphiniums (blue)': Trauma, Ethics, and Medical Communications



More official complaints about medical treatment in the UK relate to poor communications than to wrong diagnoses. This article, in considering the importance of communications training for clinicians, is structured into three sections. From use of a story that introduces the idea of miscommunication and trauma in the first section, the article moves, in the second, to a theorisation of trauma as a concept, addressing issues of intersubjectivity, the relationship between embodied and psychological being, and ethics. From this, the third section engages directly with medical communications training, exemplifying a particular literary-studies approach to matters of communication.


Medical communications subjectivity trauma literary studies meaning ethics 



This article comes out of the early stages of a project, 'Medicine and Meaning; Illness and Ownership', begun during research leave in 2012-13. I am grateful to Joe Yates, Director of the School of Humanities and Social Science, and to my colleagues in the English Department at Liverpool John Moores University who freed me from teaching and administrative duties enabling me to embark on this new area of work. Avril Danczak, Jane Davie and Margaret Kingston made it possible for me to begin thinking about medical humanities issues through their generosity of spirit, the time they gave to conversations with me, and by offering their insight, knowledge, thought and reflection on clinical experience. I am profoundly grateful to them for all of this, and for the pleasure of those conversations. (They bear no responsibility at all, of course, for what I have done with their ideas.) I am also grateful to members of the audience at the 'A Narrative Future for Healthcare' conference, hosted by King's College, London and Columbia University Medical Centre, in 2013, where I gave an earlier version of this article as a paper, especially to Will Brook, Sarah Clement and Jonathan Tomlinson for feedback or continuing conversations. My thanks to Dee Brown, David Clampin, Joanna Croft, Colin Harrison, Katharine Hodgkin, Diana Mitlin, Andy Mousley, Joanna Price, and David Tyrer who all provided support and intellectual help by discussing ideas and suggesting sources. Timothy Ashplant, James Friel and Joanna Price commented on drafts with the blend of perspicacity, rigour, kindness and honesty that characterises each of them: I am, as ever, deeply grateful. In particular, my special thanks go to Graeme Wilson for making this work possible through intellectual help with sources, contacts and ideas, as well as for many kindnesses – and, above all, for never prescribing chrysanthemums (any colour).


  1. American Psychiatric Association. 1994; 2000. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Balint, Michael. 1957. The Doctor, His Patient and the Illness. Edinburgh, London, New York: Churchill Livingstone.Google Scholar
  4. Bate, Jonathan. 2011. The Public Value of the Humanities. London: Bloomsbury Academic.Google Scholar
  5. Berger S.L., T. Kouzarides, R. Shiekhattar, A. Shilatifard. 2009. "An Operational Definition of Epigenetics." Genes and Development 23 (7): 781–3. doi: 10.1101/gad.1787609. PMID 19339683CrossRefGoogle Scholar
  6. Bersani, Leo and Adam Phillips. 2008. Intimacies. Chicago and London: University of Chicago Press.CrossRefGoogle Scholar
  7. Blankaart, Steven. 1684. A physical dictionary in which all the terms relating either to anatomy, chirurgery, pharmacy, or chymistry are very accurately explain'd by Stephen Blancard. Printed by J.D. and are to be sold by Samuel Crouch in Popes-head-Alley, and John Gellibrand at the Golden-Ball in St. Paul's Church-yard, London. [Wing (2nd ed.) B3164, Wing (2nd ed.) B3164 (Variant)].Google Scholar
  8. Bowman, Deborah, Trisha Greenhalgh and Jonathon Tomlinson. 2013. "A Narrative Future for Healthcare: Conference Report." Accessed January 14, 2014.
  9. Browne, John. 1678. A compleat discourse of wounds, both in general and particular whereunto are added the severall fractures of the skull, with their variety of figures: as also a treatise of gunshot-wounds in general / collected and reduced into a new method by John Brown . Printed by E. Flesher for William Jacob, London. [Wing B5124].Google Scholar
  10. Buber, Martin. (1923) 2004. I and Thou. London: Continuum. Ich und Du, Berlin: Shocken Verlag. First English edition 1937. London: T & T Clark Ltd.Google Scholar
  11. Caruth, Cathy. 1996. Unclaimed Experience. Trauma, Narrative and History. Baltimore and London: The Johns Hopkins University Press.Google Scholar
  12. ------ 2001. "An Interview with Jean Laplanche." Accessed October 8, 2013.
  13. Charon, Rita. 2006. Narrative Medicine. Honoring the Stories of Illness. Oxford: Oxford University Press.Google Scholar
  14. Department of Health. 2013. "More Care, Less Pathway: a Review of the Liverpool Care Pathway." Review of Liverpool Care Pathway for dying patients. Independent report. Accessed July 14, 2013.
  15. Dias, Brian. G. and Kerry.J. Ressler. 2014. "Parental Olfactory Experience Influences Behavior and Neural Structure in Subsequent Generations." Nature Neuroscience 17: 89-96. 10.1038/nn.3594
  16. Hayes, Jasmeet Pannu, Kevin S. LaBar, Gregory McCarthy, Elizabeth Selgrade, Jessica Nasser, Florin Dolcos. 2011. "Reduced Hippocampal and Amygdala Activity predicts Memory Distortions for Trauma Reminders in Combat-related PTSD." Journal of Psychiatric Research 45 (5): 660–669.CrossRefGoogle Scholar
  17. Ehlers, Anke, Jonathan Bisson, David M. Clark, Mark Creamer, Steven Pilling, David Richards, Paula P. Schnurr, Stuart Turner and William Yule. 2010. "Do all Psychological Treatments really work the same in Posttraumatic Stress Disorder?" Clinical Psychology Review 30 (2): 269-276. doi:  10.1016/j.cpr.2009.12.001
  18. Foa, Edna B., Terence M. Keane, Matthew J. Friedman, and Judith A. Cohen, eds. 2009. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guildford Press.Google Scholar
  19. Frank, Arthur W. 1995. The Wounded Storyteller. Body, Illness, and Ethics. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
  20. Freud, Sigmund. (1920) 1955. Beyond the Pleasure Principle. The Standard Edition of the Complete Psychological Works of Sigmund Freud: Vol. XVIII: 7-68. London: Hogarth Press.Google Scholar
  21. ------. (1940) 1964. "The Theory of the Instincts.” In An Outline of Psycho-Analysis. The Standard Edition of the Complete Psychological Works of Sigmund Freud: Vol. XXIII: 233-35. London: Hogarth Press.Google Scholar
  22. General Medical Council. 2011. "The state of medical education and practice in the UK." Accessed July 8, 2014.
  23. General Medical Council. 2012. "The state of medical education and practice in the UK." Accessed August 8, 2014.
  24. General Medical Council. 2013a. "Good Medical Practice." Accessed March 6, 2013.
  25. General Medical Council. 2013b. "Guidance for Patients." Accessed March 6, 2013.
  26. General Medical Council. 2013c. "The State of Medical Education and Practice in the UK." Accessed August 8, 2014.
  27. Greenhalgh, Tricia. 1998. "Narrative based Medicine in an Evidence Based World." In Narrative Based Medicine. Dialogue and Discourse in Clinical Practice. Edited by Tricia Greenhalgh and Brian Hurwitz, 247-265. London: BMJ Books.Google Scholar
  28. Greenhalgh, Tricia and Brian Hurwitz. 1998. Narrative Based Medicine. Dialogue and Discourse in Clinical Practice. London: BMJ Books.Google Scholar
  29. Johnson, Mark. 2007. The Meanings of the Body. Aesthetics of Human Understanding. Chicago and London: University of Chicago Press.CrossRefGoogle Scholar
  30. Kaminsky, Z.A., T. Tang, S.C. Wang, C. Ptak, G.H. Oh, A.H. Wong, L.A. Feldcamp, C.Virtanen, J. Halfvarson, C.Tysk, A.F. McRae, P.M. Visscher,, G.W. Montgomer, I.I. Gottesman, N.G. Martin, A. Petronis. 2009. "DNA Methylation Profiles in Monozygotic and Dizygotic Twins." Nature Genetics. 41 (2): 240–5. doi: 10.1038/ng.286
  31. The King's Fund. 2008. "Seeing the Person in the Patient. The Point of Care review paper."Accessed August 8, 2014. .
  32. Kurtz, Suzanne, Jonathan Silverman and Juliet Draper. (1998) 2004. Teaching and Learning Communication Skills in Medicine. Oxford and San Francisco: Radcliffe Publishing.Google Scholar
  33. Kushner, Howard I. and Leslie S. Leighton. 2013. "The Histories of Medicine: Toward An Applied History of Medicine." In Humanities in the Twenty-first Century: Beyond Utility and Markets, edited by Eleonora Belfiore and Anna Upchurch, 111-136. Basingstoke: Palgrave Macmillan.CrossRefGoogle Scholar
  34. Lanius, R.A., R.L. Bluhm, P.A.Frewen. 2011. "How Understanding the Neurobiology of Complex Post-traumatic Stress Disorder can inform Clinical Practice: A Social Cognitive and Affective Neuroscience Approach." Acta Psychiatrica Scandinavica 124 (5): 331-48. doi:  10.1111/j.1600-0447.2011.01755.x. Epub 2011: Aug 19.
  35. Levinas, Emmanuel. 1969. Totality and Infinity: an Essay on Exteriority. Translated by A. Lingis. Pittsburgh: Duquesne University Press; The Hague: Martinus Nijhoff.Google Scholar
  36. ------. 1985. Ethics and Infinity. Translated by R.A. Cohen. Pittsburgh: Duquesne University Press. (Interviews originally broadcast, 1981).Google Scholar
  37. ------. 1988. Existence and Existens. Translated by A. Lingis. Dorodrecht: Kluwer Academic Publishers.Google Scholar
  38. ------. 1997. "The Name of the Dog or Natural Rights." In Difficult Freedom. Essays on Judaism. Translated by Seán Hand, 151-153. Baltimore: The Johns Hopkins University Press. Originally published as Difficile Liberté. Essais sur le judaïsme. Editions Albin Michel: Paris, 1963 and 1976. Original English translation, The Athlone Press: London, 1990.Google Scholar
  39. ------. 1998. Otherwise than Being, or, Beyond Essence. Translated by A. Lingis. Pittsburgh : Duquesne University Press.Google Scholar
  40. Levine, Peter A. 2010. In an Unspoken Voice. How the Body Releases Trauma and Restores Goodness. Berkeley, California: North Atlantic Books.Google Scholar
  41. Luckhurst, Roger. 2008. The Trauma Question. London and New York: Routledge.Google Scholar
  42. Malabou, Catherine. 2012a. Ontology of the Accident: An Essay on Destructive Plasticity, Translated by Carolyn Shred. Cambridge: Polity Press. Originally published 2009 as Ontologie de l'accident, Paris: Éditions Léo Scheer.Google Scholar
  43. ------. 2012b. The New Wounded: From Neurosis to Brain Damage. Translated by Steven Miller, New York: Fordham. Originally published 2007 as Les Nouveaux Blessés, de Freud à la neurologie: Penser les traumatismes contemporains, Paris: Bayard.Google Scholar
  44. Masson, Jeffrey. 1984. Freud: The Assault on Truth: Freud's Suppression of the Seduction Theory. London: Faber.Google Scholar
  45. May, Todd. 1997. Reconsidering Difference: Nancy, Derrida, Levinas, and Deleuze. University Park, Pennsylvania: The Pennsylvania State University Press.Google Scholar
  46. Menzies Lyth, Isabel. 1960. "Social Systems as a Defense Against Anxiety". Human Relations 13:95-121.Google Scholar
  47. Milne, Alan Alexander. 1925. When We Were Very Young. Methuen: London.Google Scholar
  48. NHS England. 2013. "Guide to good handling of complaints for CCGs" [Clinical Commissioning Groups]. Accessed July 8, 2014.
  49. Nealon, J.T. 1998. Alterity Politics: Ethics and Performative Subjectivity, Durham and London: Duke University Press.Google Scholar
  50. Neri, Janice. 2011. The Insect and the Image: Visualising Nature in Early Modern Europe, 1500-1700. Minneapolis and London: University of Minnesota Press.Google Scholar
  51. Pratt, Mary Louise. 1992. Imperial Eyes: Travel Writing and Transculturation. London: Routledge.CrossRefGoogle Scholar
  52. The Quality Assurance Agency for Higher Education. 2007. "The Subject Benchmark Statement for English." Accessed August 8, 2014.
  53. Roth, Michael. "Leo. Two Prominent Thinkers consider new Forms of Intimacy." Accessed January 14, 2014.
  54. Silverman, Jonathan, Suzanne Kurtz, and Juliet Draper. (1998) 2005. Skills for Communicating with Patients. Oxford and San Francisco: Radcliffe Publishing.Google Scholar
  55. Small, Helen. 2013. The Value of the Humanities. Oxford: Oxford University Press.CrossRefGoogle Scholar
  56. Soteriou, Marina. 2013. "GMC Guide for Patients 'will not boost complaints.'" Accessed March 6, 2013.
  57. Strachey, James. (1953) 1977. "Sigmund Freud. A Sketch of his Life and Ideas." In Sigmund Freud, On Sexuality. Three Essays on the Theory of Sexuality and Other Works. Translated and edited by Angela Richards, 13-26, (quotation, 17). Harmondsworth, UK: Penguin Books.Google Scholar
  58. Wajnryb, Ruth. 2001. The Silence. How Tragedy Shapes Talk. Crows Nest, Australia: Allen & Unwin.Google Scholar
  59. Žižek, Slavoj. 2008. "Descartes and the Post-Traumatic Subject" in Filozofski vestnik 29 (2): 9-29.Google Scholar
  60. ------. 2011. Living in the End Times. New York and London: Verso.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.English Department, School of Humanities and Social ScienceLiverpool John Moores UniversityLiverpoolUK

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