For decades, blacks have faced shorter life expectancy than their white counterparts. This persistent disparity has led to a gap in life expectancy between the two groups. Nationally, this gap has decreased over the last 40 years. However, this is not the case at the state-level as some states have experienced little or no improvement in the life expectancy gap. Such is the case in Wisconsin, where the life expectancy gap is the largest in the nation for males, and the gap actually has grown for females over the last two decades. This study seeks to examine this persistent gap in Wisconsin by looking at different causes of death and the ages when they contribute most to the gap. Additionally, this study will examine how the contribution of certain causes of death have changed over time, both between blacks and whites, and also within each group. Using 1999-2001 and 2009-2011 data from the National Center for Health Statistics, this study found that heart disease and malignant neoplasms (cancer) contributed most to the life expectancy gap between blacks and whites and also over time within each group. For females, diabetes and perinatal conditions were found to be top contributors to the black-white gap. Diabetes contributed most after the age of 50. For males, homicide was found to be a top contributor to the black-white gap, particularly among youth aged 15 to 29. Homicide among males frequently ranked near heart disease and malignant neoplasms as a leading contributor to the gap. These findings tell us that by reducing death rates from these causes at particular moments in the life course, the life expectancy gap between blacks and whites can be reduced. This study provides important evidence that health policy makers can use to address racial disparities in life expectancy.

Indiana University-Purdue University Indianapolis (IUPUI) / Medical education researchers have long been interested in understanding medical professional identity formation and its implications for the healthcare system. Various theories have been proposed to explain identity formation. Among them, Foucault’s discourse theory maintains that it is the discourse of medicine that constitutes medical professional identities. This study deployed a Foucauldian archaeological methodology to analyze the structure of modern medical discourse and establish links between discourse and professional identity formation in medical students. A total of forty-six medical students at Indiana University School of Medicine participated in either individual or focus group interviews. Direct observation of the clinical and educational settings was also performed, which resulted in additional textual data in the form of fieldnotes. Archaeological analysis of discourse was undertaken in three levels of the statements, the discursive elements, and the discursive rules and relations. Results entailed a detailed depiction of the structure of medical discourse including discursive objects and modes of enunciation, discursive concepts, and theoretical strategies related to each object. Discursive objects are things that are talked about in modern medical discourse. This study identified four discursive objects as disease and treatment, the doctor, the human body, and the sick person. Modes of enunciation are the different ways in which people talk about objects of medicine, whereas concepts consist of the notions people draw from when talking about objects of medicine. Theoretical strategies indicate certain positions that people take in relation to the objects of medicine. Rules of formation and conditions of existence for each discursive element were also established. Since Identities are entrenched through language and interaction, developing a systematic understanding of the structure of medical discourse will shed new light on medical professional identity formation. Results of this study also have profound implications for teaching professionalism and medical humanities in medical curricula. Furthermore, as a research methodology used for the first time in medical education, archaeology not only opens new territories to be explored by future research, it also provides an entirely new way to look at them.

Transitional care represents a critical juncture in the continuing care of patients with chronic conditions, particularly for adolescent patients. It also represents a significant point of failure in that process for adolescents, with many patients experiencing difficulties during the transition between adolescent and adult medicine that lead to negative long-term impact on health and wellbeing. This thesis aims at addressing adolescent transitional care processes and its obstacles through a broad medical humanities inquiry in a multidisciplinary dialogue between philosophy, social sciences, and medicine. The social, anthropological, and medical concepts of adolescence and autonomy were derived from a literature review and used to identify and philosophically analyze obstacles to adolescent transitional care. Studies were used to illuminate those obstacles. For a first person-perspective analysis, an autoethnography was developed to provide patient testimony, towards improving the reflection on transitional care. This analysis tested the alignment of the author’s experiences in interacting with a healthcare transition as part of the patient population with those recorded in the literature. This study has found barriers and facilitators concerning autonomy and communication at many levels and among many parties involved in the transition, such as patients, caregivers, healthcare providers, and healthcare systems operations, particularly regarding insurance management. This study recommends a focused coordination of primary care and/or transitional care specialists with the participation of adolescent patients’ voices and testimony to develop and manage challenges to autonomy in transitional care.

This thesis argues for a new theory of medical humanities practice and research, known as Mind Interface Theory. It begins with the claim that Sigmund Freud expanded medical metaphysics considerably in "A General Introduction to Psychoanalysis," and that this expansion affords the possibility of thinking of the mind as a user interface. Capitalizing on this affordance, the work then introduces mind interface theory as one possible imagining of Freud's metaphysical system, separate from his well-known theory, psychoanalysis. More specifically, it uses his discussion of dreamwork to reveal reprocessing as mind interface's mechanism of healing, before utilizing this reprocessing principle to orient the medical humanities' research, providing a theoretical framework for increased collaboration between humanists and physicians and a foundation for two distinct modes of activist scholarship: product-based and process-based. / Master of Arts / This thesis participates in medical humanities scholarship by advocating for a specific theory of the field that stems from a reading of Sigmund Freud’s Introduction to Psychoanalysis, a brief series of lectures which were written down for public consumption. Instead of using psychoanalysis itself to form a theory of the medical humanities, my work abstracts the broader suppositions on which psychoanalytic interpretation is rooted. This broader framework I call Freud’s medical metaphysics and define as the assumptions about causation and disease which form the basis for his philosophy of medical treatment. In making this distinction, I can more ably build my own theory of a mind interface on the fact that the basic structure of the metaphysics advocated in the lectures implies a vision of the mind that can be likened to a modern user interface. Through conceiving of the mind in terms of a user interface, I use mind interface theory to frame treatment in such a way as to promote a humanist theory of healing. The purport of the method is that humanists can assist patients through helping them utilize signs, language, and symbols to reprocess their experience. The advocation of this method is then applied to current threads in medical humanities scholarship to suggest that efforts in the field would be best served if they were directed towards studying the artifacts of patient populations for narrative and rhetorical strategies which were effective with coping with a specific illness and fostering an environment where patients are encouraged to produce such artifacts.

Lymphangioleiomyomatosis (LAM) is a rare lung disease recognized by abnormal growth of smooth muscle cells proliferating in lungs parenchyma, developing benign tumors, migrating to the other organs, and ultimately leading to respiratory failure and death. Despite existing literature mainly on clinical aspects of LAM, there is a gap of literature in regards to the knowledge, attitude, and lifestyle practices (KAPs) of LAM patients and their effects on their quality of life. The purpose of this quantitative study was to investigate the KAPs of the sporadic LAM patients as measured by the Bristol Chronic Obstructive Pulmonary Disease Knowledge Questionnaire, Beliefs and Behavior Questionnaire, Determinants of Lifestyle Behavior Questionnaire; these KAPs were then analyzed for their relationship to quality of life reports as measured by the St George’s Quality of Life Questionnaire. Transtheoretical model (TTM) was used to describe the relationship among the variables. The data were collected through online survey questionnaires from 143 sporadic LAM patients registered at the LAM Foundation. Pearson’s correlations and linear regression were used to analyze the data. The results of the analysis showed that there was a significant positive relationship between attitude, lifestyle practices, and quality of life and a negative relationship between knowledge and quality of life. The outcome achieved by this study and its implication on social change identifies the need to initiate more study-specific KAPs within LAM populations, including individuals with tuberous sclerosis complex LAM. The results could also encourage the LAM community as well as other stakeholders to implement programs, workshops, and interventions that could promote and enhance quality of life.

The Patient Protection and Affordable Care Act (ACA) aimed to increase accessibility to medical resources for those previously uninsured. Certainly, the ACA has expanded insurance to millions of Americans, however, the evidence and discourse surrounding health accessibility calls into question why, despite the growth of insured Americans, the increase in health insurance coverage under the ACA has not lead to greater accessibility for low income minorities. I propose that disparities in preventive care, the emergency room, and primary care provider services stand as barriers for low income minorities. Insurance coverage does not necessarily equate to greater accessibility if individuals do not have the means to utilize those resources.

Using recent criticism on speculation and disability in addition to archival materials, “A Public Duty: Medicine and Commerce in Nineteenth-Century American Literature and Culture” demonstrates that reform-minded nineteenth-century authors drew upon the representational power of public health to express excitement and anxiety about the United States’ emerging economic and political prominence. Breaking with a critical tradition holding that the professionalization of medicine and authorship served primarily to support and define an ascending middle class, I argue that the authors such as Robert Montgomery Bird, Fanny Fern, George Washington Cable, and Pauline Hopkins fuse the rhetoric of economic policy and public health to advocate that the era’s disenfranchised “ill” (classified as such due to demographic factors or disability/disease) be recognized as worthy citizens capable of enhancing the economic and cultural wealth of the nation. While many nineteenth-century authors drew upon the ability for sickness and death to unify disparate peoples, such instances often tend toward sentimentalism, imparting the message of inclusion by invoking readers’ sympathy. The authors included in my project, however, do not fit this mode. Instead, they used their works to insinuate that looking after the health and welfare of one’s fellow humans was simply good economics. In featuring issues of public health rather than private disability, depicting illness realistically in accordance with medical treatises and beliefs of the period, and showing the widespread consequences of disease these writers rely on their readers’ desire for economic prosperity, rather than affect, as a catalyst for social solidarity in a capitalist society. As such, my project causes us to rethink how the ascent of the novel not only helped define, but also challenged and critiqued, the identity-politics of an emerging middle class. By showing the authors studied in “A Public Duty” used literature’s pedagogical potential to argue the “sick” literally and figuratively had worth, I demonstrates these writers’ works help create and support a reconceptualization of the political body suiting a country poised to assume global prominence and urged their readers to see the variety of people living in the United States as a source of national innovation and strength.

This thesis is the first sustained study of the poet John Clare and his relationship to health. It considers health as an under-explored physical and mental state evoked across his poetry and prose that has heretofore been overshadowed by a critical preoccupation with his supposed madness. Under the banner of the Medical Humanities, I angle a critical lens on Clare and health beyond biographical readings of his mental deterioration and onto his written responses to the medical, cultural, and social understandings of health by which he was surrounded. Specifically, I argue that Clare articulates both his comprehension and also experience of health through poetic form. I take a thematic approach to the reach of Clare's works composed between 1804-1864, and focus on what I argue to be the most predominant 'forms' that health takes across his poetics: voice, breath, and place. The chapters unfold the poet's engagement with eighteenth- and nineteenth-century medical contexts such as nosology and theories of insanity, speech and elocution, climatic and atmospheric medicine, phrenology, and botany, in order to consider how the local formal techniques of his poems (metre and prosody, rhyme and other sonic devices, caesura, enjambment, and line-endings) shape and re-work the ideas of mental and physical health that these contexts put forward. Throughout the thesis I bring together formal and historical methodologies with modern phenomenological and cultural theories in order to draw out how Clare's exploration of health is both facilitated by the thinking of his own period, and also speaks to current research into health and illness as subjective experiences. Ultimately, I read health across Clare's poetry at the level of form in order to reveal how health inspires a textual mode that defies determinacy and unsettles distinctions between the healthy and the pathological. This thesis is the first sustained study of the poet John Clare and his relationship to health. It considers health as an under-explored physical and mental state evoked across his poetry and prose that has heretofore been overshadowed by a critical preoccupation with his supposed madness. Under the banner of the Medical Humanities, I angle a critical lens on Clare and health beyond biographical readings of his mental deterioration and onto his written responses to the medical, cultural, and social understandings of health by which he was surrounded. Specifically, I argue that Clare articulates both his comprehension and also experience of health through poetic form. I take a thematic approach to the reach of Clare's works composed between 1804-1864, and focus on what I argue to be the most predominant 'forms' that health takes across his poetics: voice, breath, and place. The chapters unfold the poet's engagement with eighteenth- and nineteenth-century medical contexts such as nosology and theories of insanity, speech and elocution, climatic and atmospheric medicine, phrenology, and botany, in order to consider how the local formal techniques of his poems (metre and prosody, rhyme and other sonic devices, caesura, enjambment, and line-endings) shape and re-work the ideas of mental and physical health that these contexts put forward. Throughout the thesis I bring together formal and historical methodologies with modern phenomenological and cultural theories in order to draw out how Clare's exploration of health is both facilitated by the thinking of his own period, and also speaks to current research into health and illness as subjective experiences. Ultimately, I read health across Clare's poetry at the level of form in order to reveal how health inspires a textual mode that defies determinacy and unsettles distinctions between the healthy and the pathological.

This thesis considers how understandings of the sexed body changed in Britain during the 1930s. Popular versions of sex changeability were grounded in medical science and I examine how medico-scientific research into hormones changed understandings of where sex was located in the body. I examine the historically specific concept of normality, which medics employed to ascertain whether or not individuals ought to have their sex reclassified. I focus on L. R. Broster, a surgeon at London’s Charing Cross Hospital. I analyse Broster’s case studies, published in 1938 as The Adrenal Cortex and Intersexuality, which showed the markers medical professionals were using to assign sex. The thesis investigates how Broster’s work in the burgeoning field of endocrinology generated distinctive narratives of sexual mutability and locatedness in the body. Broster was an important figure in the press stories about changes of sex and provides a link between them and the medical research occurring at Charing Cross. During the 1930s the popular daily, local and Sunday newspapers contained numerous articles about individuals whose sex had changed. These accounts were treated in a mostly positive tone and were held up as being symptomatic of scientific modernity. I argue that this concept of ‘sex change’ does not neatly map on to present day categories, be they intersexuality, transsexuality, transgender or any other. Older categories such as that of the ‘man-woman’ persisted into the 1930s as a way to conceive of sexual ambiguity and changeability. That sex could change, and in particular that women could become men, was an idea that had a wide reach across popular culture. New concepts of hormones and of sex change were also taken up in special- interest magazines, adverts, fiction and popular science. I explore the dissemination of ideas about sex changeability and the role of hormones beyond the press and medical studies to show their pervasiveness. I pay particular attention to two very different magazines, Urania and London Life. These magazines extended the life of articles about changes of sex by reprinting and recontextualising them. They point to the interest that such stories attracted and the ways in which they were harnessed to competing ideological ends. Women's increased participation in sport also changed understandings of the sexed body, having an impact on gender roles and the sexed and gendered meanings ascribed to physical features such as muscles. Women’s athleticism suggested that competitiveness could also be a female trait, and that muscularity was not exclusively male. I consider how the achievements of sportswomen, and the more typically masculine bodies they developed, challenged the received differences between men and women. Attention to the sexed body as a site of cultural concern expands the remit of queer historiography beyond sexual identities and practices. I argue that scientific developments and popular culture coalesced to create an environment in which sex characteristics were not fixed and the sexed body was seen as mutable.

This thesis uses a combination of medical humanities, queer public theory, and literary analysis to showcase the uniquely American connections between alcoholism and masculinity in the literature of Ernest Hemingway. By situating both Hemingway and his characters within the medico-legal rhetoric of modernism’s famous Parisian Jazz-age, which occurred at the same time as American prohibition, I reveal changes in white American men’s relationships with gender, bodily autonomy, and the patriarchy that are often overlooked due to Hemingway’s publicly constructed masculine persona. My work provides new queer interpretations of The Sun Also Rises (1926) and the posthumous Garden of Eden (1986) divorced from Hemingway’s masculine persona and critical of how celebrity and scholarship impacted the public reception of these novels and American masculinity as a whole. Through my analysis, I forward a new, uniquely American concept in the masculine gender performance I call the autonomy of masculinity.