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<p>  </p> <p>Medicine is often referred to as both a science and an art. The scientific rigor of medicine has allowed for the advanced and effective treatment of disease whereas the humanistic art of medicine has allowed for clinicians to uncover how best to care for their patients in a compassionate manner. This dissertation hopes to discover how medicine can coordinate scientific expertise with compassionately focused care. The goal of this dissertation, then, is to uncover how medicine can begin to develop a more personalized medicine in which patient’s values and life-plans are coordinated with a scientific understanding of the treatment of disease. First, this dissertation establishes how medicine can be split into two perspectival understandings of disease (a first-personal and second-personal understanding), then it argues how these two understands can be coordinated with one another to develop a more holistic understanding of patient care. Next, this dissertation illustrates how concepts from phenomenology hold relevance within clinical practice in order to show how clinicians can develop a more robust understand of their patients as persons. This understanding is then used to recapture an account of the clinical relevance of empathy so that clinicians are better able to imagine what it might be like to be a patient living through illness.</p>

<p>This dissertation is a rhetorical-historiographic analysis of the emergence and dissolution of a model of therapy, one that showed promise in the 1950s as a treatment for a deadly disease (alcoholism) using a recently developed pharmaceutical drug (LSD-25). By the time this treatment model, called “psychedelic therapy,” was fully developed and ready to be tested, the rhetoric surrounding LSD in the 1960s public sphere had already turned mainstream psychiatry against the drug. Psychedelic therapy became rhetorically inextricable from the counterculture that grew out of its fringes, although its basic principles were actually borrowed from the widely-accepted Alcoholics Anonymous recovery movement. Moreover, the therapy only worked if the patient took the drug in a context designed to facilitate a particular type of experience, akin to a spiritual conversion. This method flew in the face of psychiatry’s insistence on double-blind placebo-controlled trials, which could only account for the drug’s strictly biochemical effects, regardless of therapeutic context. Through my analysis of archival sources, letters, conference proceedings, and research publications, I argue that psychedelic therapy’s failure to gain legitimacy despite its early success indicates how attributions of  rhetorical action (or lack thereof) serve to mark out the boundaries of discursive arenas. These demarcations of <em>rhetorical </em>legitimacy thus allow for disciplinary legitimacy, even while the techniques, strategies, and materials of particular rhetorical appeals circulate among disciplines and other arenas without regard for these limits of legitimate persuasion. A drug may undeniably affect a person’s behavior, but to assert that the drug is persuasive will necessarily raise questions of legitimacy that must be resolved before it can be incorporated into a set of disciplinary practices.</p>

Problem-based learning (PBL) is a popular curricular approach in medical education. This thesis asks the question: How does PBL teach medical students about what matters in medicine using qualitative methods. The research demonstrates that PBL contributes to the on-going marginalisation of social issues in medical education.

<p>This dissertation traces both professional and public concerns about the Earth’s environmental limits from the late 1960s to 1990s, at the intersection of reproductive rights and aerospace technology. It considers two rather ‘radical’ and opposing grassroots activist approaches for how to best address the environmental and population crises that gained public traction at the turn of the 1970s: zero population growth and space settlement. The current scholarship has examined the ‘era of limits,’ and modern environmentalism and population control activism from both U.S. and global perspectives, considering how policy, science, gender, politics, and the media shape public understandings and both local and state responses. Zero growth proponents, through both coercive and voluntary campaigns, sought to demonstrate and halt the damage that unchecked economic and population growth was causing the planet. Yet these histories rarely consider the rise of new spaceflight technologies and thought during the same period, which promised a pro-growth, technology-infused solution to the limits to growth, one that would not impose restrictions on consumptive, environmental, or reproductive behavior. Responding to recent scholarly efforts to better contextualize aerospace technology into social and cultural histories of the post-Apollo era, this dissertation focuses on the grassroots activism of two organizations: Zero Population Growth (ZPG), which advocated for zero growth, and the L-5 Society (including a student-run affiliate chapter called the Maryland Alliance for Space Colonization), which promoted space settlement and the manufacturing of clean, pollution-free energy and mining resources for Earth. In this dissertation, I argue that in order to fully understand the implications of ‘Earthly limits’ on American society, we need to look at the role of grassroots activists. How did their concerns form, persist, and change over the course of the late twentieth century? Using primary and archival material and oral histories of the members, it analyzes their dynamics, goals, and stakes in ideas about limits to growth and a finite Earth. Centering on the diverse personal stories and experiences of former activists reveals their unique motivations for joining their respective groups, why they advocated for such different approaches to the limits to growth, and how their drive for a better future continued long after popular enthusiasm for zero growth and space settlement waned by the late 1970s.</p>

Suicide holds an ambivalent position in contemporary social and cultural contexts. It questions what it means to live and die, yet provides no clear-cut answers about death or dying, life or living. This thesis explores some of the ways suicide has been understood and represented, to demonstrate that knowing suicide is dependent not only on what suicide means, but also on how meanings of suicide become part of knowledge. Knowing suicide is not a matter of responding to it as self-evident, transparent, neutral and obvious, but rather is implicated in social processes and norms central to how knowledge gains intelligibility. Guided by poststructuralist, postmodernist, feminist and postfeminist philosophies, the thesis takes up gender and gendering as its central focus, to interrogate how knowledge about suicide becomes knowledge. Critically examining a wide variety of textual sources, it argues that suicide is principally rendered as a masculine, and even a masculinist, practice. Knowing suicide today is anchored in suicidology - the study of suicide - and maintained by institutional sites of practice including sociology, law, medicine, psy-knowledge and newsprint media, each of which is analysed here. Suicide as masculine and masculinist practice is invoked through multiple, often-contradictory and inextricably linked readings of gender, even while claiming homogeneity. Its gendered foundations can however be made to appear gender-neutral, even when actually gender-saturated. The twin gender movements of neutrality and repleteness are in fact crucial to the knowing of suicide. The thesis establishes that knowing suicide can never occur outside discourse. Even more importantly, how suicide enters discourse cannot be thought outside gender. The body matters to the production of deeply problematic understandings of agency, intent and violence, on which the production of suicide as masculine and masculinist depends. It becomes clear that such dependence rests not only on gender, but also on race and sexuality, as conditions of its knowing. The thesis suggests that further attention be given to the production and maintenance of highly reductive and limiting homogenous truth claims in suicide - truth claims that validate and privilege some interpretations of suicide, at the expense of rendering others less legitimate and serious. If the processes and practices of interpreting suicide become a site of permanent debate, they are more likely to challenge the ways in which masculinist ways of knowing render, and limit, the intelligibility of suicide.

<div>This dissertation redefines the placebo effect in light of new empirical observations and certain strands of philosophical ethics. </div>Chapter 1 critically reviews available definitions of placebo responsiveness against their abilities to hang together the diversity of empirical observations and emerging research interests. Projecting Wittgenstein's example of a child learning pain language, Chapter 2 redefines the phenomenon as a particular kind of experience of meaning and reconsiders clinical empathy in terms of the loss and recovery of language that belongs to illness experience and diagnosis. Chapter 3 broadens the account of psychosomatic responsiveness from the experience of meaning to the experience of values, utilising Canguilhem's definition of health and Nietzsche's genealogical account of the health of values. Chapter 4 explores the foregoing by recounting how Wittgenstein's moral philosophy might hold together the traditional ethical and bioethical question of what makes life worth living with psychosomatic responsiveness.

<p>My thesis examines how eugenicist and psychologist Robert M. Yerkes’ experimental intelligence research helped to situate the non-human primate as the ideal research subject for human betterment research in the twentieth century U.S. Yerkes believed that the primate was the ideal research subject to address questions of human betterment and social welfare, specifically best to create methods of evaluating the imagined threat of intellectual disability. While Yerkes has been studied extensively in the history of psychology, primatology, and eugenics, rarely have his separate contributions to these fields been placed in conversation with one another. Placing the primate at the center of Yerkes’ work allows for all three fields to engage with one another in a new perspective. By analyzing Yerkes’ publications about the Multiple-Choice Experiment within the context of the American eugenics’ movement, we can see how the primate came to hold a central position in U.S. scientific research, the advancement of human welfare and betterment, and as a means of defining what it means to be human. This story offers a glimpse into this longer process of how the primate came to occupy this position, but even a glimpse offers historians of the American eugenics’ movement new questions. What was the role of the non-human animal in the formulation of American eugenic theories? How have we historically used the natural world in our attempts to separate ourselves from it? And can we truly reconcile a history with eugenics if we continue to ignore the role of animals within it, they who today exist unquestionably within the status of the sub-human?</p>

<p dir="ltr">This dissertation argues that shifting secular conversion therapy practices and theories in North America between 1910 and 1980 consistently relied on both queer affective experience and anti-queer and anti-trans animus to justify often brutalizing medical interventions. Canadian and American conversion therapists’ pathologizing views of queer sexual behavior and gender identity were shaped by complex interplays between cultural, legal, social, and medical perspectives, but predominately worked to uphold heteronormative social structures leading to discrimination, hate, and harm towards queer people in both countries. Focusing on affect thereby encourages scholars to recognize how conversion therapies in all their variable historical permutations are both medical <i>and </i>cultural practices that have attempted to use queer patients’ affective needs for acceptance, love, safety, and validation in ways advancing anti-gay and anti-trans social narratives in purportedly therapeutic settings since the early twentieth century.</p><p dir="ltr">This research uses a transnational approach that is at once sensitive to national differences between the American and Canadian queer experience while looking to draw connections between conversion therapy’s development and individual experiences of this practice in two national contexts over time. It additionally pays careful attention to the ways social power hierarchies based on race and class informed individuals’ affective experiences of conversion therapy between 1910 and 1980.</p>

<p>Since the late 1970s, biomedical researchers have heavily invested in the development of portable insulin pumps that allow people with Type 1 Diabetes (T1D) to carry several days-worth of insulin to be injected on an as-needed basis. That means fewer needles and syringes, making regular insulin injections less time consuming and troublesome. As insulin pump use has become more widespread over the past twenty years among people with T1D, the social and cultural effects of using these medical devices on their everyday experiences have become both increasingly apparent for individuals yet consistently absent from social and cultural studies of the disease.</p><p><br></p><p>In this dissertation, I explore the technological, medical, and cultural networks of insulin pump treatment to identify the role(s) these biomedicalized treatment acts play in the structuring of people, their bodies, and the cultural values constructed around various medical technologies. As I will show, insulin pump treatment alters people’s bodies and identities as devices become integrated as co-productive actors within patient-users’ biological and social systems. By analyzing personal interviews and digital media produced by people with T1D alongside archival materials, this study identifies compulsory patterns in the practices, structures, and narratives related to insulin pump use to center chapters around the productive (and sometimes stifling) relationship between people, bodies, technologies, and American culture.</p><p><br></p><p>By analyzing the layered and intersecting sites of insulin pump treatment together, this project reveals how medical technologies, health identities, bodies, and cultures are co-constructed and co-defined in ways that bind them together—mutually constitutive, medically compelled, cultural and social. New bodies and new systems, I argue, come with new (in)visibilities, and while this new technologically-produced legibility of the body provides unprecedented management of the symptoms and side-effects of the disease, it also brings with it unforeseen social consequences that require changes to people’s everyday lives and practices. </p>