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A tension between free will and determinism shapes narratives of type 2 diabetes and obesity, contributing to stigma and defining how these conditions are culturally understood. This research involved an interdisciplinary analysis drawing on philosophy, narrative theory and illness narrative scholarship. It undertakes close readings of two remission memoirs-William Banting's Letter on Corpulence (1863) and Tom Watson's Downsizing (2020)-in dialogue with Augustine's redemptive and conversion narrative, Confessions. Discourses of metabolic illness oscillate between models of personal responsibility and biological determinism. Subjects are both blamed and rendered passive. In contrast, Banting's and Watson's remission memoirs mobilise a redemptive narrative form structured by deficiency, transformation and renewal. The two texts, written a century and a half apart, assert the authors' agency while positioning them as generative people who seek to transform others. They contest dominant biomedical and institutional narratives that marginalise patient voice and prioritise clinical authority. This article links two memoirs of metabolic illness to a tradition of redemptive story-telling, asking for a rethinking of agency, responsibility and transformation regarding type 2 diabetes. There are implications for both clinical practice and cultural understanding.
This essay explores how graphic memoirs reshape our understanding of physical care by portraying it not as menial labor but as a form of somatic creativity that blends ethical intention with aesthetic sensitivity. Drawing on Richard Shusterman's somaesthetics and Felicity Aulino's rituals of care, it examines Sarah Leavitt's Tangles: A Story About Alzheimer's, My Mother, and Me (2012) and Joyce Farmer's Special Exits: A Graphic Memoir (2010) to show how both works transform caregiving from a stigmatized task into a model of empathetic exchange by challenging the social stigma that devalues intimate bodily care as degrading "dirty work" and equates dependency with a loss of dignity. While unflinchingly depicting the difficult realities of embodied care, Tangles and Special Exits reimagine it as an artistic collaboration between caregiver and cared-for-a practice that affirms dignity and creative potential. Through their distinctive visual and narrative sensitivity, these graphic care memoirs illuminate the sensory and ritual dimensions of caregiving, presenting it as an ethical and aesthetic practice vital to sustaining human connection. In doing so, they issue a powerful call for systemic change, urging a cultural revaluation of embodied care as a practice grounded in creativity, reciprocity, and shared vulnerability.
The aim of this study is to examine Atatürk's recurrent renal disease throughout his life in light of historical and medical evidence and to evaluate, from a medical history perspective, whether this condition is more consistent with pyelonephritis or with "trench nephritis," as described among soldiers during World War I. This study was designed as a qualitative narrative review using document and content analysis. Primary and secondary sources obtained from the Archives of the Presidency of the Republic of Türkiye, the National Library, newspaper archives, physicians' reports, memoirs, and scholarly works were systematically examined. The data were classified chronologically, and symptoms, diagnoses, treatments, medical recommendations, and treatment centers were analyzed thematically within a comparative clinical framework. The findings indicate that between 1909 and 1923, Atatürk' experienced recurrent episodes of renal pain, fever, fatigue, and urinary inflammation. The periods of the 1911 Italo-Turkish (Trablusgarb) War, the 1915 Gallipoli (Çanakkale) Campaign, and the 1918 Vienna-Karlsbad treatments are particularly notable. The therapies applied (rest, hot baths, hydrotherapy, dietary regulation, and spa cures) were consistent with contemporary medical practice in that era. The clinical presentation shows overlapping features compatible with both chronic pyelonephritis and trench nephritis. Due to the analytical limitations of historical data, a definitive diagnosis of Atatürk's renal disease cannot be established. Nevertheless, it is likely that both trench nephritis like episodes triggered by wartime conditions and a recurrent pyelonephritis process beginning at a young age contributed to his clinical course. Despite significant health challenges, Atatürk's uninterrupted continuation of military and political leadership stands as a striking testament to his personal resilience and strong sense of duty.
This article examines medical and lay perceptions of captivity-induced psychopathologies observed among British prisoners of war during the Second World War. Drawing on medical reports, POW memoirs, and camp publications, it explores how both medical and lay observers understood captivity-induced neurotic illness as a collective, environmentally driven disorder rather than an individual pathology. By reintroducing 'barbed wire disease' into the historical narrative, this paper challenges trauma-centred interpretations of military psychiatry and highlights the social and environmental dimensions of mental illness in captivity, offering new perspectives on rehabilitation, resilience, and the boundaries between mental health and ill-health.
The resistance war against the United States was not merely a military struggle but also a diplomatic and international public opinion battle. In this context, constructing the image of the Vietnamese Revolution played a particularly crucial role in consolidating legitimacy and garnering international support. Consequently, the ideological, cultural, and social fronts within revolutionary battlefields became an organic component of the revolutionary foreign policy strategy. Alongside formal diplomatic activities at the central level, political and ideological work within revolutionary battlefields particularly the Southern battlefield contributed to shaping and disseminating the image of the Vietnamese Revolution to the international public. However, the role of grassroots political-ideological work in image-building and supporting foreign affairs has not yet been systematically examined in existing diplomatic and international relations literature. This article aims to analyze the role of political and ideological work in the Southern battlefield in constructing the Vietnamese revolutionary image for foreign affairs from 1954 to 1975. Through this analysis, the study clarifies the relationship between building domestic political and social strength and consolidating the international image and legitimacy of the Vietnamese Revolution. The study employs the historical method combined with document analysis and international relations approaches regarding image, legitimacy, and soft power. Research is based on an examination of party documents, propaganda materials, memoirs, revolutionary journalism, and various international sources related to peace movements and global public opinion on the Vietnam War. The research indicates that political and ideological work in the Southern battlefield did not only serve to build internal revolutionary strength but also acted as a vital resource for constructing the national image, reinforcing legitimacy, and enhancing the diplomatic effectiveness of the Vietnamese Revolution during the anti-American resistance war.
This study aims to reconstruct the political and philosophical legacy of Nikolai I. Astrov, whose work bridges prerevolutionary liberalism and the intellectual traditions of the emigrant community, and to demonstrate how his writings transform the language of administrative service into a philosophy of memory, responsibility, and civic mission. The relevance of the research lies in the need to clarify how liberal ideas and categories of responsibility are reshaped under conditions of institutional collapse and forced displacement. The study is situated within an interdisciplinary framework that integrates tools from memory studies, intellectual history, and conceptual history. The corpus comprises 48 publications, 37 letters, one volume of memoirs, and six public lectures. Qualitative coding and lexico-semantic analysis were applied; Cohen's κ coefficient reached 0.82, indicating strong inter-coder reliability. The analysis suggests that Astrov articulated a distinctive model of civic identity grounded in the interplay between the ethics of action and archival reflection. The study contributes to scholarship on Russian liberal thought and émigré intellectual history by showing how administrative practice can be reconfigured as a language of ethical responsibility and memorial testimony. The practical value of the study lies in the potential application of its findings in courses on the history of political thought, public history, and the philosophy of memory, as well as in the development of digital cartographies of the intellectual networks of the Russian diaspora.
The film Marguerite tells the story of the relationship between an elderly woman with diabetes and the nurse who visits her at home to provide care. It highlights how care brings people and things into contact. It helps us understand its poetic dimension-that is, the way it deepens our relationship with the world and reveals its unnoticed or forgotten aspects.
In the research and literature on pain-related suffering, a difference has recently been made between suffering processes of the minimal self in contrast to the hardships of the narrative self. This article proposes that an in-between layer of selfhood needs to be distinguished and studied to understand pain-related suffering in a more thorough manner: the enworlded self. Pain-related suffering is a complex phenomenon involving mood-related processes and everyday challenges on at least three different levels: lived bodily experiences, lifeworld matters, and questions about personal identity. These three different levels correspond to three connected aspects of layered selfhood: the minimal self, the enworlded self, and the narrative self. By using a published memoire focusing on chronic pain experiences, this article attempts to enlighten the middle ground of enworlded selfhood and also identifies two different regions of the lifeworld in which the damaging and alienating experiences take their toll: the work-world and the family-world. In addition, a third region of the lifeworld is identified: the patient-world, a region which is formed and expands as the chronic-pain sufferer searches for medical-professional advice and assistance. By addressing the three different layers of selfhood and how they interact in the everyday life of the patient, chronic-pain suffering can be better understood and, also, possibly alleviated by taking appropriate measures that fit the attuned pattern of the pain experiences of each individual.
Hematological malignancies (HM) occur mostly in older patients; aging is potentially associated with loss of autonomy and cognitive impairment. However, the role, burden, and supportive needs of primary caregivers (PC) of older patients with HM have rarely been investigated. Thus, our main objective was to measure associations between the instrumental, educational, and emotional unmet needs of PCs of older patients with various HM and the quality of life (QoL) in these dyads, and, secondarily, to explore related factors. This multicenter cross-sectional study was offered to all patients over 65 years diagnosed with any HM, treated or not, having a PC, and able to fill out a self-questionnaire. Questionnaires were given to outpatients, who passed them on to their PC to fill in and return. Questionnaires assessed burden, cognition, quality of life, tasks for which help is needed, and needs from the PC's perspective. Among 104 included patients, only 59 questionnaires of dyads were analyzable. The median age of patients was 76 years and of PCs was 70 years. PCs were mainly the spouses (n = 36/59). Few PCs stated they needed support: 10% required emotional support (higher when PC had cognitive complaint, p = 0.001), 18% instrumental support (higher when patients were male, p = 0.05 or PC had cognitive complaint, p = 0.01) and 24% educational support. The median EQ-5D-5L global score was 65 in patients and 80 in PCs. The patients' self-perceived burden (SPB) had a median at 5/10 (IQR = 7). When the patient was male, the Zarit burden score was higher (p = 0.002), as well as disrupted schedule (p = 0.05), financial problems (p = 0.03), and health problems (p < 0.001), and self-esteem lower (p < 0.001) at Caregiver Reaction Assessment (CRA) sub scores. An overall cognitive complaint concerned 54.4% of patients and 33% of PCs. There was a higher proportion of cognitive complaints in male patients (70% vs 33% in females, p = 0.01), who reported a significantly higher level of responsibility in their last professions and were more likely to be under active cancer treatment. This study highlights the need to explore cognitive complaints before and during treatment and potentially provide neuropsychological assessment and educational support in these dyads.
Rising hospitalization rates among older inpatients and their complex needs challenge traditional acute care models. Hospital-acquired complications and deconditioning remain major risks, especially when organizational constraints limit meaningful interactions. This qualitative study explored the perceived care needs for older inpatients and acceptability of Meaningful Activity Facilitators (MAFs) to address these needs in acute geriatric wards in France. Using a multiple data source approach, we conducted non-participatory field observations and semi-structured interviews with patients and healthcare workers in two French geriatric wards. Topics included mobility, cognition, nutrition, hydration, mood, and organizational constraints. Participants discussed the role, benefits, barriers, and implementation challenges of MAFs. Staff, particularly nurses, identified understaffing and heavy workloads as key barriers to providing regular personal engagement. Patients often described insufficient contact despite acknowledging staff's interpersonal efforts. Both groups expressed support for introducing MAFs, viewing them as a means to enhance patient experience, care quality, and staff satisfaction. Concerns were raised about close teamwork, role clarity, and preventing task overlap. The integration of MAFs in acute geriatric settings appears acceptable and promising for enhancing patient interaction and potentially reducing complications such as delirium or deconditioning. Careful planning, training, and role definition will be critical for successful deployment.
Everyday services are increasingly being digitalised, while the proportion of older adults continues to grow. Ensuring that digital services are accessible to this population is essential to prevent digital exclusion and support autonomy. This study aimed to explore older adults' perspectives, experiences, and needs regarding digital services, identify perceived barriers to accessibility, and examine associated ethical and societal concerns. This qualitative descriptive study recruited 48 French community-dwelling older adults in France (28 women, 20 men; mean age = 76.06 years, SD = 9.21; 42 urban, 6 rural). Semi-structured interviews were conducted using an 18-item guide developed from a review of the literature on digital accessibility. The study design and reporting were informed by the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Interviews were audio-recorded, transcribed verbatim, pseudonymised, and analysed using inductive thematic analysis. Coding was performed independently by two researchers, and discrepancies were resolved through discussion. All participants reported using at least one digital technology, primarily for communication, information-seeking, administrative procedures, entertainment, and, more rarely, for professional or obligatory tasks. Participants described both advantages (e.g., convenience, ergonomic interfaces) and difficulties (e.g., lack of support, interface complexity, technical failures), leading to diverse coping strategies such as seeking help, self-learning, delegation, or avoiding digital tools when possible. Feelings toward digitalisation were ambivalent, combining perceived benefits with frustration, concerns about data security, and reflections on the impact of digitalisation on autonomy and human relationships. Participants also identified barriers to accessibility (e.g., lack of digital literacy, financial constraints, poor design, insufficient support) and proposed concrete solutions, emphasising the importance of accessible design, non-digital alternatives, adapted training, and human assistance. Digitalisation offers opportunities for older adults but also raises accessibility, ethical, and societal challenges. While many participants recognised the usefulness of digital services, they also highlighted risks related to autonomy, perceived choice, and reduced human contact. These findings underscore the need for digital services that are inclusive, intuitive, and supported by continuous human assistance to avoid reinforcing existing inequalities.
Maladaptive Daydreaming (MD) is a proposed mental health condition characterized by compulsive, immersive daydreaming that interferes with daily functioning. Although MD is strongly associated with dissociative experiences, its relation to interoception remains unexplored. In this study, we investigated dissociative symptoms and self-reported interoception in individuals with MD compared to matched controls. A total of 137 Italian-speaking participants (83 MDers and 54 controls) completed an online survey assessing maladaptive daydreaming (MDS-16), dissociation (DES-II), and interoception (MAIA-2). As expected, MDers showed significantly higher levels of dissociation - particularly in the domains of absorption/imagination and depersonalization/derealization - compared to controls. Moreover, MDers exhibited lower scores on specific interoceptive subscales: Attention Regulation, Body Listening, and Trusting. Network analyses highlighted maladaptive daydreaming as a central node linking dissociation and interoception. These findings suggest that individuals with MD may experience altered interoception and that maladaptive daydreaming might function as an escape from unpleasant bodily states. This is the first study to document altered interoception in MD, future research could extend the findings by incorporating objective measures. Clinically, the results highlight the potential utility of interventions aimed at improving interoception - such as mindfulness-based approaches - in addressing maladaptive daydreaming and its dissociative correlates.
Mindfulness meditation has received growing interest in research over the past decades. Mindfulness meditation training (MMT) can be employed as a mental practice to improve cognitive skills such as attention and emotion regulation and may promote well-being. Neuroimaging studies have emerged to understand the effects of MMT on brain functioning. However, no review exists on the effects of MMT on resting-state brain functional connectivity (rsFC) in healthy meditation-naïve adults specifically. We, therefore, aimed to provide an overview of studies that investigated the effects of MMT on rsFC in healthy meditation-naïve adults, as well as their link to cognitive and clinical measures. Several studies reported changes in MMT-induced rsFC within and between regions of the default mode (DMN), salience (SN), and central executive (CEN) networks. Both increases and decreases in rsFC have been observed for brain regions associated with these networks after MMT, each with differential roles in emotion regulation, stress, and cognitive functions. Some studies highlighted associations between changes in rsFC after MMT and modifications in cognitive performance and psycho-affective measures, which may be influenced by MMT-specific characteristics such as practice duration or delivery methods. MMT may induce a reorganization in the brain's functional architecture by altering rsFC within and between these networks and seems to modify processes related to attention, executive memory, emotional regulation, stress, and resilience. Investigating functional connectivity during rest in key brain networks seems a promising approach to understand the effects of mindfulness meditation on overall well-being.
To examine the feasibility of an on-site psychoeducational program for family caregivers after nursing-home admission and to describe short-term pre-post changes in anxiety, depression, and coping. In a single-arm pre-post implementation study across 70 nursing homes in the Paris area, 138 caregivers attended seven weekly 2-hour workshops led by a geriatrician, psychologists, and an advanced practice nurse. Outcomes at baseline and one week after the last session were Hospital Anxiety and Depression Scale (HADS-A/HADS-D) scores and the 38-item Caregiver Assessment of Managing Index (CAMI). Feasibility indicators were program reach, post-enrollment retention, and fidelity. Of 147 volunteers screened, 138 were enrolled and completed both assessments, with no post-enrollment drop-out. The program reached 70 nursing homes; random audio monitoring of 10% of workshops showed at least 85% adherence to manualised content. Anxiety decreased from 8.7 to 7.9 (p = .001) and depression from 5.2 to 4.6 (p = .012). After multiplicity control, two CAMI items changed, whereas category means and coping diversity remained stable. The program appeared feasible and was associated with small short-term reductions in caregiver distress without broad coping reconfiguration. Brief transition-focused programs may be scalable in routine nursing-home practice. NCT05651555.
No research has explored Theory of Mind (ToM) development in Lebanon, a culturally diverse country that defies the East-West dichotomy. This pilot study aims to adapt a ToM tool for Lebanese children, while examining age-related trends, developmental sequencing, and parental cultural influences. Forty-six children aged 3-11 years, completed the ABC-TOM and standard tasks. Parents completed an Individualism-Collectivism Scale. The internal consistency of the ABC-TOM was correct for the total and cognitive subscales, but questionable for the affective subscale, with good convergent validity with standard measures. An earlier acquisition of knowledge access was observed, with age-related variations. Sequencing patterns also varied according to parental individualism-collectivism. Overall, findings support the ABC-TOM's use and underscore the role of individual-level environmental factors in ToM development.
The genetic architecture of sporadic Early-Onset Alzheimer Disease (sEOAD, onset ≤65 years) remains largely unknown. To assess the de novo mutation (DNM) hypothesis, we performed a nationwide recruitment of 37 novel sEOAD patients-unaffected parents trios. After assessing known monogenic genes, we performed trio-based exome sequencing and jointly analyzed novel trios with 12 previously reported ones. Of these, we selected 16 trios for genome sequencing. We identified three patients with a pathogenic DNM in APP or PSEN1. Then, from the 46 remaining trios, we identified 38 non-synonymous coding DNM and 4 de novo copy number variants (CNVs) in exome data. Four DNM (2 novel, in SPHK2 and DDR1) and bi-allelic inherited variants in two genes affected Alzheimer disease-related genes. No significant burden of rare coding variants in exome/genome data from 5643 EOAD cases and 16097 controls was identified using nested windows centered on each DNM position, at the transcript level. From genome data, one non-coding DNM was predicted to affect splicing in an AD-associated gene, PINX1. Overall, 48% probands carried ≥1 inherited risk factor with odds ratio (OR) > 1.5 and GWAS-defined Genetic Risk Scores (GRS) distribution was more consistent with random distribution than enrichment in higher scores in probands. We confirm that DNMs in known monogenic genes explain sEOAD in a minority of cases, while candidate DNMs in other genes might account for a small proportion of additional cases. The majority of sEOAD patients may have a complex etiology including multiple inherited variants, however, GRS might not explain most of its genetic component.
Ibogaine has garnered interest for its potential therapeutic properties in substance use and psychiatric disorders. Unlike classic psychedelics such as psilocybin or LSD, ibogaine remains underexplored in clinical research. This review aimed to synthesize the clinical literature on ibogaine use in humans over the past 3 decades, focusing on outcomes and safety. We conducted a narrative review of studies on ibogaine's clinical use published from 1990 to February 2025, including randomized controlled trials (RCTs), open-label, retrospective, and observational studies. Databases were searched for reports on efficacy and safety across various indications. Twenty-four studies and 38 case reports/series were included. Most of the positive efficacy data come from uncontrolled, open-label, or retrospective studies, many conducted in nonclinical settings, with a high risk of bias. No double-blind RCT to date has demonstrated that ibogaine or noribogaine can effectively treat opioid use disorder (OUD). Only 1 small RCT reported significant effects for cocaine use disorder. Although observational data suggest that ibogaine may alleviate symptoms of OUD, PTSD, or polysubstance dependence, these findings remain exploratory. Moreover, serious ibogaine-related adverse events have been reported, especially cardiotoxicity due to QT prolongation, which represents a considerable risk given the currently unproven efficacy. While ibogaine remains a compound of interest for neuropsychiatric research, current evidence is insufficient to support its clinical use. Further studies are needed to better demonstrate ibogaine's efficacy, optimize its safety profile, and determine how it could be integrated into psychiatric care, especially in relation to the emerging therapeutic use of classic psychedelics.