Gender, Sexuality, and Women's Studies in the Health Humanities Purpose This research focuses primarily on the intersection between gender, sexuality, and medicine. Beginning with historical texts and exploring the work of ancient philosophers through the development of modern medicine, this project progresses to a study of modern texts related to current relations between medicine and gender/sexuality. Though it may not be the primary area of study, any research into relations between medicine and gender would not be complete without also examining the connections between race, gender, and medicine, as it is impossible to fully explore the intricacies of gender and sex and their relationship to the healthcare field without also exploring how race shapes an individual’s interactions with the medical field. Source: The British Museum Ancient Medicine 450 B.C.E. to 1600 C.E. Beginning with the birth of Hippocratic Medicine and expanding into the Middle Ages, the precursors to modern medicine are confusing, often conflicting, and absolutely essential to understanding the modern contexts through which we understand medicine today. While Aristotle's assertion that a female is, essentially, "a mutilated male" and Trotula's suggestion that a woman consume the powdered testicles of a hare in order to conceive a male child may seem far from modern medical science, one can trace clear threads throughout history leading from these ancient texts to current attitudes and practices. While the four humors theory is no longer supported by evidence-based science, many plants from Avicenna's list of herbs used to treat abnormal uterine bleeding have studied medicinal purposes. While science is now able to recognize that menstrual blood is not the result of the female body purging toxins due to its relative coldness in comparison to the male body, there still exist in society many harmful stereotypes and assumptions about menstruation. For further reading, see the texts listed below and visit our archive. Suggested Readings Hippocratic Writings On the Generation of Animals by Aristotle The Canon of Medicine of Avicenna "Women's Medical Practice and Health Care in Medieval Europe" by Monica Green The Trotula, translated by Monica H. Green Medicine, Religion and Gender in Medieval Culture, edited by Naoë Kukita Yoshikawa Exercises for Students Analyzing any of the statements from the "Aphorisms" section of Hippocratic Writings , compare these statements to current scientific knowledge. Which statements would be considered accurate even today? Which statements have traces of truth to them? Which statements seem completely nonsensical to the modern reader? Source: Vrouwengeheimen: gynaecologie in de middeleeuwen" by Margreet Brandsma Development of Modern Medicine 1600 to 1950 From wandering uteruses to obstetrical machines to penis envy, the road to current scientific understanding has been paved with racism, misogyny, elitism, and prejudice. Efforts to control the female body and maintain the established societal patriarchy have often gone hand-in-hand with the practice of medicine. For centuries, physicians have built empires of prestige, admiration, and wealth from the systemic abuse of women, with poor women and women of color often being the most common targets. The early 1600s saw the advent of male physicians realizing that they could profit from obstetric practice, both monetarily and in the ability to take the control reproduction from women. James Marion Sims is still celebrated as the father of modern gynecology, and yet the enslaved women he experimented on without consent and without anesthetic died in bondage. Sigmund Freud built a career out of dismissing his patients' claims of sexual assault by burying them in victim-blaming rhetoric. These prejudices are yet not erased from society, and they continue to leak into medical practice. To learn more, explore the suggested readings below and visit the archive for a full annotated bibliography. Suggested Readings The Female Body in Medicine and Literature, edited by Andrew Mangham and Greta Depledge Medical Bondage by Deirdre Cooper Owens From Hysteria to Hormones by Amy Koerber Fragment of an Analysis of a Case of Hysteria by Sigmund Freud "The Freudian Coverup" by Florence Rush Exercises for Students After reading Medical Bondage , examine links between these nineteenth century atrocities and the case of Henrietta Lacks. Source: The Female Body in Medicine and Literature, edited by Andrew Mangham and Greta Depledge Modern Medicine 1950 to 2020 The last seventy years have marked a great transformation in global understandings of medicine, science, gender, and sexuality. In comparing Kinsey's analysis of female sexuality to modern understandings and attitudes about sex and the human body, one may identify many similarities and many differences. Stigma surrounding sexuality, particularly in relation to women's sexuality, still permeates through the current sociopolitical climate. Though attitudes about sex and reproduction have progressed greatly over the past seventy years, society still invests much political and social interest in controlling women's sexuality. Those who bear the largest brunt of this particular brand of oppression are often women of color. The racist and misogynistic legacies of the early days of medicine still remain in modern healthcare practices and in society, sacrificing the health and safety of the nation's most underprivileged populations. Over the nearly seventy years between the publication of Sexual Behavior in the Human Female and today, the United States has experienced an awareness of new, more nuanced meanings of gender identity, gender expression, and sexuality, with many of these changes happening rapidly within the last decade alone. In understanding sexuality, gender, and even phenotypic sex as a spectrum, society is slowly learning to become a more welcoming and accepting place, and healthcare providers are learning to provide better, more comprehensive, and more inclusive care to all of their patients. Though much progress has been made, there is still much progress left to go, especially in medicine. Healthcare is practiced by humans, and no human is immune from bias. It is only through acknowledgment, humility, understanding, and lifelong learning that providers can best benefit their patients and allow the medical field to fully and respectfully serve every single person that needs its care. Suggested Readings Sexual Behavior in the Human Female by Kinsey, et al. (Parts I and II) The Pride Guide by Jo Langford Killing the Black Body by Dorothy Roberts Exercises for Students In comparing all three sections of this project, identify one aspect or attitude of medicine and society that has persisted throughout history, and one that has greatly changed. This may be easier in comparing texts from different sections of the project. Suggested comparisons are below. Medical Bondage & Killing the Black Body What connections can be made between the control of and experimentation on enslaved women's bodies and the government regulations which discourage and demonize Black women's reproduction in modern day? Hippocratic Writings and/or On the Generation of Animals & From Hysteria to Hormones How has the concept of the "wandering uterus" changed throughout time? "Women's Medical Practice and Health Care in Medieval Europe" & The Female Body in Medicine and Literature, chapters 4 and 6 What were the motivations of majority-male physicians in establishing themselves as superior to mostly-female midwives and in taking over as the primary providers in birth? The Female Body in Medicine and Literature, chapters 8 and 10 & Sexual Behavior in the Human Female, chapter 5 How are attitudes about female masturbation reflected in the contexts of both literature and science? Below is a resource for understanding the spectrums of gender identity, expression, attraction, and sex. Check out genderbread.org for more information on this diagram. View Archive Contact the Researcher Maya Albanowski

What are the Health Humanities? We have adopted the Pitt Center for Bioethics and Health Law description of health humanities: The health humanities (also known as the medical humanities) is "an interdisciplinary field of humanities, social science, and the arts and their application to healthcare education and practice. 'The humanities and arts provide insight into the human condition, suffering, personhood, and our responsibility to each other. They also offer a historical perspective on healthcare… [and help] to develop and nurture skills of observation, analysis, empathy, and self-reflection — skills that are essential for humane healthcare. The social sciences help us to understand how bioscience and medicine take place within cultural and social contexts and how culture interacts with the individual experience of illness.' With these aims, in 1997, Center faculty developed the School of Medicine’s Area of Concentration in Medical Humanities for medical students." (Paraphrased by LITMED, the leading medical humanities database founded in 1993.) This site will enable us to give undergraduate students pursuing careers in medicine and other health-related fields a sense of the role of the Humanities as undertaking a narrative, interpretive, critical, and analytical understanding of what it means to be human. Welcome to the Health Humanities Learn more about the purposes for this course by watching a short video created by student researcher Kayla Valentine. Explore Our Site Resources A list of general resources used by health humanities student researchers. Research A catalogue of projects created by our undergraduate researchers. Team Meet the team of undergraduates behind the research. Archive A general archive of sources used by students in their research.

Disparities in Modern Obstetrics & Gynecology Our Themes of Focus: Uncovering the historical reasoning behind the racism that is systemically interwoven into the healthcare field. Focusing specifically on racial disparities within the field of gynecology. As well as an inquiry into the disparities of Gynecological/Obstetric care in regards to management of pain and chronic diseases with a specific focus on endometriosis. Focusing on aspects of of not just racial bias in medicine but an overall mistreatment of women in general but an overall highlight on racial implications. Zoë Allyn & Michelle Onafowokan Table of Contents Section 1: Historical Impact on Modern Healthcare Disparities within the Gynecological Practice Resources Section 2: Disparities in Diagnosis, Treatment, and Pain Management Relating to Endometriosis with Considerations of Racial Implications Section 1: Historical Impact on Modern Healthcare Disparities within the Gynecological Practice Abstract: This paper focuses on analyzing the historical information on the “father of gynecology” Dr. Marion J. Sims, and how his unethical and nonconsensual procedures on enslaved black women contributed to the modern healthcare disparities, specifically black women, seen in healthcare today. Dr. Marion J. Sims was an American physician in the mid-1800s who focused on treating women’s disease. He became considered the “father of gynecology” after he discovered the technique for repairing vesicovaginal fistulas, which is a childbirth complication in which an opening occurs between the vaginal walls and the bladder. While Sims had made great strides to fix this childbirth complication for women, the ways he went about it were unethical as he performed experimental surgeries on enslaved women without their consent. This research paper questions the ramifications of Dr. Sims' experiments and treatment of enslaved black women on the modern healthcare disparities in women’s healthcare today and was performed by analyzing and reading through a variety of sources that described both the historical aspect of women’s healthcare and the modern-day issues present. The findings display that there is a direct connection between the mistreatment of enslaved black women and the disparities seen in the healthcare of black women today, based on the historical analysis performed and the modern-day statistics and patient testimonies examined. The implications of this demonstrate that the United States' deeply racist history has a significant impact on the healthcare minorities receive today. This work is significant as it works to spread awareness of the effects of racism on the United States healthcare industry and to work to reduce racial disparities seen in black women’s gynecological care and ensure they receive the proper healthcare they need and medical professionals are trained effectively to do so. Historical Analysis: The 1840s was a time period when major scientific and medical developments were developed, primarily in the gynecological field. One doctor, in particular, is credited with significant findings in modern gynecology, Dr. James Marion Sims, who in the mid-eighteen hundreds infamously coined his “groundbreaking” surgical technique for vesicovaginal fistula repair that was thought to be the beginning of what we know today as modern gynecology. Sims’s story is known worldwide, and he is renowned as the “Father of Modern Gynecology”. While his discoveries credited him with this title the ethics surrounding his discoveries make him a controversial figure. A lesser-known story is that of the true mothers of gynecology, the enslaved black women whom Sim’s discoveries based through his experiments performed both without anesthesia and consent. Over the span of four years, “Sims performed experimental surgeries, without their consent and without the benefit of anesthesia, on at least 14 enslaved black women” (Khabele et al. sec. 1). To explore a new surgical technique, Sims sought out enslaved women who had been plagued with fistulas and made deals with their owners promising to find a cure. While many of the women’s names were not mentioned within historical texts, three were repeatedly brought up in Sims’ work. Their names are Anarcha, Betsey, and Lucy. The three women were acquired by Sims’ based on an arrangement he made with the slave owner who considered these women their property. Sim’s proposition: “If you will give me Anarcha and Betsey, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them” (Wailoo, par. 4). The owners were willing to participate in this exchange due to the conditions that several enslaved black women developed after childbirth: vesicovaginal fistulas. This post-partum complication, an opening that forms between the bladder and the vaginal walls, results in severe abdominal pain and the leakage of urine and other fluids. Enslaved black women were vulnerable and were likely to develop the condition as a result of “poor nutrition, lack of prenatal care, and births at an early age” (Ojanuga 1993). The condition is not able to heal on its own and requires medical intervention. Dr. Sims worked to perfect a restorative operation on vesicovaginal fistulas, repeatedly operating on the enslaved black women he had acquired. Under Sims, each woman underwent up to thirty operations over four years, allowing him to refine his technique, with each procedure, they were provided no anesthetics (Wailoo par.5). His previous promises to cause the women “no harm” held little weight at this time as the prevalent notion in the medical community was that black individuals did “not feel pain”. His contemporary, Dr. Cartwright, claimed that the black body was “insensible to pain” and “more tolerant to hard labor” (Wailoo par. 8). To this day, defenders of Sim’s excuse his cruelty as being a product of the underdeveloped scientific knowledge about the human body during this time. Despite these false claims, there is significant evidence that demonstrates the pain and endangerment that these women faced. In one instance, Lucy’s surgery “lasted for an hour and Lucy endured excruciating pain while positioned on her hands and knees” (Ojanuga 1993). Ojanuga described how degrading the process was and detailed how “she must have felt extreme humiliation as twelve doctors observed the operation” (Ojanuga 1993). Anarcha’s story mirrors Lucy, highlighting the excruciating pain, humiliation, and lack of consent throughout the procedures. A particularly disturbing poem written by Anarcha Wescott, one of Sim’s other victims, detailed the horrors she endured in order to further Dr. Sim’s discoveries. She wrote of how Sims forced “four strong field hands to hold me down, kneeling, he doesn't say nothing to me” (Armstrong lines 33-35) and how he would say “shut up gal and a hand over the mouth”(Armstrong line 38). She wrote, “Doctor cut us so many times, sew us this way, sew us that way. But the stitches still take” explaining that she had “no say” and describing fields hands holding her down as she screamed and bled time she fainted, saying “he cuts me inside–I feel the blood runnin’ down my legs to the floor–then he picks up the curved needles–and it goes on and on till I pass out” (Armstrong lines 42-45). This is especially disturbing considering the claims that Sim’s had made regarding consent, writing: I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not (Wall, 1302). The accounts of his victims, described above, invalidate these claims, and show that the ideas of informed consent and bodily autonomy were completely ignored for him to climb the ranks to being highly regarded in the medical community. While he may have achieved his goal and been named the so-called “father of gynecology”, it was only possible through the emotional trauma and non-consensual exploitation of the black women who fell victim to his experiments. He used these women as disposable “Guinea pigs” for perfecting these dangerous procedures before he brought them worldwide, to rich white women, whom he never operated on without anesthesia (Khabele et al. sec. 1). After Sims had perfected his technique of repairing vesicovaginal fistulas and had spread awareness of his discovery, he began performing the surgery on white women as well, however, it was noted that while many white women came to Sims for treatment, “none of them were able to endure a single operation” (Ojanuga 1993). This blatantly displays how painful the procedures truly were, however, due to Sims' implicit racial bias and disregard for the women he was experimenting on, he failed to regard their pain and would continue to operate on them despite their screams. This occurred even after he had defended his un-anaesthetized treatments and claimed that he would “never resort to them [anesthetics] in these operations, because they are not painful enough to justify the trouble, and risk attending their administration” (Wall). However, another physician during Sims’ time, named Dr. Crawford W. Long, removed a tumor from his patient James Vernable in 1842 “using sulfuric ether as an anesthesia” (Ojanuga 1993). He was regarded as the “first doctor to perform a surgical operation in which a patient suffered no pain” (Ojanuga 1993). This revelation occurred prior to Sims’ experimentation, displaying how methods of anesthesia had been established, but Sims intentionally chose the absence of anesthesia because he disregarded black women’s pain, and the disregarding of black women’s pain is still a prevalent situation today. Additionally, the idea that anesthetics and consent were not the “order of the day”, due to the time period being that of slave-holding society, is not entirely true. There are multiple medical discoveries that were made during this time that did not include the use of slaves and included the idea of consent. In fact, it was rare to use enslaved individuals in the experimental medical context as they most often “worked as field-hands and household servants, but they were seldom used as experimental subjects” (Ojanuga 1993). What Sims had done was not only abusive towards the enslaved women, but was also unusual and not commonly performed. He chose this option because he had little to no respect for the enslaved black women, which is also seen in the lack of consent within his experimentation. Consent was also an established idea during that time, that Sims’ blatantly ignored. For example, a physician named Ephraim McDowell, who was alive during Sims’ time, was the first successful individual to perform a successful abdominal operation. In his experiment, McDowell “removed a 22-pound ovarian tumor from Jane Todd Crawford” (Ojanuga 1993). Mrs. Crawford was a white woman who had “given her informed consent for the experiment”. According to Agatha Young, “he had called the operation an experiment, nothing more…and that she was more than likely to die while the experiment was in progress, but Jane was brave; she accepted” (Ojanuga 1993). Jane was clearly told what to expect and consensually agreed to participate in the operation. There was no evidence of Sims asking for the consent of the women to participate in the operations, he did so without informing them of what would occur and with complete and total disregard for their pain as not only would Sims make his patients suffer through his invasive procedures, but he would then tell “his enslaved patients they must now work as his assistants”, with essentially no credit given to them in his publications (Bock par.11). When Sims did acknowledge his team of enslaved women, they were described as both smart and dignified, however, Sims staff and patients were depicted as white. This is as Cooper Owens described, an erasure of the black experience that occurred “visually and historically” (Bock par. 12 and 13). Unfortunately, the erasure of such experiences allows racism to prevail in medicine to this day. This racial prejudice is what the modern obstetrics and gynecology field was founded upon, and the effects of misinformation and implicit bias are still prevalent in the experiences of black women in modern society. Although there is a prevalent amount of information and evidence detailing how Sims severely mistreated enslaved black women, there are still texts and people who hold Sims in high regard because of his discoveries, despite the unethical ways he went about obtaining his results. Modern Statistics: Today we see the “legacy” of Dr. Marion Sims in the mistreatment and silencing of black women in regard to their healthcare in terms of quality and representation. As recently as 2016, there have been reports of medical students and residents holding “unfounded and deeply mistaken beliefs about blood of black and white patients coagulating at different rates, skin of black patients being thicker than skin of white patients, and African Americans having lower sensitivity to pain” (Wailoo, par. 15). The learned implicit bias of future healthcare workers can have profound impacts on the way that they practice medicine in the future, further inducing a healthcare environment that is anything but inclusive. Many healthcare education systems do not have the educators, courses, or materials needed to properly inform them on the racial disparities within healthcare today, and how to work to lessen the divide. An example of this within the gynecological practice is the disregard of consent when completing medical training. Medical students participating in obstetrics-gynecology clerkships are not taught the moral lesson of informed consent, and it is not required as they perform “nonconsensual pelvic examinations at the start of their training” (Friesen). It has been stated that “students who have completed obstetrics-gynecology clerkships place significantly less importance on seeking permission from women who are to be anesthetized before performing pelvic examinations” (Friesen). Students are taught to disregard consent for pelvic examinations, and as a result, are more likely to implement a lack of consent within their own practices as physicians. This parallels Sims and his experimentation on enslaved black women. Sims too felt as though he did not need the informed consent of the women because he believed he had performed the surgeries on them for the advancement of medicine and educational purposes, similar to what the medical students today do. Informed consent is vital and should be taught to all healthcare professionals. Women’s bodies are not test subjects to be used, and this fact needs to be made clear to prevent nonconsensual examinations from continuing to be done on women and improve the healthcare women, especially African-Americans, receive. Again, studies have shown repeatedly proven time and time again that the quality of healthcare that black women receive is substandard at best. This is particularly present in the maternal mortality rates of black women in comparison to any other race. In 2005, a shocking study showed that out of 100,000 live births, 39.2 non-Hispanic black women died in childbirth, this compared to the 11.7 white women, is outrageously high (Bryant et al. Table 1). When trying to find a medical reason for this unfathomable gap in mortality rates, studies then “found that black women in the national sample did not have higher prevalence of preeclampsia/eclampsia, postpartum hemorrhage, placenta previa, or placental abruption, but for all 5 conditions, black women had case-fatality rate 2.4-3.3 times higher than that of white women” (Bryant et al. 338). This shows that the root of the issue is in the quality of care that black women are receiving, rather than a predisposition to common lethal conditions. A response to this issue by Dr. Camille Clare explains this phenomenon is “not because of biological differences but because of structural racism” (Clare par 1). Outside of just mortality rates, black women are less likely to be taken seriously in any context of medicine and their requests for treatment are often brushed aside by medical professionals. Studies on frequency of pain management through the distribution of both inpatient and discharge Opioid prescriptions clearly highlight this lack of consideration for black women’s pain. It was found that “non-Hispanic white women were significantly less likely to report a pain score at discharge of 5 or higher than both Hispanic and non-Hispanic black women. Yet non-Hispanic white women received significantly greater MMEs/d [oral morphine milligram equivalents] as inpatients than Hispanic and non-Hispanic black women (par. 11). The study’s conclusion: “Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain” (Badreldin et al., abstract).This clear racial bias in the validation of pain complaints only adds to the mistrust that black women have in the medical industry. Statistics have shown that the distrust in healthcare often leads to delayed entry into prenatal care, as late as after the completion of the first trimester (Bryant et al., Table 1). Not only does this put both the mother and baby more at risk for danger during delivery, but it leads to further underdiagnosed conditions and less effective treatment for many women. Perceived Racism and Testimonies: There are significant racial and ethnic disparities within the United States’ health care system, specifically against African Americans. Racial and ethnic disparities in healthcare are often described as differences in the quality of care received by particular groups who have similar health insurance and the same access to a doctor when there are no differences between these groups in their preferences and needs for treatment. This is present within every healthcare field, especially in the gynecological practice. This is an unfortunate result due to the racist history of the United States and the racial bias against black women, originating from physicians such as Marion Sims. As a result, black women have had to suffer with inadequate healthcare, their pain being ignored and their fears going unacknowledged. This idea was displayed articulately in a quote by Vanessa Cristina dos Santos Saraiva, who stated that “when addressing the situation of Black women, one cannot disregard the historical violence and sexual abuse, work exploitation and denial of the right of life, evidenced in the denied or non-assistance is accessing public services, especially health services, in primary, secondary, or tertiary care” (Saraiva). The continued implicit racism held by medical professionals and the systematic racism that is deeply integrated within the United States leads to decreased health equity and equality of black women, and this is seen through their stories. An example of this is a study that was conducted asking various American black women, between the ages of 18 to 45, in surrounding metropolitan areas, Boston, Atlanta, and Chicago, about their experiences with the reproductive healthcare system. The results display how the reproductive healthcare system has failed a vast amount of black women in getting the care they both need and deserve and how many medical professionals are not able to provide the care they vitally need. As seen in the jarring statistics and disparities, black women are at a disadvantage in terms of reproductive outcomes and risks. This is widely recognized, and one woman, regarded as participant 20, within the study discussed this saying “It just frightens me a little bit to one, think about actually going through labor, but then, also, do I have to write my will within that timeframe of being nine months pregnant, or within that year postpartum?” (Trader). She is right, labor is already an extremely nerve-wracking occurrence, and women deserve to know that their health is regarded and protected and should have trust in their medical providers. Knowing that one is at higher risk of mortality and complications just because of the color of their skin can cause a large amount of stress and anxiety, which is noted when that same participant continues to say “I don’t think people understand the type of stress that comes with knowing so much about what’s going on in the Black community” (Trader). Another participant displayed similar anxious thoughts saying “We saw the news that black women are more likely to die, and now I’m scared to get pregnant” (Trader). The mortality and morbidity rates surrounding childbirth for black women cause such anxiety that it prevents some women, as seen, from wanting to get pregnant. Every woman deserves to have the choice of if they want to bring new life into the world, and the reproductive healthcare system is failing black women daily, by allowing these justified thoughts to run through their heads. Black women are also more susceptible to not having their news acknowledged or heard when speaking with a healthcare professional. Again, medical professionals in the past repeatedly disregarded black women’s pain, creating fallacies that they are not susceptible to pain or imagining false biological bases for pain differences between races and ethnicities. This is still a prevalent idea today and is seen in the testimonies of black women’s voices being silenced. An example of this is seen in the testimonial of Dineo Khabele, an obstetrician-gynecologist herself, who had a jarring delivery experience. When going to the hospital to give birth to her child she regarded the feeling she and her husband felt entering the hospital, saying “My husband and I, a black couple with a Harlem address, were admitted to the hospital with indifference” (Khabele et al., sec. 1). She later goes on to describe her labor process saying “I tried to ask for an epidural, but my labor pains were openly mocked. It is hard to describe how humiliating it is to be dismissed when vulnerable…all I remember is wanting to be heard” (Khabele et al., sec. 1). This horrific experience Khabele underwent aligns very similarly to the experiences of the enslaved black women Marion Sims experimented on. Almost 200 years later, black women’s voices are still being ignored, having to endure feelings of humiliation and vulnerability, and their pain is still not being taken seriously. This is seen again in the testimony of Linda D. Bradley, a black physician, who came to the hospital as a victim of sexual assault, a time of such vulnerability and pain, and treated horrendously by medical professionals. She described how the chief resident of the hospital was impatient with her asking her to “open her legs now” and proceeded to try and open them himself. “Her tears meant nothing to him. He did not acknowledge her pain and fear, he did not say that he felt sorry for what had happened to her” (Khabele et al. sec. 1). Once again, a repetition of history is occurring, the same cycle. Black women’s fears and pains go unacknowledged just as the enslaved women’s feelings had, there has been little to no change in how black women are seen in the healthcare industry. As the gynecological statistics continue to rise and more and more black women continue to tell their tragic stories, mistrust within the healthcare industry continues to fester in the black community. With black women, referring back to the study, stating that they “felt like the approach of the healthcare professionals was dismissive or passive…they wondered whether racism was at play and it contributed to their mistrust in reproductive healthcare” (Trader). Black women in America have every right to be guarded and hold mistrust in the reproductive health care field, as history has shown and simply turning on the news channel today as well, that their needs will continue to go unrecognized and untreated until a significant difference is made. Future Avenues of Research: The health humanities aspect of medicine, particularly the connection between the racist history of the practice of gynecology and the impacts it has on modern healthcare, is extremely under-researched and deserves more recognition. In order to work towards building a better healthcare system that serves all communities within the United States equally and respectfully, awareness of the issues needs to be brought to attention and actions need to be taken. An excellent example of this is the Baldreldin study, which found that while Hispanic women, non-Hispanic white women, and black women do not differ in perceived pain, black women experience disparities by being underdiagnosed and receiving fewer pain management medications when postpartum. This study worked to reduce racial disparities black women receive in the postpartum setting by uncovering how implicit racial bias contributed to reduced pain management medications and bringing awareness to it. Additionally, another study that is working to reduce healthcare disparities experienced by black women was the Trader study, which interviewed multiple black women in metropolitan areas on their reproductive healthcare experiences. Their study displayed the deep mistrust and reluctance many black women hold against the medical community due to the lack of listening and undermining done by medical professionals and bringing awareness to how black women today feel regarding their gynecological health. For future research, we hope to advance theirs and our own research by looking into multiple aspects of women’s healthcare, such as pain management and IUD insertions, to continue this conversation and bring awareness to the growing disparities that occur within women’s healthcare, and discover new ways to make sure women in the United States needs are met and heard. Section 2: Disparities in Diagnosis, Treatment, and Pain Management Relating to Endometriosis with Consideration of Racial Implications Authors’ Notes: Chronic pelvic conditions run in my family, my sister was diagnosed with endometriosis at 14 and my mother suffered from severe uterine fibroids before she was forced to get a hysterectomy. I remember before her surgery, she would go to her doctor and tell him about her pain instead of taking it seriously, he told her she needed to lose weight and that would get rid of the problem. It was then that I realized that many male doctors are not taught to understand women’s health issues. One ultrasound told my mother that she had fibroids in her uterus, but her doctor did not consider this as an option. She told me when she finally went to a female doctor, she felt like her concerns were finally heard and she was finally able to take action with treatment. The story of my mother and so many other women is what inspires me to do this type of research. Women’s health is something that has been deprioritized in the medical field and that is something that I intend to change as a future health care professional. To be completely honest I was unaware of the true extent of the part race plays in the unequal treatment of women in healthcare until I met my research partner Michelle. She opened my eyes to a whole other set of issues: not only are women overall under prioritized in medicine, but women of color receive extreme mistreatment in healthcare. Michelle’s passion for women’s health only fueled mine more and together we were able to come up with an approach to research that addressed the mistreatment of women of color in healthcare as well as the overall silencing and undermining of women’s pain. Through our research, we hope to inspire a new generation of healthcare professionals who take into consideration the patient as a whole and not just a page out of a medical textbook. —Zoë Allyn (Co-Author) In late 2020, as the world grappled with the challenges of the pandemic, I settled in front of my laptop, eager to indulge in my go-to pandemic binge-watch. However, my viewing experience took an unexpected turn when it was interrupted by a poignant political ad. The United States was in the midst of a heated political season, and the ad's narration brought to light a distressing and undeniable fact: the alarmingly high maternal mortality rate among black women in the country. Intrigued and concerned, I immediately turned to Google to verify this shocking statistic. To my dismay, it was indeed accurate. As a black woman myself, I was deeply unsettled by this revelation. It was disheartening to think that in modern society, such a critical issue remained unaddressed by the medical community. This revelation sparked a fire within me and drove me to dive deeper into the disparities in medical care that people of color face. I uncovered a disheartening array of discrepancies and disparities that have persisted for far too long. It became abundantly clear to me that one effective way to begin addressing these issues was through greater representation in the medical community as well as spreading awareness about these undeniable issues. I firmly believe that the lack of diversity in the healthcare field may contribute to the inadequate care experienced by black women and children. As someone who is passionate about improving healthcare access and outcomes for minorities, this realization was a profound turning point in my life. It ignited a desire within me to pursue a career in the medical field, one where I could actively work toward dismantling these barriers and disparities. Through conducting research within the health humanities department alongside my partner, Zoë Allyn, I believe we are both actively working to reduce the disparities seen within women’s healthcare. Our unique experiences have allowed us to come together as a team and produce important work that will serve the healthcare community as a whole. As two aspiring healthcare professionals, we want to be best equipped to care for our patients and have their needs met, their thoughts heard, and their feelings validated, and producing work such as this paper prepares us to do so while also spreading awareness to vital issues, such as endometriosis treatment, diagnosis, and pain management. —Michelle Onafowokan (Co-Author) Abstract: The main focus of this paper was to analyze the disparities seen in the diagnosis, treatment, and pain management regarding endometriosis within the United States, considering the racial biases and prejudice that may exist within the treatment of this disease. Endometriosis is a condition in which the tissue that makes up the uterine lining of a woman’s uterus is found outside of the uterus. As a result of the condition, women suffer from a variety of symptoms, such as extremely painful periods, pain during sex, infertility, severe pelvic pain, and stomach issues. Endometriosis affects approximately 11% of women within the United States, however, this statistic may be larger than perceived. Endometriosis takes a significant amount of time to be identified, with the average diagnosis period ranging from four to eleven years. This research paper explores the delay in the diagnosis of endometriosis and the social, racial, and economic factors that impact the diagnosis time. Additionally, both prior to and even after diagnosis, women who suffer from endometriosis and who are exhibiting extreme symptoms of pain do not receive the care and pain management needed. With many of their concerns and questions being downplayed or simply ignored by healthcare professionals. This paper aims to uncover why the treatment and pain management surrounding endometriosis are not prioritized and why American women, particularly women of color, are not provided with the healthcare they so desperately need to alleviate their pain. Our collective findings have found that perceived racism and sexism play a large role in the diagnosis, treatment, and pain management of endometriosis seen in the United States today. This work is significant as it works to spread awareness on endometriosis issues and promote change within the healthcare system and the diagnosis, treatment, and pain management of this condition so that women across the United States are empowered and can have their concerns taken seriously, and their pain regarded and treated properly. Clinical Exploration: Historically, endometriosis has been under researched and the little research that has been conducted has been largely under representative of women of color. In the early 19th century, the most prevalent theory was Sampson’s theory of retrograde menstruation, that is, the backwards flow of menstrual blood towards the pelvic cavity rather than exiting the body through the vaginal canal (Amso & Banerjee) His theory essentially hypothesized that endometrial cells from retrograde menstruation attach to the surface of the pelvic cavity where they proliferate and invade the tissues leading to the manifestation of endometriosis (Amso & Banerjee). Although this theory had not been proven with in vivo evidence, it still prevailed and was added to by Brosen who theorized that women with endometriosis may have both a greater progeny of fibroblasts, tissue building cells, as well as a greater tendency for adherence to tissue surfaces (Amso & Banerjee). During this time, it was a prevalent belief that endometriosis was a disease of “white-middle class women who had put off child-bearing” and due to the racist assumption that “women of color were less civilized than their white counterparts and therefore less susceptible to the stress of modern life” (Bougie). This theory of persistent retrograde menstruation along with the exclusion of women of color from prominent medical research only fueled this untrue notion. One study performed in New York in 1951, “declared that endometriosis was almost non-existent among their African-American charity patients” (Bougie). This was obviously untrue and Donald L. Chatman, an African American Gynecologist, discovered that “1 in 5 of his private African-American patients demonstrated laparoscopic evidence of endometriosis but that 40% of these women had been wrongly diagnosed with pelvic inflammatory disease” (Bougie). It was the common beliefs at the time that led to the misdiagnosis and undertreatment of so many black women. Eventually, retrograde menstruation as the main causation factor of endometriosis was later disproved by David Redwine who in 1988, “demonstrated endometriosis in the posterior cul-de-sac of an infant who died of sudden infant death syndrome” (Amso & Banerjee), this vital discovery, which was demonstrated by several others at the time, proved that endometriosis could exist prior to the onset of menstruation, essentially eliminating menstruation as being the cause of endometriosis. The replacing theory was concerning the embryonic origins of endometriosis. The endometrium is a tissue of mesodermal origins, a germ layer from which the musculoskeletal system and connective tissues derive from. As this tissue is derived from the mesoderm, its ectopic expression must be due to a mesodermal abnormality which is ultimately controlled by genetic factors (Amso & Banerjee,). This could potentially be an explanation for the endometrial tissue’s appearance throughout the body not just outside the pelvic cavity, as it is a tissue derived from the mesoderm, it can therefore manifest anywhere there is a tissue also of mesoderm origin (Amso & Banerjee). Although David Redwine paved the way for criticism against the common beliefs surrounding endometriosis, underrepresentation in research led to the continuation of untrue conclusions about women of color’s experience of endometriosis. Today, we characterize endometriosis by “the growth of endometrial-like tissue outside of the uterus” and it has shown to be a “progressive disease, with periods of regression” (As-Sanie et al.). There is still not a concrete understanding of what the underlying cause of endometriosis is and the current ‘gold-standard’ diagnosis technique is exploratory laparoscopic surgery. The lack of understanding of endometriosis in the medical field as well as the invasiveness of the diagnostic procedure leads to the delayed and misdiagnosis in many women. Studies show that “on average, women experience a delay of 7-12 years from the onset of pain symptoms to surgical diagnosis”(As-Sanie et al.). This is in part due to the normalization of women’s pain especially when it is related to their menstrual cycles. Doctors often are hesitant to believe the severity of a woman’s pain and “on average, women see their primary care physician 7 times before referral to a specialist” (Giglio-Ayers et al.). Even if a doctor is willing to take women’s menstrual pain seriously, there are no standardized screening questions for them to evaluate pelvic pain to aid in earlier diagnosis (As-Sanie et al.). It was even found through surveys of general health care providers that “half could not name 3 of the main symptoms of endometriosis” and half also “believed that earlier diagnosis of endometriosis cannot prevent the course of disease because there is no effective treatment” (As-Sanie et al.). Doctors are giving up hope on the diagnosis of endometriosis because they believe there is nothing they can do to help it. The options for treatments are incredibly limited, the first being non-steroidal anti-inflammatory drugs (NSAIDS) which have been shown to be insufficient in pain relief for women with endometriosis (Agarwal et al.). The second option for treatment is hormone therapy and androgenic steroids, if these are not effective, the only other course of action is hysterectomy which is devastating to any woman especially those who are trying to conceive (As-Sanie et al.). Even a hysterectomy which is the most radical medical intervention for endometriosis, has not been shown to fully eradicate endometriosis symptoms. In patients who underwent hysterectomy without oophorectomy (ovary removal), “7.3 underwent reoperation within 2 years because of recurrence of pelvic pain, and 21.6% underwent reoperation within 7 years” (As-Sanie et al.). Although there is still much work to be done regarding the treatment options for endometriosis, the treatments do provide some temporary relief of symptoms. However, the distribution of the treatments across all races has shown to be unequal. Studies found that “Hispanic and non-Hispanic Black women had lower odds of endometriosis diagnosis than non-Hispanic White women” (Giglio-Ayers et al.). This is not necessarily because the condition is more prevalent in white women, but rather the disparities within healthcare which limit the diagnosis of people of color. It has been proven that there is no “biological plausibility” for the difference in diagnosis of endometriosis across races and therefore the issue is systemically driven (Giglio-Ayers et al.). Unfortunately, the rates of intervention are not much better, studies show that “White, Asian, Native American, and patients of other races underwent intervention more frequently than Black and Hispanic patients” (Hung et al.). Exponential costs of health management, which are shown to be “more than 3 times higher for women with endometriosis compared with patients without endometriosis, even 5 years before and 5 years after diagnosis”, further contribute to the access of treatment for many women (As-Sanie et al.). Studies show that “patients with medicaid and private insurance underwent intervention more frequently than patients with Medicare, who were self pay or no charge” (Hung et al.). Overall the treatment of women with endometriosis has been lacking at best especially in women of marginalized groups. Endometriosis Testimonies: Endometriosis is a condition that affects women around the globe, with 11% of women in the United States suffering from the disease. Within this statistic and this condition, there are a multitude of disparities witnessed within the diagnosis as well as treatment of the disease. When examining patient testimonies on their endometriosis experience and the struggles they have endured, there were several commonly held themes between these women across the United States, highlighting the disparities within the gynecological field of healthcare within the United States. The continued implicit racism, sexism, and even ageism within the gynecological field of healthcare have allowed women, especially women of color, to suffer through a condition without getting the efficient care needed for a long duration of time, and this is seen through their stories. A common theme seen within patient testimonies is the continued dismissal of their pain, starting from a young age. Endometriosis is a condition that affects women of reproductive age, which can begin as early as fifteen years old, however, symptoms of endometriosis can present once a woman gets her period, which can happen as early as nine years old. Many women approached healthcare professionals with concerns regarding their extremely painful periods, to experience immediate dismissal. That is present in Hallie Fischer’s endometriosis story, with Fischer being a teenager having to stand up for herself to get the healthcare she needed. Fischer describes how she began to experience symptoms of endometriosis in fifth grade, which entailed “heavy periods and pain” (Croyle) as well as “extreme nausea that caused significant weight loss, and pain in her right side that put her in the ER four times” (Croyle). With extreme symptoms such as this, Hallie, like many other women, reached out to medical professionals, especially since Hallie’s mother had endometriosis, making her well aware of the symptoms she was suffering from. However, when reaching out to healthcare professionals whom she is meant to trust, she was continually dismissed, with comments such as saying she “was too young to have endo or that a lot of young girls have these issues with their cycle” (Croyle). This example details the disparities seen in endometriosis diagnosis; despite having extreme symptoms and even a mother who suffers from the condition, healthcare professionals do not take patients' concerns seriously and instead offer remarks that dismiss the patients' concerns. Hallie highlighted this as well, stating that she “had doctors who just wanted to fix the symptoms, and not the problem” (Croyle). This example of dismissal is present in a variety of endometriosis testimonies, with patients exhibiting symptoms from a young age and their issues being ignored is a prevalent recurring theme. A similar occurrence was present in Trenasia Brownfieldd’s endometriosis story, as Brownfield had “heavy and painful periods beginning at 14” (ENDOFOUND) and how her “OBGYN didn’t think anything of it, she said it would all fix itself and the pain would go away” (ENDOFOUND). The continued dismissal by medical providers with extreme menstrual cycle pain plays a significant role in the long diagnosis times for endometriosis. Patients are exhibiting symptoms at an early age and being told that what they are experiencing is “normal” when it is not. Patient Alexa Reilly described her endometriosis pain as a “feeling of lava, it felt like daggers had emerged in my uterus and were repeatedly stabbing my cervix” (ENDOFOUND). The description of these symptoms displays that this is abnormal and extreme pain, however, when Reilly reached out to medical providers, she was often told she could “just take ibuprofen” (ENDOFOUND). Then, Reilly stated that “when I thought these issues were significant enough to mention to a doctor, the doctor typically confirmed that periods are just weird, and I shouldn’t worry” (ENDOFOUND). The continued dismissal of patient concerns and the normalization of extreme menstrual pain contributes to the pain management issue of this condition as well, as women are made to feel as though they are being overdramatic when, in reality, they are suffering from a severe condition, unable to get the treatment they need. Another common theme displayed among patients is these feelings of guilt, shame, and anger as a result of the continued dismissal of their gynecological health. When a patient expresses their concerns to a healthcare professional, and they are dismissed, it makes the patient feel as though what they are experiencing is normal and that they should not be concerned. With a condition such as endometriosis, whose primary method of diagnosis is exploratory surgery, numerous women felt as though they were not suffering from the condition and their pain was normal due to medical providers telling them so. This created an environment for feelings such as guilt and shame to arise due to women being made to feel their concerns were not valid when they clearly were. Reilly described how she felt, stating, “I felt overwhelmed by the heat of anger at my feeling that doctors and other healthcare providers didn’t believe me” (ENDOFOUND). Also describes her feelings of shame, stating, “I felt shame at having a healthcare team perform surgery only to possibly find out that nothing was wrong at all” (ENDOFOUND). Patients should not be made to feel that having their concerns looked at or checked out is an issue; it is a healthcare professional's job to note the symptoms a patient is experiencing and come up with a method to treat the issue head-on. Reilly later discussed how she came to a realization, saying that “regardless of how the laparoscopy had gone, the pain I was feeling had not been fake, however, the relief was sometimes interrupted by an anger that became much clearer after the surgery than before…if all of that was really inside me, why had I been made to feel like my pain might not even be real on so many different occasions?” (ENDOFOUND). Healthcare professionals need to be listening and advocating for their patients, and considering endometriosis as a diagnosis when patients come in exhibiting the symptoms that align with the condition. The continuous invalidation of the patient’s feelings is what causes the diagnosis time to be as long as it is, as well as contributing to the minimal treatment and pain management offered. Women’s pain has continuously been ignored in the United States and needs to be remedied immediately. An additional prevalent theme observed when examining patient testimonies is the advocacy of the patients and the formation of support groups. Due to the repeat invalidation multiple women within the United States face concerning this condition, with the average woman seeing four to five doctors before receiving their diagnosis, women have had to resort to other methods in order to be taken seriously. Fischer discussed how she turned to online communities and supported other women suffering from the condition, telling women to “keep advocating for themselves until they receive the help they need…what they are feeling isn’t normal, even though so many people tell us it is” (ENDOFOUND). Online communities, such as the Endometriosis Foundation of America, where these testimonies originated, allow women to find solace and connect with one another over their struggle with the condition and promote the advocation of their rights and needs with healthcare professionals. Patient Reilly discussed how she had to detail her symptoms in a very specific manner in order to be taken seriously, with bullet points detailing the amount of suffering she was in. Reilly said, “I carefully recorded the number of super-plus tampons I bled through each day of my period, how many times I had diarrhea…I traced a little silhouette of a person I found online and with red colored pencil, colored every part of my body that had been enveloped by the lava pain” (ENDOFOUND). Patients, such as Reilly, had to work to convince providers that they were suffering from an abnormal condition, which is not how the healthcare system should operate. Patients should not have to resort to extreme detailing of symptoms and hope to be taken seriously, which Reilly also expressed stating, “I was afraid of not being listened to, being interrupted, or being misunderstood, I saw this piece of paper as a possible solution” (ENDOFOUND). This fear of being dismissed, ignored, and invalidated is cultivated through experiences of lack of listening from medical providers and is a culture that needs to be dismantled. Women who are exhibiting endometriosis symptoms originating from the age of their period should be taken seriously immediately. Pain should not be ignored, downplayed or invalidated by medical professionals and should be examined and treated responsibly and effectively. Medical professionals have a duty to serve their patients, and endometriosis patients are not being served or heard, and awareness needs to be brought to this fact. In order for effective change to occur, for the endometriosis diagnosis time to be reduced, and for their treatment and pain management options to be effective, medical professionals need to listen and advocate for their patients, and this starts with being aware of the issue. Future Avenues of Research: We believe that the health humanities aspect of medicine is an under-researched and under-recognized but extremely important field that deserves more recognition. In order to work towards building a better healthcare system, specifically one that is attentive to the needs of women and their gynecological care, regardless of socioeconomic status, race, or age, it is vital to raise awareness on these issues that are so ingrained within our healthcare system today. In the future, we hope to advance our own research and contribute to the continued conversation of endometriosis diagnosis, treatment, and pain management while also examining other gynecological care disparities such as IUD insertions and maternal mortality. In continuing our research, We hope to advance the field of health humanities research and continue to advocate for women and their gynecological care so that every woman across the United States can feel confident walking into an appointment, knowing their needs will be met, their feelings validated, and their voices heard. Resources Section 1: Armstrong, Penny. “1852: J. Marion Sims Perfects a Repair for Vesicovaginal Fistula.” Journal of Midwifery & Women’s Health, vol. 50, no. 4, 2005, pp. 295–295, https://doi.org/10.1016/j.jmwh.2005.03.007 . Badreldin, Nevert, et al. “Racial Disparities in Postpartum Pain Management.” Obstetrics and Gynecology (New York. 1953), vol. 134, no. 6, 2019, pp. 1147–53, https://doi.org/10.1097/AOG.0000000000003561 . Bock, Eric. “Reproductive Medicine Advances Linked to Slavery .” National Institutes of Health , U.S. Department of Health and Social Services , 1 Apr. 2022. 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Meet The Researchers Kayla Valentine Kayla Valentine is a current Senior at the University of Pittsburgh, and will be graduating in the spring of 2021 with degrees in English literature and public & professional writing with a scientific concentration, as well as a studio arts minor. Her research interests include humanitarian studies, medicine, the patient narrative, and the language of medicine. In her free time, Kayla enjoys writing, reading science fiction and mystery novels, mothering a tortoise and crested gecko, and spending time with her loved ones. View Research Maya Albanowski Maya Albanowski is a 2022 graduate of the University of Pittsburgh with a BS in microbiology and BPhil fiction writing. Her research interests include narrative medicine, medical history, and gender and women's studies. Maya will be attending University of Pittsburgh School of Medicine after graduation. In her free time, Maya enjoys writing and reading fiction, listening to music, spending time with her friends, and playing with her two dogs and her cat. View Research Abigail Buckley Abigail Buckley is graduating from the University of Pittsburgh in December 2020 with a Biological Sciences major, Chemistry and English Literature minors, and the Conceptual Foundations in Medicine Certificate. She will be attending medical school next fall. Her research interests include translational sciences research, narrative medicine, and minority and women's historical studies. In her free time, Abby enjoys reading, knitting, doing yoga, hanging out with her family, and having dance parties. View Research Anjalika Chalamgari Anjalika Chalamgari is a current sophomore at the University of Pittsburgh, majoring in History and Philosophy of Science with minors in Neuroscience, Chemistry, and Creative Writing. In addition to her work with Professor Satyavolu, Anjalika is a student leader for Pitt's Resident Student Association and conducts psychological oncology research in Dr. Jennifer Steel's lab. She is also an avid fencer and enjoys watching old movies! Anjalika hopes to attend medical school after graduating. View Research Devesh Malik Devesh Malik is an honors student at the University of Pittsburgh, majoring in Biological Sciences with minors in Sociology and Chemistry and a Certificate in the Conceptual Foundations of Medicine. Devesh is a student ambassador for the university through the Blue & Gold Society, where he served as the Vice President of Internal Affairs for the 2020-2021 academic year. He also conducts clinical research at UPMC Children's Hospital studying the relationship between genetics and pediatric acute encephalitis with Dr. Kate Kernan. Devesh enjoys reading sci-fi novels, playing the guitar, and listening to music or interesting podcasts in his free time. He plans to graduate from Pitt in December 2021, and hopes to attend medical school the following year. Project: The Evolution of the Physician-Patient Relationship View Research Siddhi Shockey Siddhi Shockey graduated from the University of Pittsburgh in the Spring of 2021. She received her Bachelors degree in English Writing with a concentration in Nonfiction along with a minor in Chemistry and certificate in Conceptual Foundations of Medicine. Currently, she is working as a Health Care Assistant at Planned Parenthood while she applies to medical school. In her free time, Siddhi likes to read, knit, crochet, and bike around Pittsburgh while listening to her favorite podcast, You're Wrong About. Project: Health Inequities: Gender, Race, and Incarceration in the U.S. View Research Aliana Rao Aliana Rao is a current senior at the University of Pittsburgh graduating in spring of 2022 with an honors degree in neuroscience with minors in religious studies and chemistry. Her research interests include the history and intersectionality of medicine and religion. Aliana hopes to attend medical school after graduation. In her free time, Aliana enjoys reading, working out and using her Peloton, and baking, and spending time with her friends. View Research Rachel Bittner Rachel Bittner is a current junior at the University of Pittsburgh studying Neuroscience and English Literature with minors in Chemistry and Creative Writing. Her fellowship explored the various psychoanalytic theories of the literary fairy tale and presented an atlas of works describing their relevance within psychotherapy. Rachel hopes to attend medical school after graduation. In her free time, Rachel enjoys needle felting, reading (namely Victorian literature and contemporary fantasy), writing, and taking care of her numerous plant babies. View Research Anju Zhang Anju Zhang is a first year pre-pharmacy student at the University of Pittsburgh. His research hopes to document and preserve the changing views on trans history in the western world., as well as increase available resources to the LGBT+ community. Anju enjoys listening to music, working out, and cooking and eating copious amounts of food in his free time. Project: The History of Trans Medicine View Research Harmony Arungwa Harmony Arungwa is a current Junior at the University of Pittsburgh pursuing a English Writing major, Chemistry and French minors, and the Conceptual Foundations in Medicine Certificate. Her research interests include interdisciplinary studies, medical language, and healthcare bias. In her free time, Harmony enjoys fiction writing, reading, exercise, and creating artwork. She hopes to attend medical school after graduation in 2024. View Research Sachit Anand Sachit Anand is an incoming honors sophomore at the University of Pittsburgh pursuing Neuroscience and Computer Science majors on the pre-med track. He is a Brackenridge Fellowship recipient, New Student Ambassador, Lambda Sigma and Phi Eta Sigma member, and a graduate of Panther Leadership Academy. He has always been fascinated by the intricacies of the brain, especially its intelligence, and spends hours reading anatomy texts and memoirs of neurosurgeons. He is captivated by the recent advances in Artificial Intelligence and Cognitive Computing and the different ways that these technologies are assisting in transforming our understanding of human brain functions. His research explored the ethical constraints behind using Artificial Intelligence solutions in healthcare. Sachit enjoys listening to music, jogging, and playing piano and guitar in his free time. He also likes to play soccer and tennis and enjoys watching Real Madrid, and Roger Federer matches. He likes programming Python and Java, evaluating data, analyzing information, and applying analytical and mathematical tools. Project: Ethical Challenges to Positioning Artificial Intelligence in Healthcare View Research

Valuing the Patient-Physician Lexicon Purpose The patient-physician relationship determines patient outcomes. It’s an aspect of medicine that has been highly studied and patient-focused healthcare strategies have risen over the last few decades. Effective communication between a patient and a doctor will decide a patient’s quality of care. Howbeit, throughout my studies, literature on doctor lexicons highlight medical terminology or speech patterns rather than causal language. The actual words spoken are neglected. I moved my research goal from performing lexical analyses on dialogues I’ve gathered to justifying the need for examining word choice because of the sparsity of information on the topic. My research investigates how important vocabulary—each and every word spoken to a patient—may be to improving communication. Approach I had strict criteria for the literature I selected. As any linguist would agree, if studying word-choice, the language from which terms are selected from must also be defined. Including languages other than English—already somewhat incorporated as English is a bit a bully language, beating other dialectics up in alleyways—would require separate etymological studies and extensive research about culture and sociology from the nations most associated with said languages. That was beyond the scale of my current abilities, especially within a single semester. Furthermore, variants of English weren’t included for similar reasons. That unfortunately eliminated many interesting papers from my preliminary dataset. Additionally, I insisted on only studying the doctor-patient relationship because of stark differences in how doctors are trained versus other highly skilled medical workers. Doctors also have a unique social status in the U.S., which would affect the relationship between them and their patients, thus impacting the way the two groups speak to each other again. Early in the research, I “banned” any sources without at least a few direct quotes from doctors in conversation with patient as I intended to perform my analyses this semester. Once I shifted my goals, I incorporated material that directly referenced on that type of dialogue and/or would build a case for the importance of lexical research in medicine. Researchers dealing with jargon were excluded because I was interested in how conversation went. I found that most words in dialogues largely excluded technical terminology, even more so following decades of patient-centered practices advising clarity. My approach made finding information about medical language in relation to word-choice difficult. I ended up looking primarily for guides before moving onto books and published papers. My common search terms included but are not limited to: “patient outcomes doctor patient relationship,” “patient-doctor dialogues,” “physician-patient dialogues studies,” and “lexical analyses doctor patient.” Below, I have collected and recorded 39 sources. All are listed in the archives with respective hyperlinks. Main Texts The four books below were the primary sources in research. Each contains at least one strong association with my source evaluation criteria and are mentioned in relation to each other as well as other relevant literature. Sarah Manguso: The Two Kinds of Decay Manguso’s experience with medicine is painful, like many other patients. That makes her story, the honesty she’s barred to the world—to medical professionals willing to listen—important. After collapsing on her Harvard campus, Manguso was diagnosed with a rare autoimmune disorder that dissipated her cells, threatening to not only kill her but the person she wanted to become. Her book details how long-term patients view medicine and their memorable relationships with physicians. Manguso remembers years of inaccurate diagnoses before one neurologist landed on Idiopathic demyelinating polyradiculoneuropathy, a rare form of Guillian-Barre syndrome. She remembers her first central line, “My hematologist might have thought I’d wanted my parents there to help me feel less fearful, but I didn’t know enough about the procedure to feel fearful” (37). Her doctor informed her about the science behind the procedure but not that “some would be standing over me, massaging my collarbone, while I lay blindfolded…the doctor flubbed the procedure…he tried again and again to jam the tube into my vein… At one point I thought I felt a jet of blood spurt into my chest cavity, and that’s when I lost my composure. Months later, after his hair had gone from steel gray to white, my father told me it had looked like a horror movie” (37-8). Manguso’s trauma largely centers around the doctors around her, who seem unable to relate to her. The poor communication from the doctors ricochets onto Manguso until she’s able to take control over her treatments. The Two Kinds of Decay explains that chronic patients don’t simply desire control. They need control to survive the medical complex—not just their illnesses. Though the only long-form patient narrative included in my research, I found Sarah Manguso’s memoir essential to shaping any further exploration into doctor-patient communication. She gives a sharp reminder that the lasting impressions doctors form with patients are too often devastating. These interactions destroy a patient’s confidence in the medical system at large and are often compounded experiences. Many medical professionals in these cases do not wish the harm they cause, but the difference between a positive and negative impact can be a single word or action. Two Kinds of Decay solidifies word-choice’s importance in the medical field. Doctors’ empathy is often incomprehensible to patients. They don’t know the doctor outside their professional relationship, and not everyone is accustomed to others’ caring for them. Furthermore, neurodivergent patients struggle with reading neurotypical social cues, which may increase their stress. Manguso details one such troublesome, empathetic doctor. “My primary care doctor visited me and said I’d already endured something much worse than most people have to endure in an entire regular-length life. His voice shook. He was forcing tears either forward or back… I refused to let him in my hospital room again…I felt no antipathy, just a certainty that his pity would accrue to me and would grow in me like the sea of antibodies with which I was already invisibly killing myself, and that I couldn’t take in any additional poison” (84). Eric J. Cassell: Talking with Patients Volume 1: Theory of Doctor Patient Communication Dr. Cassell’s series was the constitution this research abides by. It was difficult to purchase, and I had invested more than intended on both books. Buying them was also the best decision I made during my study. In the first volume, which had been purchased after the second due to a shipping mix-up, Cassell discusses all parts of speech, personality, and psychology when dissecting patient dialogue. He also introduces paralanguage “(or paralinguistic) …the music of language: those nonword phenomena, such as pause, pitch, speech rate, and intonation” (10). Using dozens of recorded patient conversations, Cassell identifies pitfalls in communication and demonstrates how to understand patients. In one example, Cassell returns to an earlier statement, “words always stand for something (6). He describes a story an anthropologist told him. A group member was hysterical after a snake bite that they all assumed was poisonous. Once the doctor said “‘that snake is not poisonous,’ the ‘patient,’ when finally convinced, recovered rapidly” (56). As Cassell points out, language can and will change perspectives. Therefore, words alter reality. “Remember you are already dealing with two translators in any conversation: the patient’s understanding of your meaning, and your understanding of his or hers” (55). Fittingly, the book’s final chapter includes a complete list of descriptors for doctors to use when thinking about patients, including a separate adjective checklist. Eric J. Cassell: Talking with Patients Volume 2: Clinical Techniques The second volume is no less important than the first. Cassell writes from the opposite perspective of my research. He examines how doctors should speak to patients’ by looking at the side of patient-physician dialogue. Everything the doctor says should be a response to a patient’s needs, therefore interpretating patients’ statements is critical to formulating a treatment plan. Cassell is unique as he involves language and mental health in his research. Much of what is said about communication aligns with another source author, Alan Alda, experience at a dentist office. “Physicians have a special responsibility to heed what the patient says about the past because, despite their misgivings, most patients do what they are told” (Cassell 123). There’s a nuance in how Cassell prioritizes listening because he takes on an intersectional approach. Cassell proves that there is little difference between practicing medicine, communicating well, and as Alda says, acting. Likely because medicine is an intersection for all aspects of life. Heading back to etymological research, Cassell raises the importance of word choice when describing his approach when taking histories, “Close is not enough for history taking. Thus, to get at the real story of patients’ illnesses, it is not sufficient to peel the experiences away from the patients’ assignments of meanings, we must be doubly careful to keep our own meanings out of the story” (39). Cassell further expands on this, stating, “Thinking about symptoms, attaching meanings to them, searching for explanations, are as much a part of the illness as are its physical expressions” (125). He even performs his own close readings, something that helped me contextual physician’s thinking processes and how they wish to use their words. “…if you change the wording of a question, you may change the response… Whenever I change a question or introduce a new one, I think about it and work on the wording for quite a while” (89-90). The factors Cassell brings up in both volumes must be preserved when attempting to optimize word choice. “When we say that a woman has carcinoma of the breast, three years after mastectomy, the present tense is warranted because it conveys our understanding of the prognosis and what it requires of her physicians today… ‘She has Parrot’s disease’… does not even necessarily imply that the female is human” (149). Alan Alda: If I Understood You, Would I Have This Look on My Face?: My Adventures in the Art and Science of Relating and Communication Life experience rules the stories Alan Alda tells, all stemming from one encounter with his dentist. When told he’d experience tethering in his mouth, Alda, “well over the age of fifty, and certainly old enough to ask him to put the knife down and answer a few questions,” saw the dentist in his “priestly surgeon’s gown…impatient” and accepted the procedure, not realizing it would destroy his frenum—impacting his career, as he no longer smiled properly, and his relationship with his doctor (9). Above all, Alda recalls the doctors’ language. “I told you there were two steps to the procedure. I haven’t done the second step yet,” followed by a cold, unapologetic letter advising against a lawsuit (10). Ironically, medicine, with or without intent, sometimes causes all the pain it wishes to heal—just like with Manguso. Proper word choice utilized alongside improved patient-empathy would given both the dentist and Alda the tools to navigate this experience better. Alda thought so as well. Following this experience, he reflects, “I wanted the feeling that I was actually being seen by him….[The dentist] was speaking into the vague mist of interpersonal nothingness…[it was] disengagement from the person we hope will understand us” (10). Alda synthesized his acting talent with an honest captivation for the human experience in a manner that has changed the development of science communication. His book details the origins of those alterations, including the foundation of the Center for Communicating Science at Stony Brook University. Alda drew from his understanding of relating, “real conversation can’t happen if listening is just my waiting for you to finish talking” (18). He writes about the focus groups and research studies he’s been involved with, testing anything from Viola Spolin’s improvisation activities to relational studies that transferred emotion through sporadic string ensemble music. “the shock for me—and it was a happy shock—was that almost all the kids seemed to be playing the music with more freedom, even more joy” (79). Alda includes an entire chapter that focuses on training doctors to be more empathetic, summarizing the work of psychiatrist Helen Riess, who researches empathy after an experience hooked up to a skin conductance machine with a patient. “‘I realized that with this careful attention I had learned to be more empathetic’” (50). She explains that empathetic intelligence, cognitive empathy (valuing patient intelligence within the relationship), and affective resonance (feeling of connectedness) are essential to building proper communication channels. Much of this research connects well with Cassell’s second volume, where he details how a patient “swamped by hopelessness” transferred that emotion to a student who “felt hopeless because the patient felt hopeless. The student was entirely unaware of the origin of his feeling of hopelessness,” (Cassell 3). This is relating at its peak, defined by Alda as, “It’s being so aware of the other person that, even if you have your back to them, you’re observing them. It’s letting everything about them affect you; not just their words, but also their tone of voice, their body language, even subtle things like where they’re standing in the room or how they occupy a chair. Relating is letting all that seep into you and have an effect on how you respond to the other person.” (18). In terms of my research, Alda’s book was a blessing. Word-choice assessments weren’t isolated to the accuracy of dictionary or even social definitions of words. I had to include the quality of whatever meaning a sentence communicates. Reiterated, word-choice is tied with good communication because relationships are built off the “power of commonality” (152). Specifying the role of individual words in conversations is important because language is the peck of human socialization. It builds a people together, building the similarity Alda mentions. “For the best communication to take place, it may be that we can’t just be alike; we may have to be aware we’re alike” (150). Word choice is not only easily malleable when looking at the fundamentals of communication; it’s also a subset of that awareness. Highlighted Papers and Noted Sources Outside the four main texts I read, my research encompassed several different books, papers, and articles. As my research expanded, I introduced literature that broadened my “Patient-Communication” section beyond dialogues and included theories or other relevant work on how doctors should speak to patients. The “Radiologist Series” is sectioned away from the other sources due to the specialized hypothesizes those researchers pursued. “Linguistic Focus” draws back to my original research question and will include content that has strong evidence for future analyzes. Those may have otherwise been sectioned into “Patient-Communication.” Lastly, “Natural Language Processing” delves into machine learning systems that recreate create dialogue from physicians. Patient Communication Stanford Medicine: "GET SMART: How to Talk to Your Patients About Antibiotics" Stanford Medicine: "Serious Illness Conversation Guide" This infographic focuses on increasing patients’ comfort with antibiotics, presenting a guide for medical professionals to aid concerned patients. The “GET SMART” strategy emphasizes several steps like gaining trust, explaining the reasoning behind prescriptions, and clearly defining future expectations regarding the medication’s effects. The advice is solid with a clear emphasis on clarifying each statement a physician makes for the patient’s benefit. Unfortunately, this resource fails to identify vocabulary to use and doesn’t suggest that physicians explore reasons why patients have anxiety about medications, which could range from addiction concerns to financial strain. This isn’t uncommon for doctor-patient conversation guidelines. Though the short format of the document restricts the amount of information, “effective communication strategies” aren’t complete without including the language those strategies are employed with. GET SMART is an example of how critical language choices are undervalued in current medical education. Word choice matters and guides that advise on speaking with patients should include tested—studied—phrases that will yield clarity to patients and provide better foundations for ongoing communication between both parties. AMA STEPS Forward: "Choosing Wisely: Promote Patient-Physician Conversations to Improve Patient Engagement and Choose Appropriate Care" AMA provides a program centered on bettering physicians’ interactions with minority populations and building trust with patients called STEPS Forward. Their miniguide presents several questions for physicians to consider when broaching conversation. STEPS Forward also addresses doctor’s top concerns like “Time Constraints,” “Overcoming Patient Preferences/Value,” and “Fear of Patients’ Dissatisfaction,” by reflecting on the average patient’s actual beliefs. In terms of dissatisfaction, the document notes that many patients want appropriate care, not necessarily long visits, medications, or numerous health plans. This source contributed to my overall understanding of how physicians are taught to communicate with patients. Similar to the GET SMART infographic, no word choices are included. Despite referencing patient’s thoughts on doctor’s concerns, the document also contains no sources with direct patient quotes. AMA STEPS Forward: “Empathetic Listening: Honor the Patient Experience During Crisis” Unlike the 4-in-one script source, this is a direct module from the STEPS Forward program. The “Empathetic Listening” module revolves around increasing empathy—a central topic in Alan Alda’s book. It presents the five “STEPS” of empathetic listening: “Connect with Empathy by Honoring the First ‘Golden Moments,’” “Listen for Underlying Feelings, Needs, or Values,” “Remain Present When You Are Listening,” “Look for Cues to Speak Versus Listen,” and “Reflect on Your Experience.” As a research source, the module aligned with the importance of implementing the right vocabulary with a patient and highlighted listening over speaking. Given that doctors are more accustomed to playing the role of a “speaker,” the module is an essential resource when restructuring one’s approach to patient-dialogue. Yet, I found some fault in how their advice was presented. Alda mentions that empathetic listening is only hard and challenging when unbalanced. Though difficult, there are ways to slowly incorporate better communication tactics. “The problem is that some of these tips can have the opposite effect if you’re not aware of what’s going on in the other person’s head—or in your own. Or if you’re not aware of how your own feelings are affecting your tone of voice. Active listening can easily morph into veiled hostility” (73). The “Empathetic Listening” module reads like a textbook and here I think it falls short. The STEPS module may not be effective in continued use. I did find their shorter guideline documents in line with Alda’s writing. They highlight actions and give brief examples before identifying group activities to practice skills, such as overcoming deflective listening. Also, Dr. Cassell’s approach is visible in sample questions like “Is the patient feeling [this emotion] because they have this particular [value or need]?” emphasize the “Interior World of Language” (Cassell 45). The conversation guide selects key statements that are attributed to different parts of patient conversation. Key words in sentences are bolded, which are noted for future research on word-choice, such as “goals,” “fears and worries,” and “hope.” These words are powerful because they identify the reason a doctor would ask a certain question for a listening patient. The key words also provide a frame for other words in the sentence. For example, “I want to share with you my of where things are with your illness.” “Understanding” indicates that doctor communicates that they are knowingly giving information (on their perspective) to the patient. “Where things are” suggests an unconscious unease with directly referencing current problems the patient’s illness may cause, but also promises to define the situation or illness at hand. This source was specific to severe illnesses, biasing the word usage in the phrases and perhaps making it inapplicable to other conversational settings. AMA STEPS Forward: "Scripts to Help Your Practice Collect Patient Payment at the Time of Service" Most medical organizations value the dispersal of short scripts and infographics, likely because the materials are easily circulated and require less effort to produce or follow while standardizing the pinnacle of “quality care.” This source contains 4 scripts to help professionals approach payment conversations with patients. “Show kindness, yet expect to be paid.” There are a few lines in each that address difficulties in communicating payments, including checking out and possible patient reactions. An example: “And when do you anticipate paying the balance of today’s visit?” (3). Each script included a statement identifying the “frame” of the health provider’s words. The line above attempts to confirm a date of payment as well as formalizing the patient’s agreement to pay the provider. In my research, I originally disregarded scripted that weren’t centered around clinic conversation or diagnosis. However, all the conversations one has with a patient are essential to maintaining a proper relationship and ensuring that both parties are heard. This script also yields itself to future research I will perform as it contained direct lines, and therefore direct words, for me to analyze. Though the writer clearly explains that the script should emphasize patient commitment, I wonder what research was done to make sure these statements are the most effective? In my conversations with medical students, as mentioned in the introduction, many instructors pulled from their own life experiences. While a reliable, if not the best, data source for medical providers, the experience of each doctor is nuanced, region-specific, and it’s nearly impossible to test objectively because it relies on an individual’s personal understanding of how their words are arranged. James E. Groves: "Taking Care of the Hateful Patient" Grove’s article deals less with the imagined “devil” patient and more how trauma and unmet needs manifests in doctors’ most begrudged. He identified clingers, demanders, help-rejecters, and self-destructive deniers as unpleasant patient archetypes—but Groves explores these patients scare medical professionals, “admitted or not, the fact remains that a few patients kindle aversion, fear, despair or even downright malice in their doctors” (883). I found value in the psychology behind his research. It adds another layer of nuance to language that can be addressed once word-choice assessments are performed. Perhaps by structuring word banks against the extremes of patient needs and the doctor’s meaning, then working up from there. Groves identifies the emotions’ these archetypes cause as a form of countertransference, liking in Freudian psychology reworked by psychoanalyst D.W. Winnicott. This article approaches the patients with empathy while providing physicians with broad guidance on working against these brewing, poor relational dynamics. He describes the clingers as “naïve about their effect on the physician…what is common to them as a group is their self-perception of bottomless need and their perception of the physician as inexhaustible” (884). He explains that their clinginess requires careful boundaries set from the moment early signs (extreme gratitude and “the doctor’s feelings of power and specialness to the patient…puppy love”), such as avoiding psych referrals and telling them that “the physician has not only human limits to knowledge and skill but also limitations to time and stamina” (885). Grove approaches other patient types in this manner as well. Though his article gives much to learn regarding tailoring word selections to patient needs, I think the paper stands as a good example of a long-form way to communicate word-choice findings to medical providers. He threads in genuine humor along with situational examples, granting fellow physicians’ understanding and respite from their own feelings of inadequacy with certain patients. Alt Text: "Hateful" Patients BMJ Publishing Group Ltd.: "Patient Semi-Structured Interview Questions" I found a series of patient-interview questions from the British Medical Journal. It has no source attached to it, but I did like the number of statements there and the information influenced search terms: “patient-interview dialogues” and “clinician patient interviews studies.” It appears to come from a study on physician-communication done at “Townsville Hospital,” so I will follow up and discover the actual article detailing the experimenters and research goals. However, unless the researchers are from the U.S., I will disregard this study in word analyses as British English varies from American English. The American College of Obstetricians and Gynecologists (ACOG): “Effective Patient-Physician Communication” The ACOG’s reaffirmed committee opinion number was another confirmation of how current medical approaches to patient communication are taught. Not only in that they tend to lack word-assessment and follow mnemonics, (and at this point, I had speculated and confirmed that the tendency to use mnemonics was residue from medical school) but also that the current guidelines would be critical to making optimal word choices easily applicable on the field. Though their research contained little to no dialogue, they combined the nationally recognized “RESPECT” Model (rapport, empathy, support, partnership, explanations, cultural competence, and trust) with the Five Step Patient-Centered Interview checklist. For word-choice to be utilized, it shouldn’t be a laundry list of terms and extensive definitions, but small word banks sectioned off using current strategies. At no point do I suggest that decades of research and reliable experience be cast aside. Rather, word-choice assessments sharpen what exactly is being said, making sure each word is used within the proper context, with the proper meaning, to eliminate a particular area of miscommunication. Donald A. Schon: The Reflective Practitioner The search for actual textbooks that included patient-dialogues and well-taught example statements lead me to find Donald A. Schon’s . The book is not centered around medical professionals, but there is heavy attention to communication across different work fields. The chapter “The Patient as a Universe of One,” delves into the relationship of psychiatrist within the medical world throughout history before examining the dynamic between a supervisor and a psych resident. Schon notes that the supervisor has an “instruction [consisting of] demonstrating and advocating a kind of therapeutic reflection-in-actin, but it is also an approach of mystery and mastery…he keeps the sources of his performance mysterious. The Resident has complementary approach to learning. It is one of mystery and passivity. He withholds his feelings of dissatisfaction and frustration…he does not ask for what he wants to learn” (126). Though this was not a choice I explored in this research, I am fascinated by this dynamic—it demonstrates that doctors’ personal experiences are, at times, inaccessible to their students. Furthermore, in conversations with patients, how much is missed because of assumptions? If word-choice assessments were used this vagueness may not be solved, but it could reduce other confusion factors or passively improve how medical professionals generally communicate. Schon’s book is then a great resource for identifying these types of communication fractures in both patient-dialogue but instruction. I intend on returning to at least this chapter to clarify how word-choice assessments should be taught. Mack Lipkin: “Teaching Medical Interviewing: The Lipkin Model” The Lipkin Method, an approach to teaching patient-interviews to medical students and residents, is discussed in chapter 36 of Mack Lipkin, Jr.’s “The Medical Interview.” He explains “his approach integrates principles of learner-centered (or self-directed) learning with core human values, such as unconditional positive regard for others and attention to affect” (422). Formulated after his experience in a problem-solving graduate lab, Dr. Lipkin wanted to reproduce the high-level student-learning rates he saw. His implementation of the method in medical school courses at the University of Rochester and later residency trainings serves as a possible parallel to integrating word-choice assessments into doctors’ training. Dr. Lipkin altered his course to accommodate participants’ time constraints, meeting weekly or learning contracts that are later turned into 10–15-minute presentations. “ The major barrier to using learner-centered approachs during inpatient months is the overwhelming patient care responsibility faced by the house staff team” (434). They are often won over by accomplishing their goals during his program, “Lipkin asked each resident beginning the elective to define goals and objectives… encouraged that their work together be based on real experiences” (433). I hope that future research leads to methods that support physician education in this manner, making patient communication stronger without burdening already overwhelmed medical professionals. Vidant Health: “Conversation Scripts for Providers” I include the Vidant Health conversation script because it contained words for assessment, and I realized that a full discussion on physician’s word choices is inept without some mention of all possible influences to a doctor’s language. Insurance companies do insist that doctors they employ or otherwise work with follow certain instructions in conversation. Vidant also served as a case study: What messages do insurance companies want to send? How do their messages dictate doctor’s speech? Vidant’s dialogues encompassed the entire visit, unlike others that gave more leeway with a few statements. Ultimately, I found several scripts from insurance companies that were disregarded because they didn’t fit into my research methods. As mentioned in the introduction, I had maintained a narrow definition of what fit into assessable words for my original research plan. Many insurance company scripts were written, or edited, by lawyers, which didn’t fit the more organic word-flow I wanted to investigate. Furthermore, many insurance company scripts were either too specific or including medical professionals other than doctors. I had wanted my study to only examine doctors’ lexicons because other professionals like nurses, physician assistants, etc. were trained differently. They also maintained different historical and current social statuses and alternative relationships with patients. While their vocabularies are no less important or fascinating, it would have broadened the research scope too much. PC: Noted Sources Karen Knops and Sangeeta Lamba: Clinical Application of ASCEND: A Pathway to Higher Ground for Communication Sneha Baxi Srivastava: The Patient Interview Maysel Kemp White and Vaughn F. Keller: “Difficult Clinician-Patient Communication” J Cutan Aesthet Surg: « Patient Satisfaction » Charles Casassa: “Just Go with It: My First Patient Interview" Timothy Gillian: “Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline” Mark N. Ozer: The Interactive Assessment: A Means for Enhancing Development Ann Kind and Ruth B. Hoppe: “‘Best Practice’ for Patient-Centered Communication: A Narrative Review” M. Jawad Hashim: “Patient-Centered Communication: Basic Skills” Radiologist Series Andrew B. Rosenkrantz: “Differences in Perceptions Among Radiologists, Referring Physicians, and Patients Regarding Language for Incidental Findings Reporting” Rosenkrantz’s study was instrumental in defining my word choice key. His research provided samples on condensing word choice analysis in the medical context alongside the report “Examining the Linguistic Needs of Internationally Educated Nurses: A Corpus-based Study of Lexico-Grammatical features in nurse-patient Interactions.” I found his work early on in my research, and it was backed up by two other studies related to how radiologists, other physicians, and patients can have different interpretations based on the slightest change in words. Rosenkrantz documented how those three groups viewed common terminology applied to liver lesions. He studied phrases like “benign cyst” vs “cyst” vs “tumor considered unlikely,” addressing how “terms used to characterize the level of uncertainty may themselves be a source of further uncertainty.” There is enough change in how these groups interpret terms such as these that it affected patient treatment. “However, a referrer's likelihood of ordering follow-up imaging varied markedly according to the expression used to describe the lesion, ranging from 22% to 88% when the lesion was reported as anything other than a “benign cyst.” There are real consequences to miscommunication beyond patient dissatisfaction—medicine is a life-saving practice and thus anything detrimental to patient care will cause death. Word-choice analyses is understudied in medicine but may save lives with little research costs or trouble in implementation, as the Lipkin Method models. Rosenkrantz concludes, “referring physicians and, to an even larger extent, patients had greater perceived concern than did radiologists regarding numerous expressions used in radiology reports to describe an incidental finding.” Marian I. Mityul and Brian Gilcrease-Garcia: “Interpretive Differences Between Patients and Radiologists Regarding the Diagnostic Confidence Associated with Commonly Used Phrases in the Radiology Report” This source, along with the other two radiologist studies mentioned in greater detail, studied interpretations based on different word choices in patient scans. The researchers compared patient and radiologist interpretations on patients’ likelihood of cancer. Terms assessed: “likely represents,” “compatible with,” “consistent with,” “concerning for,” “may represent,” “suspicious for,” “cannot exclude,” “diagnostic for,” “probably,” and “represents.” David M. Panicek and Hedvig Hricak: “How Sure Are You, Doctors? A Standardized Lexicon to Describe the Radiologist’s Level of Certainty” Yet another lexical study, Panicek and Hricak’s research remains consistent with the data from Rosenkrantz. They made a small list of “certainty terms in standardized departmental lexicon, with associated numeric estimate of radiologist’s certainty”: consistent with, suspicious for/probable/probably, possible/possibly, less likely, unlikely. They also define how each phrase should be employed. Their terms were already in use at Memorial Sloan Kettering Cancer Center, where the radiologists were located. The researchers only arranged those terms, noting that they don’t intent the list to be optimal but rather an attempt to “share our experience with the hope of stimulating others to develop and adopt standardized terminology for this critical aspect of radiology reporting.” The lexicon was casually introduced and grew to “nearly universal” acceptance with compliance up to 98%. This is exactly what I wish to do after applying an etymological lens to each word. The quality of the radiologist research series convinced me to open my source evaluation terms, including short chart notes when advisable. Though there is a difference between written and spoken words, the way the researchers’ spoke about the lexicon implied that it was spoken about at Memorial Sloan. Hence, small phrases which are easily recalled would be included when talking to fellow doctors and thus to patients (these are not overly complex medical terms). Linguistic Focus Alt Text: Future Research guide for word-choice assessments Herbert H. Clark: “On the Use and Meaning of Prepositions” Prepositions were a special focus I keyed in on when I first begun my research. Partly because I personally love using them in my own writing and was curious about their unique speech functions, but mainly because prepositions were prevalent in the few scripts I found. Clark’s research investigates thirty-three prepositions’ meanings and similarities, centering on “their meanings as a system of relations” (421). With the help of 110 middle school students, some undergraduate students, and different grouping systems, Clark arranged the prepositions according to their similarities based on “Intersection Coefficient, a measure of the similarity of two distributions of words” (423). Other methods were used to factor in possible preposition substitutions and free association—how easily related one word is to another in the mind. Within 528 pairings for the thirty-three prepositions, Clark discovered that “sentence composition, free associations, and semantic judgments were expected to be closely related, and they were found to be so…the main finding is that two prepositions are treated as semantically related when they are interchangeable in discourse” (427). His work is relevant to analyzing doctor’s word choice and provides an additional research method for understanding the connotations physicians apply to their words. Cross-studying that with patients could identify gaps that encompass word choice but may also extend into other semantic features. “[The way humans process words] implies that free associations originate in underlying cognitive units and not directly in sentences that [we] might produce” (430). NOTE: Dr. Clark is also known for his “common ground theory” that highlights shared knowledge as the standard for meaningful conversation. Link to that work: https://web.stanford.edu/~clark/ Shelley Staples: “Examining the Linguistic Needs of Internationally Educated Nurses: A Corpus-based Study of Lexico-Grammatical Features in Nurse-Patient Interactions” Staples’ research failed to apply to two areas of my source evaluation standards. It focuses on non-physicians and including analyses on non-English languages. However, I briefly include it in my research sources because of the study’s structure. The lexico-grammatical features studied are specific to the provider-patient interaction. “Research has revealed two main grammatical features that seem to serve these purposes: expressions of grammatical stance (e.g., sort of, probably, only) (Malthus et al., 2005, Prince et al., 1982, Skelton and Hobbs, 1999a, Skelton and Hobbs, 1999b, Skelton et al., 1999), and conditionals (e.g., if you are in pain in the morning, see Dr. Carl or whoever) (Adolphs et al., 2004, Ferguson, 2001, Holmes and Major, 2002). The use of personal pronouns by doctors and nurses (e.g., I and you) has also been shown to reflect the patient-centeredness of the interaction (Adolphs et al., 2004, Holmes and Major, 2002, Rees and Monrouxe, 2008, Thomas and Wilson, 1996).” It was one of the few studies that had an explicit center on causal medical dialogue between a medical professional and a patient. The study also included real-time dialogue rather than case notes, which is preferrable. I will likely refer to this source when structuring future resource. It breaks down the sentence components in more detail, including the assumed purpose of the part of speech (verb vs. “mental verb” to describe “feel” or “think”). Steven A. Cole and Julian Bird: The Medical Interview: The Three Function Approach This source was discovered late into the research process, after I’d made the switch from strictly studying words in patient-physician dialogues to justifying the importance of word-choice analyses. As a result, only Units 1-3 are represented in the actual body of literature since those are dedicated to physician statements. Numerous sentence examples are offered and will be included in word assessments as they fit into all established source evaluation criteria. Bird and Cole’s Three Function Approach adjusts another guideline, Function Three, and aims to develop medical students’ skills when fostering bonds with patients. “The three functions address three core objectives of the clinician-patient communication process: (1) build the relationship; (2) assess and understand the patient’s problems; and (3) collaborate for management of these problems” (xii). Information is sectioned into distinct categories like Partnership or Personal Support. “Statements of personal support enhance rapport. The physician should make explicit efforts to reassure the patient that he or she is there and wants to help” (19). The dialogues are sometimes equipped with the oh-so beloved mnemonics and statement goal explanations. Breaking the units into chapters and sectioning conversation goals/topics prevented the book from reading like a textbook, reducing some of the strain Alan Alda warns of. In an introduction written by Dr. Mack Lipkin, another author in the research literature, stresses that the normal physician performs 250,000 interviews during their career. “It is the responsibility of each diligent clinician or future clinician to know at least the main points of this literature, and this book represents one useful starting point” (viii). I believe that the current literature alongside the lack of studies deeply involved with doctor’s lexicons (outside of jargon) represents a similar responsibility with word-choice. M.D. Anderson: “The Complete Guide to Communication Skills in Clinical Practice” Dr. Anderson’s “pocket guide” includes a mnemonics like “CLASS” Protocol (context, listening skills, acknowledge, strategy, summary), which covers some of the same concepts Dr. Cassell does, including the ever-resourceful open-ended question and clarifying statements like “Tell me more about that.” The “HEY BUSTER” section about “Challenging Emotional Conversations with Patients and Families” has structured “Wish statements” like Dr. Cassell’s series of tested clinical responses. “That wonderful all-purpose question, ‘What do you mean by that?’—will do the job,” (121 vol 2). These similarly emphasize “put[ting] your own agenda aside until the other person is finished” (Anderson 21). I found that the pocket guide had several helpful dialogue lines for future word-choice analysis alongside those mnemonics. His guide was compact without density issues, but still had an aspect of “story” to it, as if the different mnemonic protocols were novella chapters. While I still believe word-choice assessments are important for fine-tuning communication between doctors and patients, and thus the doctor-patient relationship, Dr. Anderson seemed aware that the pocket guide wasn’t all encompassing. It’s structured around quick tactics to pick and improve on, which also increases the guide’s adaptability to new information. I think this should be included as a standard of transferrable research into patient communication. LF: Noted Sources Debra Roter and Richard Frankel: “Quantitative and Qualitative Approaches to the Evaluation of the Medical Dialogue” Natural Language Processing (NLP) Timothy Bickmore and Toi Giorgino: “Health Dialog Systems for Patients and Consumers” Giorgino and Bickmore address the growing industry for computer systems capable of interviewing patients based on natural speech patterns. They report on existing natural language processing systems (NLPs) that use data from physicians to formulate set vocabularies that later are programmed into these systems beyond following a script. The paper mentions that sentence structures (sounds, phonemes, words, syntactic structures, etc.) that are analyzed at different linguistic levels (syntactic, pragmatic, lexical) are generally used in most dialogue systems. NLPs intersect computation linguistics and medical informatics in ways that benefit patients, providing fast quality care and reducing fear of stigmatization. Bickmore and Giorgino give examples of evaluation programs that control dialogue quality too “PARADISE uses a decision-theoretic frame-work to combine evaluations of system accuracy (success rate at achieving desired conversational outcomes) with the ‘‘costs’’ of using a system—comprised of quantitative efficiency measures (number of dialog turns, conversation, time, etc.) and qualitative measures (e.g., number of repair utterances)—to yield a single quality measure for a given interaction” (12). My concern with the use of NLPs falls under the inauthentic of their speech patterns and the near impossibility to keep up with ever evolving human vocabularies alongside their accepted misuses. Meaning that language constantly changing, and people often do not speak “properly” or make errors that another human can easily interpret. These systems are also AIs, as seen with the Apache sources, and thus are prone to racism. Non-native English speakers and speakers of dialectics like African American Vernacular English or Chicano English may be similarly discriminated against. For my research purposes, I do see value in these systems as different methods for parallel studies meant for human use. About the Author Archives NLP: Noted Sources Mike Miliard: “How Mercy is Using NLP with Its Epic EHR to Improve Analytics for Cardiac Care” Mike Miliard: “EHR Natural Language Processing Isn’t Perfect, But It’s Really Useful” Maruti TechLabs: “Top 14 Use Cases of Natural Language Processing in Healthcare” Xavier Amatriain: NLP & Healthcare: “Understanding the Language of Medicine” The Apache Software Foundation: “Open NLP Documentation” The Apache Software Foundation: “cTAKES Apache cTAKES” https://www.globalnlptraining.com/blog/logical-levels-nlp-change/

Literature and Medicine (ENGLIT 0541) Literature and Medicine is a course designed and taught by Professor Uma Satyavolu in the Pitt English Department. It explores the relation between literature and medicine, and posits the centrality of acts of reading and writing, of interpretations of signs and symbols, to the practice of both literary criticism/production and medicine as it is commonly understood. The following are collections of student essays and work from the course. Spring 2021 Emily Falge is a freshman at Pitt, majoring in global business management and health services with a minor in French. In the future, she hopes to work in healthcare administration, and believes that the health humanities will help her greatly in her career. Read Emily's essay here: Saharsh Talwar is a current freshman at the University of Pittsburgh pursuing a dual degree in Natural Sciences and Economics with minors in Chemistry and Sociology and a Certificate in the Conceptual Foundations of Medicine. He is extremely interested in pathology/immunology research and hopes to attend medical school after graduating. Read Saharsh's essay here: Lauren Charlton is a sophomore neuroscience major on the pre-med track. Read Lauren's essay here: Riya Patel is a first-year undergraduate at the University of Pittsburgh with a prospective major in Neuroscience on a pre-dental track. Her essay discusses how modern medical humanities conveyed through literature possess the ability to facilitate a more collaborative, transparent, and inclusive dynamic between medical professionals and the general public. Read Riya's essay here: Alexandra Glova is a sophomore majoring in Biology on the Pre-Physician Assistant Track. While she is currently a volunteer at UPMC Children's Hospital, Alexandra hopes to one day work as a medical provider; she definitely think "Literature and Medicine" has been a crucial stepping stone in this path. Outside of school, she is a member of the Tamburitzans, a Pittsburgh based performance group for a variety of international folk songs and dances. Read Alexandra's essay here: Read Samantha Branton's essay here: Read Olivia Hanley's essay here: Spring 2020 Check out the Spring 2020 class' essays on the Pitt Bioethics website: Spring 2020 Essays

Physician and Patient Narratives Archive This is a collection of the sources I compiled while conducting this research project. I highly recommend checking out some of these websites and literary magazines if you are interested in this collection of work! This is an up and coming field of research with many burgeoning programs and opportunities . Patient Narratives Physician Narratives

Health Inequities: Gender, Race, and Incarceration in the U.S. Purpose: All human beings will, at some point in their lives, find themselves in need of medical care. For many, this experience involves driving to a local clinic or hospital to seek the help of a physician, nurse, or another healthcare worker. However, for prisoners, medical care can often be more difficult to access. Furthermore, the relationship between prisoners and the healthcare system is colored by an oppressive history of systemic marginalization and unethical treatment which is often shaped by discrimination based on race, gender, and sexuality. Source: The New York Times One way in which we can begin to hold conversations to discuss these issues is through literature. At its core, literature is a means of communication. Thus, it is crucial to examine how text can be used by healthcare workers, patients, and oppressed individuals to advocate for change and draw multidisciplinary connections. This research is aimed at examining how literature can be used to identify, connect, and amplify marginalized voices in discussing and championing reparations of these systemic issues. Additionally, this project seeks to compile a syllabus which will guide students through various texts to build understanding of social determinants of health, the connection between humanities and medicine, and how writing can be used as a form of advocacy in healthcare. Methods: Using databases, I was able to access archived literature — including news articles, theses, and research publications — and longer texts related to prisons, racism, reproductive justice, and LGBTQIA+ rights in healthcare. Through close readings, I identified texts I believed to be most pertinent to the course being constructed. I searched through bibliographies to find related texts which were compiled into an archive of literature which can also be used in lieu of or to support the texts listed in the syllabus. To be included in the syllabus or the archive, the pieces had to discuss (i) the history of the prison system; (ii) the history of medical practice in prisons; (iii) the relationship between the prison and/or healthcare system and discrimination based on race, gender, or sexuality and (iv) racism, LGBTQIA+ rights, and/or reproductive justice generally. Source: Johns Hopkins Magazine Results: Through close readings, I was able to identify a series of texts — and additional related literature — relating to the prison and medical systems, their relationship, and their ability to uphold systems of oppression. These texts encompassed nuanced views of the relationship specifically between healthcare in and outside of penal systems and reproductive justice, racism, and LGBTQIA+ rights. Across these readings, I found that literature composed by healthcare workers, activists, prisoners, and writers about these topics can serve as ways of educating others and advocating for change. In the syllabus included below, I outline the role of each unit and the associated readings, as well as guiding discussion questions. While many of these pieces function as educational tools — and the subsequent questions are designed to provoke critical thinking of biopsychosocial factors — it is also important to examine how the author’s writing impacts the text’s ability to function as a mode for advocacy, personal narrative, or presenting a counterpoint. While many of the readings argue for reform, some older texts listed in the archive highlight older (though possibly racist, homophobic, and misogynist) ways of thinking. While these opinions may be controversial, it is equally important to examine the egregious missteps taken as well as the progress that has been made. Through discussing the literary merits and mistakes made across these various readings, I hope that students will be able to see the utility of literature as a tool for investigating social justice issues in the medical and various intersecting fields. Source: The New Jim Crow by Michelle Alexander Part 1: Overview of the Carceral System Before examining the role of medicine and its influences in prisons, it is first critical to address the American carceral system itself. The American penal system was first established in the 1800s and became rooted in practice during the 1830s through the advent of the Pennsylvania system. This system was first implemented in two major prisons, Eastern State Penitentiary on the outskirts of Philadelphia and Western State Penitentiary in Pittsburgh. The Pennsylvania system codified the practice of separating inmates, solitary confinement, and even menial job and wage systems. Prisons became vessels for collecting social deviants — alcoholics, the homeless, people with mental illnesses — and housing them separately from the rest of “polite society”. After all, penitentiaries were places for people to seek “penitence” through hard labor. Over the next century, prisons would continue to quietly thrive across the country until the late twentieth century. By the 1970s, with the War on Drugs in full swing, the modern prison industrial complex emerged. Prisons grew explosively across the country. Prisoners were being put to work, doing menial jobs for little to no pay. Some of their work helped run the facility while other work was contracted to prisons, viewing the inmates as a free source of labor. Individuals were given long term sentences for minor and non-violent offenses to fill the jail cells and line the pockets of those who owned the cell blocks. Meanwhile, lack of oversight, poor medical care, cramped living conditions, and abuse from guards ran rampant with little to no control by any regulatory forces. Thus, the modern carceral system was born, solidifying the existence of a state sanctioned machine of oppression. Suggested Readings: The New Jim Crow , Michelle Alexander — Michelle Alexander discusses the evolution of the modern prison-industrial complex from its conception in the slave era to its relationship with the War on Drugs and police brutality. “A National Survey of Medical and Health Facilities in Prisons, 1970", Glen A. Aker — In his Master’s Thesis, Glen A. Aker examines the emerging role of medicine in the prison system during the 1970’s, a time when the penal system was seen as a mode of reforming and rehabilitating prisoners. Guiding Questions: How has the carceral system changed over the past century? How has it changed since the beginning of slavery? What might be the connection between the carceral system and medicine in a general sense? Why does understanding this system matter for all healthcare workers, even those who don’t work in prisons? How do these texts serve as a mode for advocacy and education? What are their limitations? How do the authors structure their arguments and research to more effectively communicate their beliefs? What is the role of foregrounding these texts in historical context? Glen Aker’s thesis was written in 1970. What are some of the merits and limitations of his writing? Part 2: Racism in the Carceral System While discussing any type of social institution — such as medicine or prisons — it is important to recognize the inevitable roles that race and racism will play. Although medicine is often thought of as a noble profession focused on healing, there are many instances where doctors are unprepared to handle the impacts that race and racism have on healthcare delivery. Thus, discussions about the medical system can never be separated from discussions of race and racism. As Michelle Alexander discusses in her text, The New Jim Crow, racism within the carceral system — through factors such as Stop and Frisk or the War on Drugs — has led to the imprisonment and death of many Black and Brown people in the U.S.. Therefore, one cannot discuss the prison system without accounting for race or racism either. When focusing on medical care in prisons, we must account for the compounding effects of racism within both of these institutions. This is especially important considering the history of medical experimentation on prisoners. Additionally, we must consider how race impacts medical care after someone is released from prison to assess if our society has proper safety nets to provide for those attempting to exit the carceral system. Source: Medical Apartheid by Harriet A. Washington Suggested Readings: Medical Apartheid , Harriet A. Washington — Harriet A. Washington discusses how the medical system has systematically oppressed and abused Black people through unethical experimentation and neglect of care. She tells this story in order to generate recognition of this dark history and the necessary steps that need to be taken to face racism in medicine. Homeward: Life in the Year After Prison , Bruce Western — In this text, Bruce Western examines how inmate’s lives are shaped by prison even after they have been released, and how factors such as abuse, addiction, and mental illness can make it harder for inmates to reintegrate in society. “Discrimination based on criminal record and healthcare utilization among men recently released from prison: a descriptive study”, Joseph W. Frank et. al — This study examined the role of discrimination based on criminal status in healthcare settings. Guiding Questions: How might COVID affect prison populations, specifically Black and Brown prisoners? Does locking people up for things like minor drug offenses play a role in the medicalization of illnesses? How does our medical system fail people who are leaving prisons? Is there a safety net for them? Does race play a role? What are the consequences of discriminating based on criminal record? How might that show itself in our interactions with patients? What are some good/bad aspects of this study? How do the authors’ positionality (i.e. race, class, gender, etc.) affect their telling of the stories in their respective texts? How does this impact their ability to advocate for their subjects? How does the author’s use of POV affect the merits of their writing? What tools do the authors utilize to convey their arguments? Is it convincing? Part 3: Reproductive Care in the Carceral System Reproductive rights and healthcare have always been, and still remain, a tenuous issue. Broadly, reproductive care encompasses any healthcare involving reproductive systems and people who have uteruses; this includes transgender folks and does not depend on one’s fertility. As a result, reproductive healthcare also intersects with many social determinants of health including environmental factors, education about maintaining safe relationships, gender inclusivity, and racism. Thus, it is also important to consider how delivery of reproductive care and rights is altered in the carceral system. From parenting classes to pregnancy visits, reproducing bodies face altered, and sometimes harmful, conditions when kept in prisons. It is important, as healthcare workers and citizens, to understand how the medical system can better advocate for safe reproductive care within the penal system. Source: University of California Press Suggested Readings: Medical Bondage: Race, Gender, and the Origins of American Gynecology , Deirdre Cooper Owens — In this text, Cooper Owens guides the reader through the stories of exploited black enslaved and Irish immigrant women to examine the horrors behind the development of modern gynecological procedures, instruments, and techniques. Jailcare , Carolyn Sufrin — Sufrin takes an anthropological perspective when examining the lives and medical care of pregnant inmates and mothers living in a San Francisco jail. “Reproductive Justice Disrupted: Mass Incarceration as a Driver of Reproductive Oppression,” Crystal M. Hayes — This paper examines how prisons deny women, particularly women of color, access to reproductive care such as abortion, contraception, and the ability to parent their own children. Guiding Questions: How does being imprisoned limit reproductive autonomy? How is the experience of parenthood disrupted by the carceral system? Why is the carceral system seen as a “rehabilitation” center for “bad parents”? How does this affect parenting decisions made outside of prisons? Do the authors make their discussions about reproductive justice accessible to those who do not have uteruses or can’t reproduce? If yes, how do they do this? How does race factor into reproductive justice in prisons? What is the utility of writing about these subjects as an author (ex: Carolyn Sufrin writing Jailcare)? What do the authors do to center their subjects in their stories? Are they successful in doing this? How do the authors’ positionality (i.e. race, class, gender, etc.) affect their telling of the stories in their respective texts? How does this impact their ability to advocate for their subjects? Part 4: LGBTQIA+ Care in the Carceral System LGBTQIA+ folk are exposed to many negative social determinants of health outside of prisons — including misgendering, homelessness, assault, and addiction. Current medical systems are just beginning to listen to and reform based on the dire concerns and needs of the LGBTQIA+ community. However, within prisons, this type of care is rarely provided and often trans and nonbinary inmates face disporportionate levels of violence and harm. Additionally, because many members of the community have mental health conditions or struggle with addiction (often caused by incredibly harmful social conditions), prison has often been used as a means to isolate and control LGBTQIA+ folk. LGBTQIA+ health and rights encompass issues of race, class, and reproductive care, placing these issues at the epicenter of social justice, the medical system, and carceral institutions. Source: Queer (In)Justice: The Criminalization of LGBT People in the United States by Joey L. Mogul, Andrea J. Ritchie, & Kay Whitlock Suggested Readings: Captive Genders , Eric Stanley & Nat Smith — This is a collection of essays by transgender, gender-variant, and queer authors and activists discussing liberation from the prison-industrial complex. Queer (In)Justice: The Criminalization of LGBT people in the United States , Andrea Ritchie, Joey L. Mogul, and Kay Whitlock — Whitlock examines records of queer criminals, defendants, and prisoners to identify how stereotypes influence and harm LGBTQIA+ folk in prisons whether a crime was committed or not. “Psychiatric Facilities in Prisons and Correctional Institutions in the U.S.,” Warren S. Wille — Though mental illness intersects with gender, sexuality, race and racism collectively I chose to include this article here since students will have learned about all of these factors by this point in the course. Additionally, because LGBTQIA+ folk disproportionately suffer from mental illnesses (again, not because of their queer identity, but because of negative environmental and social factors) I feel that this article could be interesting to examine through a queer lens. Guiding Questions: How does race factor into LGBTQIA+ care in prisons? How does reproductive justice factor into LGBTQIA+ care in prisons? What topics or questions do you think still need to be investigated? How are prisons used as a form of social control? How do the authors make these experiences accessible to their audience who may or may not be members of the LGBTQIA+ community? How do the authors’ positionality (i.e. race, class, gender, etc.) affect their telling of the stories in their respective texts? How does this impact their ability to advocate for their subjects? What do the authors do to center their subjects in their stories? Are they successful in doing this? Many of the essays in Captive Genders are personal narratives. Compared to the previous sections, why is it especially important to center personal narratives when discussing LGBTQIA+ marginalization in prisons? Conclusion: Hippocrates writes that, “No one can understand the science of medicine unless he knows what man is”. Literature is just one of many ways through which one can investigate medicine through a humanistic lens. This project has found extensive literature that attempts to tackle issues of injustice in healthcare present in carceral institutions from a variety of angles. As described in the syllabus, each text selected is designed to educate students about these various perspectives. By examining the literary and rhetorical devices utilized in these texts, students will gain a deeper understanding of the humanistic values and social justice issues that arise in medicine. Additionally, I hope that they will gain an appreciation for the role of the humanities in medical education and practice. While understanding the science behind healthcare delivery is important, I hope that this course and its associated texts will shed a light on the valuable role writing and communication plays in medicine. Archive

JUNGIAN APPROACH TO ANALYZING FAIRY TALES carl jung and his Theories As a disciple of Sigmund Freud, Carl Jung expanded upon Freud’s initial approach to develop what is now known as analytic psychology, or Jungian psychology. Jung pioneered the development of extraverted and introverted personality types, archetypes, individuation, and the collective conscious. Although many tenets of Jungian psychology mirror those of Freudian psychology, the two approaches differ when applied to fairy tales. To learn more about the life of Carl Jung and his contributions to analytic psychology, use the link to the right to access an in-depth biography available through the Encyclopedia Britannica Read More The Collective Unconscious Jung introduced the term “collective unconscious” to represent a form of the unconscious that is shared by all and originates in the innate structure of the brain. It is unlike the personal unconscious, which is specific to the individual, or the Freudian unconcious, which is filled with sexual fantasies and repressed desires. The collective unconscious encompasses the soul of humanity. It is universal, impersonal, and identical in all individuals. According to Jung, it contains inherited primordial and pre-existant archetypes of the human psyche. Archetypes Archetypes are expressed in dreams, religious beliefs, myths, and fairy tales. Archetypes are present in their most primitive and simple forms within dreams. They increase in complexity within myths and fairy tales due to the operation of conscious elaboration. The main archetypes of the collective unconscious are the persona (a person’s social mask), the shadow (a person’s hidden nature), the anima (the feminine aspect of the archetypal male), the animus (the masculine aspect of the archetypal female), and the self (the archetype of wholeness). Although the archetypes are common to all humans, how they interact and express themselves differ in each person. An individual’s unique personality is formed through the integration of these dynamic relationships, a process that Jung termed ‘individuation.’ The Individuation Process The process of individuation allows for completeness or the wholeness of personality. It allows an individual to become increasingly conscious of the symbolic manifestations of the archetypes. The Persona The persona is the social mask one wears to conform to their society. It forms early in life due to our tendency to identify with the elements of our persoanlity that correspond to social norms and to reject the characteristics that clash with them. The persona is a small component of an individual’s personality, and an over-identification with the person can inhibit the process of individuation. The Anima and Animus These conta-sexual archetypes are often underdeveloped. Unlike the persona, which is oriented outward, the anima/animus is oriented inward and serve to protect the ego from the darker elements of the unconscious. As the persona functions as a bridge between the ego-conciousness and the external world, the anima/animus functions as a bridge between the ego-consciousness and the collective unconscious. Once the anima/animus archetype are integrated into one’s ego, one gains access to the archetype of wholeness, the self. The Shadow The Shadow is the collection of repressed aspects of our identity. It is composed of negative traits and the rejected personality traits that clash with the dominant social attitudes. The Self The proper expression of the self is the ultimate goal of individuation, and it occurs when the persona, shadow, anima/animus are integrated with one’s ego-consciousness. Marie-Louise von Franz and the Jungian Fairy Tale Von Franz spearheaded the Jungian interpretation of fairy tales by analyzing the archetypal figures and motifs within Western fairy tales as symbols of the collective unconscious. This video presents an analysis of The Frog Prince from an archetypal perspective, one that mirrors how von Franz would interpret the story. Further reading Archetypal Patterns in Fairy Tales (Studies in Jungian Psychology by Jungian Analysts) The Interpretation of Fairy Tales Fairy Tales for the Psyche: Ali Baba and the Forty Thieves and the Myth of Sisyphus French Fairy Tales: A Jungian Approach Shadow and Evil in Fairy Tales Individuation in Fairy Tales Back to Previous Page Freudian Analysis of Fairy Tales See Archive

FREUDIAN APPROACH TO ANALYZING FAIRY TALES Sigmund Freud and his Theories Sigmund Freud was the founder of psychoanalysis, a method that yielded a theory of the human psyche and its unconscious processes, a therapeutic means to ameliorate its ills, and a framework by which society and culture could be interpreted (Jay). To learn more about the life of Sigmund Freud and his contributions to psychoanalysis and the modern field of psychology, use the link to the right to access an in-depth biography available through the Encyclopedia Britannica Read More The Unconscious Mind Freud developed a topographical model of the mind that compared the mind to an iceberg. In the model, the conscious mind, which comprises everything humans are aware of, merely forms the tip of the iceberg, and the unconscious mind is everything submerged below the water. Freud emphasized the importance of the unconscious mind, which he viewed as a repository of primitive wishes and impulses. The goal of psychoanalysis is to make the unconscious conscious. The Interpretation of Dreams Freud’s psychoanalytic theory stressed the causal power of fantasies and repressed desires that stemmed from the development of an individual’s sexuality during childhood. He believed that dreams play a fundamental role in the psychic economy as they provided a means to discharge pent-up libidinal energy. In his The Interpretation of Dreams , Freud contended that if sexual desires couldn’t be viscerally gratified, they could be fulfilled through the imagination. Therefore, all dreams, including nightmares, represent the fulfillment of these desires. To Freud, dreams were a neurotic symptom that manifested as the result of conflict between desire and the prohibitions that prevented its realization. Although dreams defy logic, Freud provided a hermeneutic for dreamwork, a model for the exploration and inclusion of dreams in psychotherapy in his The Interpretation of Dreams . To read Freud’s The Interpretation of Dreams, use the link to the right to access a pdf version available through ResearchGate Read More Freud believed that fairy tales were like dreams and therefore contained the repressed conflicts, anxieties, and desires confined within the unconscious mind. However, unlike dreams, fairy tales showcase unconscious content, humanity’s collective desires and fantasies, as having been shaped by the conscious mind. They contain conflicts that portray universal human problems and their desirable solutions. Nonetheless, the symbols contained within fairy tales cannot be fully understood without the conscious and unconscious desires of the id, ego, and superego. The Id, Ego, and Superego Freud claimed that the human psyche was split into three distinct parts: the id, ego, and superego. According to Freud, humans are born with the most primitive and instinctive component of the personality – the id. The id primarily functions through the pleasure principle and seeks immediate gratification without consideration of consequences. It is only concerned with its own satisfaction. The ego develops as the child interacts with the world, and it is forced to contend with the unrealistic desires of the id and the expectations of the external world. The ego is based on the reality principle. To accommodate the id’s demands, it attempts to rationalize the situation to reach an achievable outcome The superego develops through the internalization of society’s morals and ethical constraints, often placed on the child by the caregivers. The superego combines the functions of the aggressive id and rational ego to counterbalance the id’s sexual impulses and the ego’s rational goals to reach a moral end. The superego is often equated with the conscious as it dictates morality and the belief of right and wrong. Fairy tales help children reckon with and integrate the warring ideals of the id, ego, and superego. The number three is highly symbolic within myth, legend, and fairy tale, and can be interpreted as the different parts of the psyche: the id, ego, and superego. To learn more about the power of three in fairy tales, click on the link to read to the right. Read More The School of Life's video further describes the tenants of Freud's psychoanalysis. Bruno Bettelheim and the Freudian Fairy Tale Bruno Bettelheim’s work The Uses of Enchantment: The Meaning and Importance of Fairy Tales is often regarded as one of the most influential studies of fairy tales. Bruno’s reputation and his The Uses of Enchantment later came under scrutiny for plagiarism, falsified credentials, and patient abuse. Alan Dundes, an American folklorist, revealed that many of the ideas in Bettelheim’s work were taken from Julius Heuscher’s A Psychiatric Study of Fairy Tales: Their Origin, Meaning, and Usefulness (1963). To further explore this controversy, click on the link to the right to read Dundes “Bruno Bettelheim’s Uses of Enchantment and Abuses of Scholarship.” Read More Bettelheim used the standpoint of a traditional Freudian and used a psychosexual analysis to understand fairy tales. He argued that fairy tales allowed children to grapple with and solve certain existential problems such as oedipal conflict, penis envy, castration anxiety, separation anxiety, and sibling rivarlries. To read more about Bettelheim's The Uses of Enchantment, click "read more" to visit The New York Times article that further explores Bettelheim's theories and arguments. Read More Further readings The Uses of Enchantment: The Meaning of Importance of Fairy Tales Fairy Tales and Freud: A website exploring psychoanalysis in children's literature Wish-fulfillment and Symbolism in Fairy Tales A Psychiatric Study of Fairy Tales: Their Origin, Meaning, and Usefulness The Hard Facts of the Grimms' Fairy Tales Back to Previous Page Jungian Analysis of Fairy Tales See Archive