Master of Arts, The Ohio State University, 2022, Medical Humanities and Social Sciences

In this thesis, I use a close reading of two memoirs by existential psychiatrist Irvin Yalom to develop a narrative approach to psychiatry. This approach treats each patient's story as a unique work of literature. It involves the psychiatrist's listening for literary elements such as tone, incongruity, and figurative speech in patient stories. It also requires the psychiatrist's engagement in cooperative acts of storytelling and interpretation, which, I suggest, provide insight into the patient's inner and outer life. This insight helps the psychiatrist to understand the patient's needs, whether these needs are psychosocial, neurobiological, medical, or otherwise. Ultimately, I argue that this approach prepares psychiatrists to respond creatively to the complex challenges of mental illness.

Committee: Aaron Friedberg (Committee Co-Chair); James Phelan (Committee Chair) Subjects: Literature; Medicine; Mental Health; Psychotherapy

Doctor of Philosophy, The Ohio State University, 2024, English

This dissertation probes into three contemporary fictional stories about dementia, two of which are not traditionally seen as examples of the genre of “illness narratives.” The first of these two (Edwidge Danticat's “Sunrise/Sunset”) is an intergenerational story about a mother and daughter pair, and the second (Alice Munro's “The Bear Came over the Mountain) is a redemption story of a husband whose wife becomes afflicted with dementia. The third story, Lisa Genova's Still Alice is a proper “dementia narrative,” but previous discussions of it have focused on its representation of the progress of Alice's dementia rather than on her exercise of agency. By analyzing the three primary texts in a fashion of literary analysis, I not only contend that narrative resources of focalization, progression, and intersubjectivity can be employed to make moving stories about illnesses such as dementia but demonstrate they can also serve as resources for dementia narrative identities' (re)formation during the illness's progress, with or without the help of other agents. By highlighting the insights into dementia identity offered by these stories—and by literary fiction more generally—this study can benefit specific groups of actual audiences such as professional and family caregivers, patient advocates, and narrative medicine scholars. In this way, the study can enrich critical conversations about dementia within the medical humanities, whether those conversations focus on its nature, its treatment, or its effects on caregivers and loved ones.

Committee: James Phelan (Advisor); Hannibal Hamlin (Committee Member); Angus Fletcher (Committee Member) Subjects: Literature; Medical Ethics

Ph.D., Antioch University, 2019, Leadership and Change

Scientists debunked the belief that breast cancer is always viral with the mid-90s discovery of the first hereditary genetic mutation linked to a significantly higher-than average chance of breast and ovarian cancer. This genetic condition, called Hereditary Breast and Ovarian Cancer (HBOC), passes the mutation from generation to generation in a family. Thousands of variations of such mutations exist, and carriers account for 10 to 15% of all breast cancer, and up to 20% of ovarian (Childers et al., 2017). In addition, genetic testing uncovered a rapidly rising number of healthy people (never had breast/ovarian cancer) who are also carriers, flooding healthcare providers seeking potential options to reduce their elevated risk. Those prophylactic measures are invasive, permanent and can cause physical—and emotional—scarring. As a newer medical phenomenon, few, if any, studies address the potential psychological implications, which include fear, anxiety, guilt, family tension, and more. Using narrative inquiry methodology, this study analyzes the authentic lived or felt experiences of individuals when they learn that they have inherited a mutation that significantly increases their risk of breast, ovarian and related cancers, and their choices that directly affect their effort to outrun a cancer that may never come. This dissertation is accompanied by the author's MP4 video introduction and is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and Ohiolink ETD Center, https://etd.ohiolink.edu/

Committee: Elizabeth Holloway PhD (Committee Chair); Jon Wergin PhD (Committee Member); Piri Welcsh PhD (Committee Member) Subjects: Alternative Medicine; Behavioral Psychology; Communication; Educational Leadership; Families and Family Life; Genetics; Health; Health Care; Health Care Management; Health Education; Journalism; Psychology

Doctor of Philosophy (PhD), Ohio University, 2012, Communication Studies (Communication)

Medical school is a formative time when future physicians learn what it means to care for patients and how to practice medicine in complex health systems. As students progress through school, they encounter significant challenges, risks, and expectations. Guided by a narrative perspective, I explore one experiential component of the professional education of medical students in the U.S.—standardized patient labs. Standardized patients are hired by medical schools to follow scripts and act as patients with various ailments and health problems. Medical students interact with standardized patients to practice diagnostic skills and prepare for clinical interactions beyond medical school. In this dissertation, I observe and analyze ways that standardized patient interactions prepare students for the narrative nature of clinical work. I also identify and interpret value sets that are maintained and disrupted through standardized patient interactions. I outline a rationale for the project in Chapter One by exploring contemporary challenges facing the health care industry and medical educators. In Chapter Two, I illustrate the theoretical importance of the project by situating the project within scholarly literature on the narrative nature of medicine and the experience of uncertainty in medicine. I detail my inquiry practices in Chapter Three, a research design that crystallized data gathered through multiple methods including observations, in-depth interviews, and the collection of documents. Chapters Four and Five offer complementary analytic representations of the SP lab at the Ohio University Heritage College of Osteopathic Medicine (OUHCOM). To begin, I take readers through a creative narrative vignette representing a typical and realistic medical student encounter in a SP lab. This story offers readers an ethnographic glimpse of the communication processes composing this pedagogy. Then, in Chapter Five, I present a traditional thematic representation developed throu (open full item for complete abstract)

Committee: Lynn Harter PhD (Committee Chair); Austin Babrow PhD (Committee Member); Benjamin Bates PhD (Committee Member); Scott Titsworth PhD (Committee Member); Joe Bianco PhD (Committee Member) Subjects: Communication; Medical Ethics

Doctor of Philosophy, The Ohio State University, 2024, English

This dissertation project is focused on a narrative medicine approach to the comics written during the pre-vaccine period of COVID-19. By analyzing these texts from a narratological perspective, informed also by various approaches in comics studies, its aim is to identify the affordances of the comic medium in order to understand its efficacy when artists choose to utilize it. The selected narratives range from fictional narratives, autobiographical accounts from “frontline workers” at the height of the pandemic, and comics utilizing reportage and informative style of writing. The goal for this project is to learn as much from the selected stories as possible in order to identify its applications towards COVID-19 and pandemic discourse, potentially contributing insight into surviving a pandemic.

Committee: James Phelan Dr. (Committee Chair); Julia Hawkins (Committee Member); Frederick Luis Aldama Dr. (Committee Member); Jared Gardner Dr. (Committee Co-Chair) Subjects: American Literature; Medical Ethics

Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2023, College of Graduate Studies

Narrative medicine is a quickly growing field that is founded in the value obtained from understanding the importance of the incorporation of patient's unique life story into their medical care. While there is an abundance of evidence supporting the use of narrative medicine in clinical practice, there is no literature detailing how narrative medicine may be applied to individuals with communication barriers, including children who are developmentally non-verbal. Through a consideration of fundamental aspects of narrative medicine, pediatric narrative medicine, and disability studies, this paper details the value and feasibility of utilizing narrative medicine among children who are non-verbal. Given the importance of further research on the utility of narrative medicine in the pediatric non-verbal population, this paper concludes with an example research study proposal, detailing how one may conduct research within this discipline. Ultimately, advocating for the utilization of narrative medicine among children who are non-verbal will best ensure that pediatric non-verbal patients' needs and values are incorporated into their medical care.

Committee: Julie Aultman (Advisor); Nicole Robinson (Committee Member); Daniel Grossoehme (Committee Member) Subjects: Ethics; Health Care; Medical Ethics; Medicine

Master of Arts, The Ohio State University, 0, Medical Humanities and Social Sciences

At the writing of this curriculum, it has been just over two years since the murder of George Floyd. Two years since the most recent call to a racial reckoning in this nation built upon the backs and blood of oppressed persons. We are more than two years into a pandemic which has also revealed disparities in the outcomes of health based on one's socioeconomic status, their social determinants of health, the implicit bias of their providers. I propose is a curriculum for medical students – ideally a mix of first through fourth year students -- a program that combines the history of medicine, social justice, narrative medicine with the goal of trialing a type of didactics that might make a difference in their interactions with patients and their understanding of the history of medicine from a social justice standpoint, before they start experiencing medicine in “live action form.” The course would involve three literary texts from three different genres – historical fiction, historical nonfiction, and memoir, all with a social justice theme. The amount of time spent on each text could range from 1-2 weeks to one three-hour session per text (a previously created curriculumongoing with the Ohio State University College of Medicine is a 3-hour seminar format, so this would be a more accessible / implementable addition to the already bursting medical school course load. Regarding size of groups – I would propose to keep groups to no more than 25 students per session with plans for small group discussions as well, so as to allow those with a more introverted disposition to participate comfortably. The cohort of the same 25 students would attend the sessions for all three literary genres, so that they could glean information fromeach format and learn from one another in a seminar style setting. Although numerous texts would be appropriate for pairing for this course, I would start with the following three: Colson Whitehead's The Underground Railroad, Harriet Washington's (open full item for complete abstract)

Committee: Jim Phelan (Advisor) Subjects: Literature; Medicine; Minority and Ethnic Groups

Doctor of Philosophy (PhD), Ohio University, 2021, Communication Studies (Communication)

This dissertation explores medical students' emerging professional identities as they learn to work with rural and urban underserved communities. Utilizing interpretive and creative ethnographic research practices, I worked with the Rural and Urban Scholars Pathways (RUSP) program, a place-based, narrative focused co-curricular within the Heritage College of Osteopathic Medicine aimed at preparing doctors for careers in underserved medicine. Guided by narrative and poststructural feminist sensibilities, I explored RUSP activities and gathered student experiences within the program over the course of 18 months. During this time, I collected observational data at cultural immersion experiences and Clinical Jazz sessions, co-facilitated a summer session of the Open Book Project elective, and conducted 27 semi-structured, in-depth interviews with RUSP students and faculty. This project was informed by four research questions: How do students construct a sense of self and others through RUSP? How is underserved medical care constructed by RUSP? What normative values, habits, and rituals are developed through RUSP? What is the role of narrative pedagogy in preparing future physicians for medically underserved care? I present my analysis in chapters three, four, and five. In chapter three, I highlight five themes that arose from my observational data and interviews with medical students and faculty as they articulated what it means to practice medicine in an underserved setting. In chapter four, I offer two collections of poetic representations conveying what it means, “to be a doctor”. In chapter five, I contribute a series of lesson plans based on my fieldwork and interviews to be incorporated in the Open Book Project elective. Finally, in chapter six, I conclude with a discussion of theoretical and practical implications as well as future directions.

Committee: Lynn Harter (Advisor) Subjects: Communication

Master of Arts (MA), Ohio University, 2018, English (Arts and Sciences)

Patient narrative is often an undervalued or dismissed genre of writing in the field of literary criticism, largely because the hermeneutics of suspicion leads critics to see these texts as “misery memoirs,” as Ann Jurecic suggests. In this thesis, I argue for a new approach to reading and to criticism that moves away from the hermeneutics of suspicion and instead seeks to find conversations between patient narratives, case narratives, and popular or dominant medical and scientific texts. This shift would have readers focusing not on the ways in which an author might manipulate a story but instead on what the reader might learn from intently examining the resulting conversations. In doing so, I do not argue for a switch in the hierarchy—from doctor-patient to patient-doctor—but instead argue that both patient and case narratives have value; without both texts, we cannot have a full picture of what it is like to live with illness. Making my argument through historical examination, I prove that by examining Charlotte Perkins Gilman's patient narratives—those found in her letters, her diaries, and her autobiography as well as in “The Yellow Wallpaper”—alongside medical and scientific texts from her time, we can not only deepen and nuance current interpretations of these texts but we can also uncover motivations that may not be immediately apparent. While “The Yellow Wallpaper,” for example, has been considered as a critique of patriarchal medicine, a horror story, and a liberation text—among others—it has never been explicitly examined as a patient narrative. This focus allows us to delve deeper into the conversation created between “The Yellow Wallpaper” and Gilman's nonfiction narratives; I focus particularly on how we can see the eugenic arguments within “The Yellow Wallpaper” and how these arguments are connected to Gilman's anxieties about marriage, motherhood, and her usefulness in society. While ignoring patient narratives makes literary critics and histor (open full item for complete abstract)

Committee: Thomas Scanlan (Committee Chair); Mary Kate Hurley (Committee Member); Myrna Perez Sheldon (Committee Member) Subjects: American History; American Literature; American Studies; Families and Family Life; Gender; Gender Studies; Health; Health Care; Health Sciences; History; Literature; Medical Ethics; Medicine; Mental Health; Philosophy of Science; Psychology; Rhetoric; Science History; Womens Studies

Doctor of Philosophy, Case Western Reserve University, 2018, English

This dissertation reveals how cognitive disability's formal and rhetorical potential developed in the U.S. from the late nineteenth to mid-twentieth century, detailing the ways in which writers determined the reader's engagement with cognitive others. Scientific pathology inspired literary authors to experiment with narrative mechanics. Conversely, literature and popular nonfiction revealed to psychologists unrecognized features of cognitive identity as well as narrative's methodological and political potential. Cognitive disability, never fully assimilable, emerges as a force that can reorganize narrative events and aestheticize their telling. My work challenges theories of disability that prefigure difference as fixed or known in narrative. Great authors redefine disability as a force that is always coming to be known. I introduce a heuristic to help scholars understand this process, specifically how stories introduce tenuous ways of representing and narrating disability, put forth conflicting ontological claims about the mind, and withhold what can be known about disability at key moments. As readers struggle to pin down what exactly disability is, narrative places them in a space where they can reflect not only on the abilities of the disabled subject, but their own.

Committee: William Marling Dr. (Advisor); Athena Vrettos Dr. (Committee Member); Kimberly Emmons Dr. (Committee Member); Jonathan Sadowsky Dr. (Committee Member) Subjects: History; Literature; Rhetoric

Ph.D., Antioch University, 2015, Leadership and Change

Transformation of health care systems will be grounded in new professional relations and collective, cross-disciplinary actions to impact care delivery. Organizing such relations and actions involves practical inquiry rather than applying professional knowledge. This dissertation presents an exploratory, performative study of the initial organizing of the Health Systems Innovation and Research (HSIR) Program in Health Sciences at the University of Utah. The HSIR program was conceived principally to catalyze cross-disciplinary innovation and health services research and enhance care delivery changes by documenting care improvements and publishing research. This study includes a composite narrative of the organizing and practical inquiry work of HSIR organizers, which highlights many questions, issues, possibilities, and priority shifts that would likely face those who would seek to transform care delivery and the cultures of academic medicine. The study identifies improvement, integration, and transformative strategies as pathways to effect change in health systems. The study includes a narrative-based analysis of cultural, dynamic, and narrative resources to enhance understanding of the HSIR story and the implications of cultural and dynamic influences for the Program's future and health systems transformation. This analysis emphasizes the cultural and dynamic influences of academic and clinical departments and other sources of dynamic influence that were operating to hinder or facilitate the larger objectives of HSIR organizers. The study also explores the significance of collective practical inquiry, exploratory inquiry, and culture change to the practice and theory of leadership and change. The HSIR study was conducted using a practice study methodology developed from practice and narrative theories, with contributions from complexity, process, learning, organizing, social construction, and relational theories and empirical studies of professionals undergoing cha (open full item for complete abstract)

Committee: Alan Guskin Ph.D. (Committee Chair); Laura Roberts Ph.D. (Committee Member); Jon Wergin Ph.D. (Committee Member); William Plater Ph.D. (Other) Subjects: Health Care Management; Organization Theory; Organizational Behavior; Social Research

Doctor of Philosophy, The Ohio State University, 2014, Womens Studies

This dissertation project theorizes the ability contract as a means for understanding the experience of women living with HIV in the United States. I understand the ability contract as the triad of labor-utility-predictability that is central to the construction of the liberal citizen-subject, extending the work of John Locke, Carol Pateman, Charles Mills and Shannon Winnubst. The theory of this project is rooted in my original field research; during the 2012-2013 academic year, I spent six months facilitating a reading group for women living with HIV. Together, we read popular memoirs written by women with what I have termed invisible episodic illness, such as lupus, early stage m.s., chronic depression and HIV. Participants in the reading group used these books as a catalyst for discussing their daily negotiations of labor, family and the medical industrial complex in relation to disability identity. I also conducted one-on-one preliminary and follow-up interviews. What I found was that my research participants all resisted a disability identification, despite many of them accessing disability resources. They also all closely connected their identity not to their current employment conditions, but to their prediction of how they will be able to work in the future. This prediction of becoming a wage-earner was the primary reason for their dis/identification with disability. What explains this close connection of disability with future labor? And what is the relationship between labor and disability at the intersection of gender, race, class, and (medical) citizenship? In order to address these questions, I developed a three-tier reading group research method; in my dissertation, I analyze life narratives of women living with HIV, both the narratives of the women in my group and published narratives; I also analyze the reading group reception to those life narratives; finally, I re-read social contract theory alongside American multiracial feminisms, disability the (open full item for complete abstract)

Committee: Wendy Smooth PhD (Committee Co-Chair); Brenda Brueggemann PhD (Committee Co-Chair); Shannon Winnubst PhD (Committee Member) Subjects: Epistemology; Ethnic Studies; Gender Studies; Health; Womens Studies