This article proposes a way of narrating chronic pain: the telling of a chronicle Recent work in the medical humanities has been critical of traditional approaches to illness narratives. In line with this criticism, we argue that the experience of chronic pain resists internally coherent, plot-driven-in other words, Aristotelian-narrative. Drawing on phenomenological studies, we state that chronic pain is an utterly meaningless experience due to its relentless continuation over time. It therefore defies any narrative search for a higher meaning or purpose as well as the search for a coherent and progressive \'plot\'. However, we reject the idea that chronic pain could therefore only be captured in the form of a meaningless, unshareable and chaotic anti-narrative. Instead, we propose that chronic pain could be borne witness to through the speech act of chronicling-an ongoing telling about ongoing suffering. Building on work of contemporary philosophers Philippe Lacoue-Labarthe and Jean-Luc Nancy, we examine what the chronicle entails by touching on three themes: time, meaning, and the body. First, we argue that chronicling allows people to bear witness to chronic pain\'s purposeless continuation over time, thereby affirming the utter meaninglessness of the experience. Second, we argue that it is precisely in the affirmation of this meaninglessness that a different kind of meaning can be experienced: a meaning which cannot be detached from the sensory experience of telling and listening itself. Third, we examine how chronicling chronic pain could allow the muted and painful body to once again meaningfully express itself to others.

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call \'normative complexity\'. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as \'explanatory complexity\'. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are \'improvements\' or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (\'orchestrated conversations\') and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination.

The practice of human organ transplantation studies is shot through with questions concerning the concepts of selfhood and identity that continually reach out towards transmigration, displacement and haunting. In particular, heart transplantation is the site at which the parameters of human life and death are tested to their limits, not simply for the recipient but for the donor too. In conventional biomedicine, the definition and therefore the moment of death is a matter of ongoing and disturbing dispute between two major channels of thought. Should we understand life to end at the point of cessation of cardiac function, or alternatively that of the brainstem? That whole logic is predicated, however, on the familiar binary of life/death that fails to address urgent concerns in three arenas: social-cultural imaginaries, postmodernist philosophy and increasingly exploratory bioscience. If there is always something about death that is uncanny, that exceeds rationalist thought, then we need to queer the concept and ask whether there are more sensitive ways of thinking the process of dying. The very concept of extended life for the recipient is no simple outcome, and the question of whose life has been prolonged is far from clear. My contribution touches on the idea of thinking transplantation in the mode of parasitism but will suggest an alternative Deleuzian way forward.

Increasing calls from medical professionals and scholars suggest an urgent need for better and more widespread understandings of the ecological dimensions of health. Such calls have included: two recent Lancet special commissions on impacts of climate change on health; and recognition by senior figures from the WHO and United Nations of relationships between human impacts on the natural world and disease pandemics, with some suggesting prevention of future pandemics may require a radical reassessment of modernity\'s relationship with the natural world.Among the medical humanities as a whole, however, calls for better and more widespread understandings of the ecological dimensions of health have not always been as prominent, or urgently expressed, as they might be.This paper, which presumes there is an urgent need for better and more widespread understandings of the ecological dimensions of human health, draws on ecological public health and other models to propose an ecological re-visioning of our conceptions of health and medical humanities; and in ways that challenge some contemporary assumptions about health, well-being and the \'good society\'. Indeed, once we begin to heed what ecocritic Tim Morton terms \'the ecological thought\', we may discover few areas of healthcare and the humanities remain untouched by its implications.With growing recognition that the fate of global human health and the fate of the biosphere are inextricably entwined, the project of a more ecologically dimensioned medical humanities appears both timely and urgent. Such a project may represent a significant opportunity for the medical humanities, and a significant responsibility.

In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient\'s experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of \'illnesses without (underlying) diseases\'. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist \'all in the mind\', and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and \'causal\' curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.

Current debates about the possible causes of depression reinforce the age-old body-mind dualism: while some claim that depression is caused by psychological or societal stress, others underline that it results from a shortage of the neurotransmitter serotonin in the central nervous system. This paper shows that Michel Houellebecq\'s latest novel Serotonin can be read as an account of depression that goes beyond this body-mind dualism. Moreover, we will argue that his way of narrating invites us to reconsider the restorative power of narrative in \'pathography,\' a genre that is a primary focus within medical humanities. The first section of the paper discusses, while drawing on Wilson\'s work on new materialism, that although the title of the novel Serotonin may suggest that Houellebecq takes sides with those who believe that depression is a brain disease, the protagonist of the novel suffers mainly from his gut feelings, which affects his entire embodied existence. Against the background of Merleau-Ponty\'s philosophy, the second section specifies this existential disruption in terms of an embodied \'I cannot.\' In the third section, we make clear how Houellebecq\'s way of narrating-plotless and episodic-reinforces these embodied feelings of incapacity. The final section, then, traces how Houellebecq, by means of his style of writing and his choice of themes, succeeds in transferring gut feelings onto the reader. If illness narratives aim at sharing experiences of illness, the \'narrative\' of depression, so we argue, had better take the form of an anti-narrative or a chaos story. Indeed, Houellebecq\'s anti-narrative succeeds in passing on to the reader the experience of a debilitating gut feeling, and a gradual loss of grip that manifests itself as a temporal and spatial disorientation.

This enquiry examines problems which haunt the \'heart\' and its donation. It begins by examining the heart\'s enduring significance for culturally mediated self-understanding, its vulnerability to misunderstanding and abuse and its relevance to challenging the determination of death by neurological criteria. Despite turns to brain-centred self-conceptions, the heart remains haunted by the hybrid experiences of identity accompanying organ transplant, the relational significance attached to dead hearts witnessed in the Alder Hey scandal and claims that heart transplants commonly constitute the legitimate killing of a person. To explore these phenomena, traditions are retrieved in which the heart-as-organ was construed in terms of a person\'s core identity. Influential Abrahamic beliefs about \'the heart\' are considered in order to explore explanations for why the heart remains culturally pre-eminent, to make intelligible our haunted hearts and to examine possible violations of solidarity in organ donation practice. Jewish and Christian Scriptures are exegeted to illumine the sources of our haunting and address the desire for holistic bodily life. In these sources, the heart is the seat of affections, intelligence and agency but requires healing, conceived via the surgical metaphors of heart transplant and circumcision, if people are to join the insightful, solidary path of pilgrimage. Absent healing, the heart experiences a judgement of the whole person-organ-and-core-at the moment of death. Through such exegesis, the doctrine of the Holy Ghost emerges as a way to make intelligible, though not dispel, the heart\'s haunting. The doctrine\'s practical significance concerns the possibility of social unity among hearts, \'intercordiality\', which construes people within a covenantal life of pilgrimage which encourages heart donation in certain circumstances, makes intelligible the Alder Hey parents\' experience of social misunderstanding and rejects ascribing any legitimacy in medical culture to the consensual killing of patients for the sake of retrieving their organs.

In \'Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox\', authors Michael Sharpe and Monica Greco begin by characterising myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as illness-without-disease. On that basis they ask why patients reject treatments for illness-without-disease, and they answer with a philosophical idea. Whitehead\'s \'bifurcation of nature\', they suggest, still dominates public and professional thinking, and that conceptual confusion leads patients to reject the treatment they need. A great deal has occurred, however, since Whitehead characterised his culture\'s confusions 100 years ago. In our time, I suggest, experience is no longer construed as an invalid second cousin of bodily states in philosophy, in medicine or in the culture at large. More importantly, we must evaluate medical explanations before we reach for philosophical alternatives. The National Institutes of Health and the Institute of Medicine have concluded that ME/CFS is, in fact, a biomedical disease, and all US governmental health organisations now agree. Although it would be productive for Sharpe and Greco to state and support their disagreement with the other side of the disease debate, it is no longer tenable, or safe, to ignore the possibility of disease in patients with ME/CFS, or to recommend that clinicians should do so. When we find ourselves in a framework that suggests the possibility of medical need is somehow beside the point for medical providers, it is time to reconsider our conceptual foundations.

Empathy is a broad concept that involves the various ways in which we come to know and make connections with one another. As medical practice becomes progressively orientated towards a model of engaged partnership, empathy is increasingly important in healthcare. This is often conceived more specifically through the concept of therapeutic empathy, which has two aspects: interpersonal understanding and caring action. The question of how we make connections with one another was also central to the work of the novelist E.M. Forster. In this article we analyse Forster\'s interpretation of connection-particularly in the novel Howards End-in order to explore and advance current debates on therapeutic empathy. We argue that Forster conceived of connection as a socially embedded act, reminding us that we need to consider how social structures, cultural norms and institutional constraints serve to affect interpersonal connections. From this, we develop a dispositional account of therapeutic empathy in which connection is conceived as neither an instinctive occurrence nor a process of representational inference, but a dynamic process of embodied, embedded and actively engaged enquiry. Our account also suggests that therapeutic empathy is not merely an untrainable reflex but something that can be cultivated. We thus promote two key ideas. First, that empathy should be considered as much a social as an individual phenomenon, and second that empathy training can and should be given to clinicians.

Focusing on the configuration of the relationship between fate and freedom of action, this article analyses recent self-help literature and online communities, particularly the genre that centres on the concept of resilience. The selected works and websites all address readers who suffer from depression, anxiety and stress. The article focuses on how the relationship between fate and freedom is represented in three literary figures: the reader, who is promised recovery; the narrator, who promises to save the reader from the mental illnesses; and the plot that the reader forms by his or her personal thoughts, feelings and experiences. Furthermore, fate and freedom will be analysed in a series of allegories and metaphors. We argue that each literary figure reflects a radical understanding of individual autonomy, that is, freedom of action. However, we also argue that each literary figure has a shadowy disadvantage, which activates a tragic reversal of fate. The article analyses how this self-help genre reflects a notion of tragedy in relation to mental suffering.