Objectives: Flotation-REST is a treatment for deep relaxation, where a person is contained in a stimuli-restricted environment and floats in water with high salt content. The aim was to investigate the effects from flotation-REST on people with insomnia diagnosis, as previous studies of flotation-REST have demonstrated some effects on sleep but have limitations regarding sample selections and sleep measures. Material and Methods: Six participants were recruited through an outpatient psychiatry clinic and posters on a university campus. All participants fulfilled criteria for insomnia diagnosis and four fulfilled criteria for major depressive disorder. Using a single case experimental design, daily changes were investigated on sleep logs regarding sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency over the course of 12 sessions consisting of 45 min of flotation-REST. No other treatments were offered simultaneously. Questionnaire data on insomnia severity (the ISI) and depressive severity (the MADRS) were also collected. Results: Three participants improved on their most salient insomnia symptom (long SOL or WASO), and two improved on sleep efficiency. The improvements were maintained 2 months after treatment. Insomnia severity decreased for three patients, whereas depressive severity decreased for five. No changes in TST were found and two patients did not improve on any sleep measure. The two participants who benefitted the most were students in their 20s. Discussion: The results were mixed. Flotation-REST may be beneficial for young adults with sleep-onset insomnia but more research is warranted.

During the last three decades there has been a wave of interest in narrative and narrativity in the humanistic and the social sciences. This narrative turn has spilled over to medicine, where narrative medicine has gained a considerable influence.However, there have also appeared second thoughts on the role of narratives in our lives, as well as on what narratives may mean in relation to clinical medicine.This article presents some influential voices in this debate and scrutinizes the assumptions of narrative medicine in the light of these. It is concluded that there are sound reasons to tread this path with some caution and avoid the too far reaching ambitions on behalf of narrativity in relation to clinical medicine. However, narrative medicine should still be seen as a promising attempt within the broader scope of medical humanities to emphasize the importance of human subjectivity in clinical medicine.

Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. 

Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.

When a person falls ill, their experience changes - sometimes in a very minor and transient way, sometimes in a decisive and lasting one. ‘Diagnosis’ is often seen as the process of scientifically and objectively identifying the causes of this subjective experience, but is the process and meaning of ‘diagnosis’ really as simple as this implies?

As this volume of The Medical Humanities Companion argues, diagnoses are an answer to complex human needs that spring from being ill, and are in turn a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. This volume makes visible the complexities and ambiguities involved in giving and receiving diagnoses, and how they shape and are shaped by views on what is real and acceptable, and how people relate to the phenomena of illness.

Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis.

In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine.

The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.

The nature and scope of medical humanities are under debate. Some regard this field as consisting of those parts of the humanistic sciences that enhance our understanding of clinical practice and of medicine as historical phenomenon. In this article it is argued that aesthetic experience is as crucial to this project as are humanistic studies. To rightly understand what medicine is about we need to acknowledge the equal importance of two modes of understanding, intertwined and mutually reinforcing: the mode of aesthetic imagination and the mode of analytical reflection.